Response Framework: Keeping Ontario Safe and Open November 3, 2020 Ontario Ontario’s Priorities Limit the Transmission of COVID-19 Put measures in place that work to limit transmission and sickness, and prevent death. Avoid Closures Keep Schools and Childcare Open Maintain Health Care and Public Health System Capacity Enable businesses to sustain operations while reducing the risk of transmission. Enable schools across the province to sustain a safe environment for classroom learning. Ensure the health care and public health system are meeting the needs of their communities. Protect Vulnerable Populations Put measures in place to protect those most vulnerable to COVID-19. Provide Additional Supports Where Possible Develop equitable responses, including financial tools for groups and sectors disproportionately affected by the pandemic. 2 Key Risk Factors of Potential Transmission Close Contact Closed Spaces Prolonged Exposure Crowded Places Forceful Exhalation There are several risk factors that help drive transmission of COVID-19. Close contact is the highest risk. Limiting these risks is critical to keeping Ontario open and safe. Personal and public health measures — such as physical distancing, staying home when ill even with mild symptoms, frequent handwashing and surface cleaning — have significant benefits and have been proven to limit COVID-19 transmission. It is critical the people of Ontario understand the risks of gatherings (crowds) in close contact in enclosed/indoor spaces to understand how to mitigate those and make informed choices. (see Appendix 2 for information on population-level risk and impact) 3 Principles for Keeping Ontario Safe and Open Responsible: Protecting the health and safety of the people of Ontario, especially those who are most vulnerable. Keeping child care centres and schools open are priorities. Proactive, graduated, and responsive: Proactive measures, including enforcement, will work to prevent transmission, thereby protecting our health care system and helping businesses stay open. Graduated measures should be targeted and informed by regional circumstances. Evidence-informed: Best-available scientific knowledge, public health data, defined criteria and consistent measures will inform public health advice and government decisions. Clear: Plans and responsibilities for individuals, businesses and organizations (employers) will be clear and outline what happens at each level. 4 Outbreaks and Community Transmission Outbreaks can start in a variety of places including workplaces, institutions, and other settings. If spread of the virus is not contained, it often results in widespread community transmission. Community transmission can result in further outbreaks, including in vulnerable settings. When there are a few or small number of outbreaks, public health units can undertake aggressive outbreak management, at each setting, to contain virus spread. Widespread community transmission requires broader scale responses. A response would include broad scale public health measures, restrictions to limiting/restricting access to control transmission, as well as testing, and case and contact tracing. When this occurs, targeted actions, particularly in vulnerable settings such as long-term care homes, retirement homes, child care centres and schools, are required to prevent illness and death. This may include rapid case and contact management, enforcement of measures, and strengthening measures where the outbreak is occurring, etc. These outbreaks can also lead to further community transmission. 5 A Comprehensive, Whole-of-Government Response to Keeping Ontario Safe and Open Actions and sustained efforts to limiting transmission and moving regions out of modified Stage 2… Case and Contact Management Testing Public Health Measures • Almost 4,000 case management and contact tracing staff province-wide undertake outreach to support isolation and testing to prevent further spread • Established target = 90% of cases and contacts followed up within 24 hours • Capacity to process over 50,000 tests/day; building to capacity of 100,000 tests/day by December 2020. • Established target of 60% of tests turned around within 1 day, and 80% within 2 days • Established benchmark of maintaining test positivity under 3% • Framework to progressively adjust public health measures to respond to the pandemic • Proactive education and outreach to businesses and organizations Education, Compliance & Enforcement Targeted Supports Communications • Compliance checks, inspection, paired with education; monitoring, and Provincial Offences Act (POA) Part I or related tools to improve