Can Ontario Open for Business One Step at a Time?

Updated: Aug 26, 2020

For those not in the know, Northern Ontario isn’t big; it’s huge! The area reaches Hudson Bay and James Bay in the north; the Quebec border to the east; the Mattawa River, Lake Huron, and Lake Superior to the south; and the Manitoba border to the west. In all, Northern Ontario encompasses an area of 802,846.19 km2 (Statistics Canada, 2016a; Statistics Canada 2016b). However, for such a large area, only 780,140 people live there, mostly in the nine cities of the region (Statistics Canada, 2016a). With the amount of space and relatively low population, the Ontario government has wrestled with the idea of a regional approach to easing restrictions meant to slow the spread of COVID-19 (Crawley, 2020; CBC News, 2020). In recent weeks, arguments for a regional approach have gained steam, as data shows that of the current COVID-19 cases in Ontario, the majority of cases are along the 401 corridor (Arthur, 2020; Public Health Ontario, 2020). However, as the Province mulls over the idea of a regional approach, there are some important things to keep in mind for the public health and government officials of Ontario. This includes the role that cities play as service hubs for rural and remote communities, the lower capacity to deal with surges, and the potential influx of tourists from areas still facing shutdowns. To look at why these topics should be highlighted, let’s take a look at Thunder Bay.

Services by the Sleeping Giant

Thunder Bay sits on the junction of many transportation routes: its grain elevators receive ships from around the world, with Canadian National and Canadian Pacific railways running through it, the Trans-Canada highway runs alongside the city, and it has one of Ontario’s busiest airports (Statistics Canada, 2015). With so many access points to the rest of the world, Thunder Bay has become well known in the district as a regional hub for transportation, services, and education.

During the COVID-19 pandemic, the Thunder Bay Regional Health Sciences Centre (TBRHSC) has taken centre stage. It highlights the importance of the city as a service hub for rural and remote communities, as almost half of the patients come from other parts of the district (TBRHSC, 2020). However, the TBRHSC had to suspend some of its services, like elective (non-life threatening or procedural) surgeries due to the pandemic (Matthews, 2020). With the province slowly reopening, the TBRHSC has started eyeing the reopening of elective surgeries to catch up to the growing backlog caused by COVID-19 (Matthews, 2020). However, being the only acute-care hospital in the city, and the only one in the district to offer many types specialised care (e.g. stroke care), reopening in a COVID-19 environment proves difficult (Jeanpierre, 2015). If it’s not carefully managed, one outbreak can put a full resumption on pause, as seen with the most recent outbreak on June 1st (Ketonen & Walters, 2020).

Outside of the hospital, Thunder Bay is also a hub for many other essential activities. Many people travel to Thunder Bay for things like Service Canada, Service Ontario, groceries, supplies, and social services. However, in a significant portion of COVID-19 cases in the district, the source of infection could not be found, indicating unknown sources of community spread (Thunder Bay District Health Unit, 2020).

As indicated by the key role of the TBRHSC in providing health services, many of the communities serviced by Thunder Bay lack the ability to tackle a COVID-19 outbreak on their own. With people coming from as far afield as Aroland First Nation, the health unit and the city’s Medical Officer of Health should remember that Thunder Bay isn’t just responsible for its own health. The city hosts a significant amount of people from all over the district, and has a responsibility to make sure that they don’t have to deal with a COVID-19 outbreak.

A carefully kept capacity

As mentioned above, the TBRHSC plays a key role for health in the district, providing 375 acute care beds for 250,000 residents spread out over an area the size of France (TBRHSC, 2020). Due to its central role for the district, the TBRHSC has faced capacity problems over the years - in 2018, the hospital was over-capacity 94% of the time (Rinne, 2020). These sorts of capacity issues are made even worse in the context of COVID-19. The TBRHSC had only 13 ventilators, one of the key instruments in saving a critically-ill COVID-19 patient, available in the city (Ministry of Health and Long Term Care, 2006). Although capacity has improved in anticipation of COVID-19, the TBRHSC still has to service a large population. As such, a reopening of the region should be carefully managed, to make sure the TBRHSC is not overburdened, so that it can continue to work towards starting up elective surgeries.

