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ON COVID-19 Policy Response Monitor

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ON COVID-19 Policy Response Monitor North American COVID-19 Policy Response Monitor: Ontario June 19, 2020 What is the North American COVID-19 Policy Response Monitor? The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis. It summarizes responses of health systems as well as wider public health initiatives. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO). Contents 1. Preventing transmission ........................................................................................................................... 2 2. Ensuring sufficient physical infrastructure and workforce capacity ......................................................... 8 3. Providing health services effectively....................................................................................................... 12 4. Paying for services .................................................................................................................................. 12 5. Governance ............................................................................................................................................. 18 6. Measures in other sectors ...................................................................................................................... 18 References .................................................................................................................................................. 33 1. Preventing transmission This section includes information on key public health measures that aim to prevent the further spread of the disease. It details how jurisdictions are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak. 1.1 Health communication On January 22, Ontario’s Deputy Premier and Minister of Health Christine Elliott announced the addition of the novel coronavirus as a reportable disease under Ontario’s public health legislation (Ontario, 2020a). In a statement released to the public, Elliott announced that while the risk posed by the coronavirus remained low, the province was actively monitoring the situation (Ontario, 2020a). On January 25, Ontario announced its first case of the novel coronavirus (Ontario, 2020b). In response, the provincial government launched a dedicated webpage on COVID-19 on March 9 (Ontario, 2020b) which is being updated twice daily to report on the number of new COVID-19 cases (Ontario, 2020c). In addition, the website includes up-to-date information on symptoms, transmission, physical distancing, self-isolation, caring for someone with COVID-19, and information for healthcare providers (Ontario, 2020j). It also provides four-page fact sheets on the coronavirus written in plain language and available in 30 languages (Ontario, 2020j). In addition to the website, information is provided on social media through the Ontario Ministry of Health, Minister of Health, Public Health Ontario (PHO), Ontario Health, and local officials (e.g. Medical Officers of Health, public health units, municipalities, etc.). Since February 20, 2020, Premier Doug Ford, Christine Elliot (Deputy Premier and Minister of Health), Dr. David Williams (Ontario’s Chief Medical Officer of Health, CMOH), and Dr. Barbara Yaffe (Ontario’s Associate Chief Medical Officer of Health) have provided regular, near-daily scheduled press briefings to deliver updates on COVID-19 (Ministry of Health, 2020f). 1.2 Physical distancing Physical distancing is recommended for all Ontarians (Ministry of Health, 2020p). On March 16, 2020, the CMOH announced that individuals should be practicing physical distancing by avoiding close contact, defined as “being within 2 metres of another person”, with people outside of their household (Ministry of Health, 2020e). On March 30, the government announced that anyone who was not ill, had not recently travelled, or was in close contact with someone with COVID-19 was strongly recommended to stay home, except for accessing healthcare or medications, shopping for groceries once per week, walking their dogs, and getting exercise, while maintaining physical distancing (Office of the Premier, 2020i). Schools, childcare facilities and youth camps On March 12, the Government of Ontario announced that all publicly funded schools were to be closed following the one-week March Break (i.e., effective March 23) until April 5, (Ministry of Heritage, 2020). The following day, a joint statement was issued by the Ministers of Health and Colleges and Universities stating that the Ministry of Colleges and Universities was working with Ontario’s post-secondary institutions to ensure each campus had a COVID-19 response plan in place to ensure students and staff were not put at risk; notably, several universities and colleges had previously announced earlier that day, 2 or in the days prior, that all on-campus activities were to be cancelled effective March 16 through April 3, or until further notice (Ministry of Heritage, 2020). On March 31, the above school closures were extended until May 4 (Office of the Premier, 2020k). On April 14, the Government of Ontario announced that schools would not reopen on May 4but did not set a date (CBC News, 2020b). On April 26, the Ministry of Education announced that all publicly funded schools will remain closed until at least May 31, (Ministry of Education, 2020d). However, to ensure the continuity of learning of students, the province announced they would be implementing new strategies including the replacement of remaining professional activity and examination days with instructional time, the implementation of an expanded summer learning program, the distribution of iPads and more (Ministry of Education, 2020d). Public and private gatherings Ontario announced its first measure to explicitly restrict mass gatherings on March 13, (Ministry of Heritage, 2020). The CMOH advised the immediate suspension of gatherings of over 250 people (Ministry of Heritage, 2020). On March 16, Ontario announced a further restriction on gathering to 50 people or less (Ministry of Health, 2020i). On March 17, the province’s State of Emergency declaration (see Section 6.1) prohibited gatherings of over 50 people until March 31, (Ontario, 2020d). As of March 28, gatherings larger than five people have been prohibited (Office of the Premier, 2020g) Non-essential businesses and services On March 13, in accordance with the provincial restriction on mass gatherings of 250 people, all tourism attractions and convention centres closed (Ministry of Heritage, 2020). On March 16, Ontario announced the closure of various recreational programs, private schools, daycares, churches and faith settings, bars and restaurants (with the exception of take-out and delivery), and restricted guidance on gatherings to advise people avoid gatherings of over 50 people (Ministry of Health, 2020i). On March 17, the province’s State of Emergency declaration (see Section 6.1) mandated the closure of the above-listed facilities. On March 23, Premier Ford announced that non-essential business would be required to close for 14 days, unless these businesses can continue operations with employees working remotely (Office of the Premier, 2020e). Outdoor facilities On March 30, the government issued a new order closing all communal or shared outdoor amenities in the province (Office of the Premier, 2020i). Long-term care facilities As of May 30, 63.5% of coronavirus-related deaths in Ontario have occurred among individuals living in long-term care (LTC) facilities (Ontario, 2020ag). To address the substantial burden posed by COVID-19 within LTC facilities, a number measures have been implemented: The first measures were announced on March 11, requiring screening of all staff, students, volunteers, and visitors in LTC homes (Ministry of Long Term Care, 2020a). Starting on March 11, the CMOH issued a letter to all LTC, retirement, supportive care, hospice and other congregate care homes to recommend these settings only allow essential visitors until further notice, such as those visiting residents who are very ill or require end-of-life care (Ministry of Long Term Care, 2020b). Under the Long-Term Care Homes Act, residents have been restricted from leaving 3 these facilities for short visits with family and friends since March 23 (Ministry of Long Term Care, 2020c). On April 16 the Ministries of Health and Long-Term Care issued a joint order, along with Ontario Health, outlining the temporary pause of discharging patients to LTC and retirement facilities; on April 29, specific criteria outlining the conditions under which transfer of hospital patients and community clients to LTC and retirement homes could occur were announced (Angus et al., 2020). Under these new criteria, the receiving home must not be amid a COVID-19 outbreak, new residents must be tested negative for COVID- 19, the transfer must occur within 24 hours of the laboratory results, and the receiving home must be able to self-isolate the new resident for 14 days (Angus et al., 2020). 1.3 Isolation and quarantine On March 16, Ontario’s
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