outcomes (e.g., warnings and fines) • Multi-ministry COVID-19 safety blitzes coordinated with local by-law and police services o Includes fines and prosecution for blatant and/or repeated non-compliance; results shared with local officials and media, POA Part III or related tools (e.g., appear before court, potential for significant fine and/or jail time) • Additional supports provided for vulnerable populations, communities, and impacted businesses • Complementary communications plan supporting broad public education and awareness 6 Framework: Adjusting and Tightening Public Health Measures Act earlier by implementing measures to protect public health and prevent closures Tactics Objective Gradually loosen measures as trends in public health indicators improve PREVENT (Standard Measures) Focus on education and awareness of public health and workplace safety measures in place. Restrictions reflect broadest allowance of activities in Stage 3 absent a widely available vaccine or treatment. Highest risk settings remain closed. PROTECT (Strengthened Measures) Enhanced targeted enforcement, fines, and enhanced education to limit further transmission. Apply public health measures in high risk settings. RESTRICT (Intermediate Measures) Implement enhanced measures, restrictions, and enforcement avoiding any closures. CONTROL (Stringent Measures) LOCKDOWN (Maximum Measures) Implement broader-scale measures and restrictions, across multiple sectors, to control transmission (Return to modified Stage 2). Implement widescale measures and restrictions, including closures, to halt or interrupt transmission (Return to modified Stage 1 or pre-Stage 1). Restrictions are the most severe available before widescale business or organizational closure. Consider declaration of emergency. 7 Framework: Adjusting and Tightening Public Health Measures • The goal is to have every public health unit region in the “Prevent” level. Lockdown • Framework is designed to ‘stack’ or ‘ladder down or up.’ Control • Measures are scaled back or implemented progressively, level by level. Restrict • If trends are improving, measures are dropped cautiously, level by level, to ensure there are no significant community or public health impacts with the rollback of measures. Protect Prevent 8 Indicators: Adjusting and Tightening Public Health Measures PREVENT (Standard Measures) Epidemiology • Weekly incidence rate is < 10 per 100,000 • % positivity is < 1 • Ro < 1 • Outbreak trends/ observations • Level of community transmission/non-epi linked cases stable Health System Capacity • Hospital and ICU capacity adequate PH System Capacity • Case and contact follow up within 24 hours adequate PROTECT (Strengthened Measures) Epidemiology • Weekly incidence rate is 10 to 39.9 per 100,000 • % positivity is 1-2.5% • Ro is approximately 1 • Repeated outbreaks in multiple sectors/settings OR increasing/# of large outbreaks • Level of community transmission/non-epi linked cases stable or increasing Health System Capacity • Hospital and ICU capacity adequate PH System Capacity • Case and contact follow up within 24 hours adequate RESTRICT (Intermediate Measures) Epidemiology • Weekly incidence rate is 40 to 99.9 per 100,000 • % positivity is 2.5-9.9% • Ro is approximately 1 to 1.2 • Repeated outbreaks in multiple sectors/settings, increasing/# of large outbreaks • Level of community transmission/non-epi linked cases stable or increasing Health System Capacity • Hospital and ICU capacity adequate or occupancy increasing PH System Capacity • Case and contact follow up within 24 hours adequate or at risk of becoming overwhelmed CONTROL (Stringent Measures) Epidemiology • Weekly incidence rate ≥ 100 per 100,000 • % positivity ≥ 10% • Ro ≥ 1.2 • Repeated outbreaks in multiple sectors/settings, increasing/# of large outbreaks • Level of community transmission/non-epi linked cases increasing Health System Capacity • Hospital and ICU capacity at risk of being overwhelmed PH System Capacity • Public health unit capacity for case and contact management at risk or overwhelmed LOCKDOWN (Maximum Measures) Trends continue to worsen after measures from Control level are implemented. NOTES: • Indicators will generally be assessed based on the previous two weeks of information. However, movement to apply measures will be considered sooner than two weeks if there is a rapidly worsening trend. • Local context and conditions will inform movement, including potential regional application of measures. • Thresholds within a region may not all be met at the same time; decisions about moving to new measures will require overall risk assessment by government. 