I am writing to recommend a new approach to the COVID-19 pandemic, to protect the health of the population of Ottawa. The current harms to health arising from societal disruption are significant and the measures to limit COVID-19 transmission in Ottawa must be sustainable and balanced following the end of the modified stage 2 restrictions implemented by the province on October 10, 2020. The approach I am recommending is that we learn to coexist with COVID, with care.

The goals of the response to the pandemic continue to be to minimize hospitalizations and death, as well as societal disruption. The rate of people testing positive for COVID-19 and the viral load measured in our wastewater started to stabilize during the second half of October. This suggests that the efforts of the people of Ottawa to keep distanced from people outside their households, wear masks indoors and also outdoors when proper distancing is not possible, keep their hands clean and stay home when they are sick are making a difference. The modified stage 2 closures reduced the incidence of close contacts in higher risk settings and supported declining levels of virus in the community. Going forward, the emphasis must remain on the importance of individuals doing their part with businesses reopening.
The rationale for continuing measures to limit COVID-19 transmission includes: the per cent of people testing positive for COVID-19 has not declined and is still sitting at 2.7%, with some areas of the city with even higher rates; the number of outbreaks remains high, leading to hospitalizations and deaths; and the potential for rapid virus spread remains if we let our guard down and become complacent, given the ongoing widespread incidence of the virus and the lack of any significant population immunity.

The rationale to adjust measures to enable businesses to open or ramp up their operations includes some signs that the majority of people in Ottawa are and will do their part to limit COVID-19 transmission as asked when the situation is serious; negative impacts on the health of the population from the unemployment and closure of businesses resulting from the pandemic; and peoples’ need to have supports that will help them live with COVID-19 through the winter and for the foreseeable future at a time when reported mental health challenges are high and there is no end in sight for the pandemic.

Little evidence exists to determine the right balance between COVID-19 control measures and supporting economic activity to keep people employed and mitigate mental health and other harms, though Ottawa Public Health (OPH) monitors situations and practices world-wide. Data collected during our case and contact management processes recently indicates that we have some significant blind spots occurring in situations not covered by provincial or municipal regulations. We continue to see problem areas such as the public gathering with extended family and larger friend circles, as well as socializing before or after playing a team sport, or travelling to or from a sports practice without wearing a mask. Similarly, school return has added transmission pressure particularly in relation to socializing on the way to and from school and other activities ancillary to school. We also see that transmission can occur in bars, restaurants and during physical activity in enclosed spaces without mask use.

Transmission of COVID-19 will occur in any setting if given the opportunity. A large part of the solution to managing these risks lies with modifying our behaviours. The risk is higher wherever people are less than two metres apart from each other and not wearing masks. Within closed spaces, even these measures will not prevent all COVID-19 transmission. People are gathering in closed spaces, in close contact without masks across our community, including at home with non-household members.

In discussions with members of our community, we have received feedback on the specific behaviours that residents of Ottawa feel are putting the community at higher risk of resurgence. On the Engage Ottawa platform – an online portal to engage with residents – people reported that dining indoors; attending indoor events with a maximum of 50 people; going to a bar or nightclub; and attending an indoor party or gathering at a friend’s home were of particular concern. There are examples and reports of larger gatherings in private settings where no COVID-19 control measures were in place. Thus, another rationale for opening businesses is as a harm reduction approach, to minimize private or underground gatherings of higher risk where there is not oversight and, too often, no COVID-19 mitigation controls in place to minimize transmission.

Ottawa Public Health has collected input to inform recommendations about COVID-19 control measures from stakeholders, including populations at higher risk (such as long-term care home stakeholders, newcomers and racialized communities), hospitals, business associations, industry leaders, other city departments, and members of the public by email, petition and on social media.