Seeing the Sleepy G

As highlighted in a news article, a regional reopening may lead to a complicated situation – while parts of the province reopen, they could see more visitors from the GTA where most COVID-19 cases are (Engel, 2020). While it may seem like good news for local businesses in Thunder Bay, people travelling from parts of the province with high case counts might bring it back, if visitors aren’t careful about quarantine. Looking at the outbreak in the TBRHSC on June 1st, it’s not hard to see how easy an outbreak can occur (Ketonen & Walters, 2020).

While a regional approach may be the answer to restarting the economy gradually, public health and government officials should keep in mind the role that their community plays in the health of their districts, counties, and regions. Reopening is something to look forward to for many, but key questions to ask are: how can we prevent exporting COVID-19 to rural/remote areas, how can we manage our health resources, and how can we stop importing cases?

References

Arthur, B. (2020, May 27). As Ontario goes with one-size-fits-all, medical officers of health join forces to take back some local control. Toronto Star. https://www.thestar.com/opinion/2020/05/27/as-ontario-goes-with-one-size-fits-all-medical-officers-of-health-join-forces-to-take-back-some-local-control.html.

CBC News. (2020, May 29). Ford says he is considering regional reopening of Ontario as new testing strategy rolled out. CBC News. https://www.cbc.ca/news/canada/toronto/covid-19-coronavirus-ontario-may-29-testing-strategy-1.5589813.

Crawley, M. (2020, May 8). Ontario rejects regional phase-outs of COVID-19 restrictions. CBC News. https://www.cbc.ca/news/canada/toronto/ontario-covid-19-end-lockdown-physical-distancing-regional-1.5545600.

Engel, E. (2020, June 3). A regional reopening plan could cause problems for area: Top doc. Orillia Matters. https://www.orilliamatters.com/coronavirus-covid-19-local-news/a-regional-reopening-plan-could-cause-problems-for-area-top-doc-2404761.

Ketonen, K. & Walters, J. (2020, June 1). Thunder Bay hospital investigating possible internal COVID-19 outbreak. CBC News. https://www.cbc.ca/news/canada/thunder-bay/thunder-bay-hospital-covid-outbreak-1.5593249.

Jeanpierre, D. (2015, May 13). TBRHSC Launches Dedicated Stroke Care Unit. Thunder Bay Regional Health Sciences Centre. https://tbrhsc.net/tbrhsc-launches-dedicated-stroke-care-unit/.

Matthews, M. (2020, May 29). Hospital increasing non-essential surgical and procedural activity. Thunder Bay Regional Health Sciences Centre. https://tbrhsc.net/hospital-increasing-non-essential-surgical-and-procedural-activity/

Rinne, G. (2018, October 11). Thunder Bay hospital over-capacity 94% of the time since Jan.1. Thunder Bay News Watch. https://www.tbnewswatch.com/local-news/thunder-bay-hospital-over-capacity-94-of-the-time-since-jan1-2-photos-1079894.

Statistics Canada. (2015). Air Traffic at Canadian Airports – 2015. https://www150.statcan.gc.ca/n1/en/pub/51-203-x/2015000/t003-eng.pdf?st=6qOF_Exn.

Statistics Canada. (2016a). Census Profile, 2016 Census: Northwest, Ontario and Ontario. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfm?Lang=E&Geo1=ER&Code1=3595&Geo2=PR&Code2=35&SearchText=Northwest&SearchType=Begins&SearchPR=01&B1=All&GeoLevel=PR&GeoCode=3595&TABID=1&type=0.

Statistics Canada. (2016b). Census Profile, 2016 Census: Northeast, Ontario and Ontario. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfm?Lang=E&Geo1=ER&Code1=3590&Geo2=PR&Code2=35&SearchText=Northeast&SearchType=Contains&SearchPR=01&B1=All&TABID=1&type=0

Thunder Bay District Health Unit. (2020). Current COVID-19 Data in TBDHU. TBDHU. https://www.tbdhu.com/coviddata.

Thunder Bay Regional Health Sciences Centre. (2020). About Our Region. About Us. https://tbrhsc.net/tbrhsc/about-our-region/