9 Proposed* Classification of Public Health Unit Regions PREVENT (Standard Measures) • • • • • • • • • • • • • • • • • Algoma Public Health Chatham-Kent Public Health Grey Bruce Health Unit Kingston, Frontenac and Lennox & Addington Public Health Haliburton, Kawartha, Pine Ridge District Health Unit Haldimand-Norfolk Health Unit Hastings Prince Edward Public Health Huron Perth Public Health Lambton Public Health Leeds, Grenville & Lanark District Health Unit Middlesex-London Health Unit Niagara Region Public Health North Bay Parry Sound District Northwestern Health Unit Peterborough Public Health Porcupine Health Unit Public Health Sudbury & Districts • • • • • • • • Region of Waterloo Public Health and Emergency Services Renfrew County and District Health Unit Simcoe-Muskoka District Health Unit Southwestern Public Health Thunder Bay and District Health Unit Timiskaming Health Unit Wellington-Dufferin-Guelph Public Health Windsor-Essex County Health Unit PROTECT RESTRICT (Strengthened Measures) • Brant County Health Unit • City of Hamilton Public Health Services • Durham Region Health Department • Halton Region Public Health (Intermediate Measures) • • • • • CONTROL (Stringent Measures) Eastern Ontario Health Unit Ottawa Public Health Peel Public Health Toronto Public Health York Region Public Health LOCKDOWN (Maximum Measures) *Proposed classifications based on data for week of Oct 26th. Updated data will be used for final review by the CMOH and approval by Cabinet* 10 Sector-Specific Public Health and Workplace Safety Measures Proposed General Public Health Measures (Gatherings, Workplace Requirements and Face Coverings) PROTECT (Standard Measures) Current Restrictions and Guidance • • • • • • Proposed (Strengthened Measures) RESTRICT (Intermediate Measures) Gathering limit for select organized public events and social gatherings (e.g., private gatherings at home, in parks, etc., barbeques): o 10 people indoors o 25 people outdoors Gathering limit for organized public events and social gatherings: o 50 people indoors o 100 people outdoors Gathering limit for religious services, rites or ceremonies, including weddings and funerals: o 30% capacity of the particular room, subject to physical distancing, indoors o 100 people, subject to physical distancing, outdoors Requirement for workplace screening Requirement for face coverings at indoor workplaces and public spaces, with limited exemptions Advice to restrict non-essential travel from areas of high-transmission to areas of low transmission Gathering limit for certain organized public events and social gatherings (e.g. barbeques): • 10 people indoors • 25 people outdoors Measure from previous level Measure from previous level CONTROL (Stringent Measures) Measures from previous levels and: • Gathering limit for all public events and social gatherings: o 10 people indoors o 25 people outdoors Gathering limit for all organized public events and social gatherings: • 10 people indoors • 25 people outdoors LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT Gathering limit for organized public events and gatherings: • 50 people indoors • 100 people outdoors Gathering limit for religious services, weddings and funerals: • 30% capacity indoors • 100 people outdoors Requirement for workplace screening Requirement for face coverings at indoor workplaces Requirement for face coverings in indoor public spaces, with limited exemptions Worker protections such as eye protection where patrons without face coverings are within two metres of workers Development and implementation of a communication/public education plan (highlighting risk) Advice to restrict non-essential travel from areas of high-transmission to areas of low transmission 12 Proposed Measures for Restaurants, Bars and Food or Drink Establishments (Standard Measures) PROTECT (Strengthened Measures) Current Restrictions • • • • • • • • • • • Limit operating hours; establishments must close at midnight Liquor sold or served only between 9 a.m. to 11 p.m. No consumption of liquor permitted between 12 a.m. to 9 a.m. Require patrons to be seated; 2m between tables Dancing, singing and performing music is permitted, with restrictions Karaoke permitted, with restrictions (including no private rooms) Require patron contact info (one per group) No buffet style service Face coverings except when eating or drinking Night clubs only permitted to operate as restaurant or bar Strip clubs are closed Proposed • Require patrons to be seated; 2m minimum between tables Dancing, singing and performing music is permitted, with restrictions Karaoke permitted, with restrictions (including no private