Work with community partners to better identify and address needs of racialized and low-income communities is critical and is progressing. I am thankful for the many partners, including the city, engaged in this work.
I have looked at the levels of unemployment resulting from the COVID-19 pandemic response, indicators of the mental health of our community, and the challenges arising from a backlog in surgical and medical procedures and I am concluding that more needs to be done to enable people to return to more of the usual supports and services in their lives.
Similar to how schools are able to be open with precautions in place, businesses should be able to open with precautions in place. People should be able to learn to live with COVID-19, with caution.
Using the information available at this point in time, I recommend the following public health measures be considered by the province to be implemented in Ottawa from November 7, 2020, for the foreseeable future, with ongoing monitoring and evaluation:
• Ensure that changes between Stages are announced at least two (2) business days before enactment to give business operators time to prepare.
• Promote messaging that the three Cs (crowded places; close-contact settings, especially where people have close-range conversations; and confined/enclosed spaces with poor ventilation) highlight where risk of transmission of COVID-19 is highest and what should be avoided.
• Discontinue messaging on “social circles” and “bubbles”. The communications of keeping close contact to people in our households plus 1 to 2 people who provide essential social support should be used instead, to ensure consistency and so that everyone understands the central importance of keeping the number of close contacts small to minimize the chance of exposure to COVID-19.
• Increase awareness throughout the province about when individuals should wear masks and how to wear masks properly (over the nose and mouth).
• Increase provincial education regarding 2-metre distancing, hand hygiene and isolating when symptomatic.
• Encourage workplaces to continue supporting employees to work from home or transition employees to work from home to decrease community transmission where possible.
• Require mask use indoors at all times and in all settings and outdoors when physical distancing is a challenge when interacting with those outside of the household.

o In addition to cohorting and protective barriers, and regardless of 2-metre distancing, masks must be worn whenever individuals are interacting or sharing a space with coworkers, at all times in all work settings indoors and even outdoors when physical distancing is a challenge).
• Provide official provincial guidance regarding the construction of cloth masks (materials and design). Currently the public is not adequately protected from mask that are poorly constructed, especially those with poor filterability, breathability, and fit.
Restaurants, bars and nightclubs and event spaces
• Align criteria for indoor gathering limits no matter the venue (restaurants, conference centres, meeting and event spaces) to require that there is always enough space between patrons from different parties.
• Require patrons wear a mask when interacting with a server or any staff and when leaving their table and when not in the process of eating or drinking.
• Encourage hand sanitizer be made available at each table to facilitate hand hygiene before and after handling one’s mask.
• Continue with current regulations: No person shall dance, sing or perform music at the establishment except where stated in ONTARIO REGULATION 364/20.
• Encourage businesses to provide safer spaces for staff breaks and ask staff to not socialize in workplaces beyond work hours without precautions.
• Ensure venues are open long enough to avoid promoting gathering in less-controlled spaces.
Gyms and fitness centres
• Require a minimum physical distance of (2m) during activities.
• Require masking in all gym and fitness centres at all times for staff and patrons.
Team sports
• For team sports, continue to support that no scrimmages or games take place.
• Limit access to locker rooms, clubhouses, and other amenities to washrooms, emergency aid and equipment management.
• Limit pre/post group activity and gatherings (carpooling, team meals, in parking lots etc.), and encourage mask use whenever possible during play (use should always be mandatory outside of play or practice).
• Prohibit coaching and training staff from rotating across various teams or cohorts of players and enable a larger number of people on the ice to facilitate cohorting with one group of coach and training staff.
Personal Service Settings (PSS)
• Require businesses to operate by appointment only and record each patron’s name and contact information.
• Require that staff wear medical grade masks and face shields.

Measures (such as regular masking, proper distancing, hand hygiene, and minimizing social contacts) require hard work and personal sacrifice. They are the small price we must all pay in order to prevent COVID-19 transmission and maintain and improve economic activity to avoid further harms caused from unemployment and increasing mental distress. I believe the people of Ottawa can learn to coexist with COVID, with care.

Thank you for your consideration. As always, I am available to further discuss these measures at any time.

Dr. Vera Etches
Medical Officer of Health, Ottawa