rooms) Require patron contact info (one per group) No buffet style service Night clubs only permitted to operate as restaurant or bar Line-ups/patrons congregating outside venues managed by venue; 2m distance and face covering required Face coverings except when eating or drinking only Eye protection where patrons without face coverings are within two metres of workers • • • • • • • • Measures from previous levels and: • Limit operating hours, establishments must close at midnight • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Require contact information for all seated patrons • Limit of 6 people may be seated together • Limit volume of music (e.g., to be no louder than the volume of a normal conversation) • Safety plan available upon request RESTRICT (Intermediate Measures) CONTROL (Stringent Measures) Measures from previous levels and: • Indoor dining not permitted, outdoor dining, take out, drive through, and delivery permitted • Limit of 6 people may be seated together • No line-ups or patron congregations outside venues, unless they maintain 2m distance and wear a face covering • Require patron contact info from all seated patrons • Dancing, singing and the live performance of brass or wind instruments are prohibited Measures from previous levels and: • 50 person indoor capacity limit • Limit operating hours, establishments close at 10 p.m. • Liquor sold or served only between 9 a.m. to 9 p.m. • No consumption of liquor between 10 p.m. and 9 a.m. • Require screening of patrons (e.g., questionnaire) • Limit of 4 people may be seated together • Closure of strip clubs Measures from previous levels and: • 10 person indoor capacity limit • Outdoor dining, take out, drive through, and delivery permitted • Dancing, singing and the live performance of brass or wind instruments are prohibited LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT 13 Proposed Measures for Sports and Recreational Fitness (Standard Measures) PROTECT (Strengthened Measures) RESTRICT (Intermediate Measures) Current Restrictions Limits: • 50 people indoors (classes) • 100 people outdoors (classes) • 50 people indoors (area with weights or exercise equipment) • Spectators allowed (50 indoors and 100 outdoors) • Limit of 50 people per room basis if operating in compliance with a plan approved by the Office of the Chief Medical Officer of Health (Guidance for Facilities for Sport and Recreational Activities) • Team sports must be modified to avoid physical contact; 50 people per league Proposed • 50 people indoors (classes) • 100 people outdoors (classes) • 50 people indoors (area with weights or exercise equipment) • Spectators allowed (50 indoors and 100 outdoors) • Limit of 50 people per room basis if operating in compliance with a plan approved by the Office of the Chief Medical Officer of Health (Guidance for Facilities for Sport and Recreational Activities) • Team or individual sports must be modified to avoid physical contact; 50 people per league • Exemption for high performance athletes and parasports • Limit volume of music (e.g., conversation level)/require use of microphone for instructor where needed to avoid shouting Measures from previous levels and: • Face coverings required except when exercising • Increase spacing between patrons to 3m for areas of a sport or recreational facility where there are weights/weight machines and exercise/fitness classes • Recreational programs limited to 10 people per room indoors and 25 outdoors • Require contact information for all patrons and attendance for team sports • Require appointments for entry; one reservation for teams • Safety plan available upon request Measures from previous levels and: • Maximum 50 people per facility (revoke CMOH approved plan) in all combined recreational fitness spaces or programs (not pools, rinks at arenas, community centres, and multipurpose facilities) • Require screening of patrons, including spectators (e.g., questionnaire) • Limit duration of stay (e.g. 60 minutes); exemption for sports • No spectators permitted (exemption for parent/guardian supervision of children) CONTROL (Stringent Measures) • Gyms and fitness studios closed • Fitness classes not permitted • Other classes in facilities have maximum of 10 patrons • Outdoor class, organized program or organized activity have maximum of 25 patrons • Team sports must not be practiced or played except for training (no games or scrimmage). No contact permitted. Measures from previous levels and: • Gyms and fitness studios permitted to be open: • 10 people indoors (classes) • 25 people outdoors (classes) • 10 people indoors (areas with weights or exercise equipment) • All sports and recreational programs in other facilities (arenas and multiplexes) limited to 10 people per room indoors and 25 outdoors. • Team sports must not be practiced or played except for training (no games or scrimmage). • No contact permitted for team or individual sports. 14 LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT Proposed Measures for Meeting and Event Spaces PROTECT (Strengthened Measures) Current Restrictions Limits: • 50 people indoors • 100 people outdoors *exception for court/government services, weddings, funerals • As of August 21, 2020, if operating in compliance with a plan approved by the OCMOH: 50 persons per room, subject to conditions in the plan Proposed Limits: • 50 people indoors • 100 people outdoors *exception for court/government services, weddings, funerals • Booking multiple rooms for the same event not permitted • As of August 21, 2020, OCMOH plan: 50 persons per room, where physical distancing can be maintained, subject to conditions in the plan Measures from previous levels and: • Limit operating hours, establishments must close at midnight • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Require contact information for all seated patrons • Limit of 6 people may be seated together • Limit volume of music (e.g., to be no louder than the volume of a normal conversation) • Safety plan available upon request RESTRICT (Intermediate Measures) CONTROL (Stringent Measures) Limits: • 10 people per facility indoors • 25 people outdoors • 6 people per table Measures from previous levels and: • Maximum of 50 people per facility (revoke capacity limit on a per room basis as per CMOH plan) • Limit operating hours, establishments close at 10 p.m. • Liquor sold or served only between 9 a.m. to 9 p.m. • No consumption of liquor between 10 p.m. and 9 a.m. • Limit of 4 people may be seated together • Require screening of patrons (e.g., questionnaire) LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT (Standard Measures) Measures from previous levels and: Limits: • 10 people per facility indoors • 25 people outdoors 15 Proposed Measures for Retail PROTECT (Strengthened Measures) Current Restrictions • Fitting rooms must be limited to non-adjacent stalls Proposed • Fitting rooms must be limited to nonadjacent stalls • Line-ups/patrons congregating outside venues managed by venue; 2m distance and face covering required Measure from previous level and: • Limit volume of music (e.g., to be no louder than the volume of a normal conversation) • For malls - safety plan available upon request RESTRICT (Intermediate Measures) CONTROL (Stringent Measures) Measure from previous levels and: • Interior dining spaces closed (tables/seating in food courts) in shopping malls. Measures from previous level and: • Require screening of patrons at mall entrances (e.g., questionnaire) For consideration during winter: • Limit capacity in retail stores and in shopping malls LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT (Standard Measures) Measures from previous levels and: • Interior dining spaces closed (tables/seating in food courts) in shopping malls. For consideration during winter holiday season: • Limit capacity in retail stores and in shopping malls • Guidance for mall operators and retail stores 16 Proposed Measures for Personal Care Services (Standard Measures) PROTECT (Strengthened Measures) RESTRICT (Intermediate Measures) Current Restrictions • Persons who provide services must wear appropriate PPE • Masks must be worn except for receiving services that tend to an area of the face that a mask would cover • Oxygen bars, steam rooms, saunas, whirlpools and bathhouses closed Proposed • Oxygen bars, steam rooms, saunas, and whirlpools closed Measures from previous level and: • Require contact information from all patrons • Safety plan available upon request Measures from previous level and: • Services requiring removal of face coverings prohibited • Change rooms & showers closed • Bath houses, other adult venues, hot tubs, floating pools and sensory deprivation pods closed (some exceptions) • Require screening of patrons (e.g., questionnaire) CONTROL (Stringent Measures) Measures from previous level and: • Services requiring mask removal prohibited • Change rooms & showers closed (some exceptions) • Baths, hot tubs, floating pools and sensory deprivation pods closed (some exceptions) Measures from previous level • Services requiring removal of face coverings prohibited 17 LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT Proposed Measures for Casinos, Bingo Halls and Gaming Establishments (Standard Measures) PROTECT (Strengthened Measures) RESTRICT (Intermediate Measures) Current Restrictions • Capacity cannot exceed 50 persons. • Table games are prohibited. • OR casinos, bingo halls, and gaming establishments operate in accordance with a plan approved by the Office of the Chief Medical Officer of Health. • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. Proposed • Capacity cannot exceed 50 persons. • Table games are prohibited. • OR casinos, bingo halls, and gaming establishments operate in accordance with a plan approved by the Office of the Chief Medical Officer of Health. Measures from previous level and: • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Require contact information from all patrons • Safety plan available upon request Measures from previous levels, and: • Liquor sold or served only between 9 a.m. to 9 p.m. • No consumption of liquor between 10 p.m. and 9 a.m. • Require screening of patrons (e.g., questionnaire) CONTROL (Stringent Measures) • Casinos, bingo halls and other gaming establishments are closed. LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT Measures from previous levels and: Limits: • 10 people per facility indoors • 25 people outdoors 18 Proposed Measures for Cinemas Current Restrictions PROTECT (Strengthened Measures) RESTRICT (Intermediate Measures) In facility/area • 50 indoors • 100 outdoors OR • 50 indoor per auditorium if cinema operates in accordance with the approved plan from the Office of the Chief Medical Officer of Health CONTROL (Stringent Measures) • Cinemas are closed. • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Drive-in cinemas permitted to operate, subject to restrictions Proposed In facility/area • 50 indoors • 100 outdoors OR • 50 indoor per auditorium if cinema operates in accordance with the approved plan from the Office of the Chief Medical Officer of Health • Face coverings except when eating or drinking only • Drive-in cinemas permitted to operate, subject to restrictions Measures from previous level and: • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Require contact information from all patrons • Safety plan available upon request Measures from previous levels and: • 50 per facility (revoke OCMOH approved plan) • Liquor sold or served only between 9 a.m. to 9 p.m. • No consumption of liquor between 10 p.m. and 9 a.m. • Require screening of patrons (e.g., questionnaire) Closed, except for: • Drive-in cinemas • Rehearsal or performing a recorded or broadcasted event remains permitted • Singers and players of brass or wind instruments must be separated from any other performers by plexiglass or other impermeable barrier 19 LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT (Standard Measures) Proposed Measures for Performing Arts Facilities PROTECT (Strengthened Measures) RESTRICT (Intermediate Measures) Current Restrictions • 50 spectators indoors and 100 spectators outdoors with 2m physical distance maintained • Singers and players of wind or brass instruments must be separated from spectators by plexiglass or some other impermeable barrier • Performers and employees must maintain 2m physical distance except for purposes of the performance • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. Proposed • 50 spectators indoors and 100 spectators outdoors with 2m physical distance maintained • Singers and players of wind or brass instruments must be separated from spectators by plexiglass or some other impermeable barrier • Rehearsal or performing a recorded or broadcasted event permitted • Performers and employees must maintain 2m physical distance except for purposes of the performance • Drive-in performances permitted Measures from previous level and: • Liquor sold or served only between 9 a.m. to 11 p.m. • No consumption of liquor permitted between 12 a.m. to 9 a.m. • Require contact information from all patrons • Safety plan available upon request Measures from previous levels and: • Liquor sold or served only between 9 a.m. to 9 p.m. • No consumption of liquor between 10 p.m. and 9 a.m. • Require screening of patrons (e.g., questionnaire) CONTROL (Stringent Measures) • Spectators not permitted; rehearsal or performing a recorded or broadcasted event permitted • Singers and players of brass or wind instruments must be separated from any other performers by plexiglass or other impermeable barrier Measures from previous levels and: • Closed to spectators • Rehearsal or performing a recorded or broadcasted event remains permitted • Singers and players of brass or wind instruments must be separated from any other performers by plexiglass or other impermeable barrier 20 LOCKDOWN Stage 1 / Pre-Stage 1 PREVENT (Standard Measures)