Over the past few decades, the government has slowly eroded Canada’s healthcare system. In the mid-’70s, there were about 6.9 hospital beds per 1,000 people in Canada. But as of 2019, due to the gutting of public services and austerity, that number dropped to just about 2.5 hospital beds per 1,000 people. As a result, the slightest bit of pressure can put hospitals throughout the country in crisis. And so, it’s not a surprise the pandemic has been a disaster for Canada, including in Ontario. Huge peaks of infections, hospitalizations and death over the past couple of years have brought home how horrifyingly underequipped the system has become.

But even still, after the peak of each wave of COVID-19, there has been relative calm — a time when infections recede, hospitals empty out and life seems to approach something closer to normal. Each of these gaps between waves has presented an opportunity for Ontario’s government to learn from its mistakes and do what’s necessary to prepare for the next wave: shore up battered hospitals, improve ventilation in schools, make high-quality masks widely available, and increase rapid and PCR testing capacity.

Yet each and every one of these opportunities has been wasted. Instead of seeing them as a time to prepare, Premier Doug Ford’s government regarded them as a chance to drop our guard and try to achieve normality, despite it no longer being on offer. And now, we find ourselves overwhelmed by the latest Omicron wave, with cases and hospitalizations higher than ever before, and January becoming one of the deadliest months of the pandemic.

Here’s a look at how Ontario wasted downtimes instead of improving four crucial public health measures that could have saved lives throughout the pandemic.

Testing

While COVID-19 is a novel coronavirus, having to deal with pandemics is nothing new. Through past epidemics and pandemics, such as MERS and SARS, we’ve learned that testing is key to preventing viruses from overwhelming society. Some countries, such as South Korea, applied this knowledge very early on in this pandemic.

On Jan. 11, 2020, when China had reported just 40 some cases of COVID-19 to the World Health Organization, the South Korean government began distributing tests for generic coronaviruses. By the end of the month, they were sending out tests for specific strains of the virus. They also set-up drive through and walk through centres, allowing testing to be done in about 10 minutes, with results delivered within three days. According to a May 2020 paper on the South Korean strategy, “These two pillars, testing and tracking, have allowed the nation to blunt the exponential spread of the disease, without having to halt all internal movement and access between its cities.”

So, there was no excuse for Ontario, and Canada more broadly, not to get a testing system in place early on. But this didn’t happen. By the time Canada’s testing regime began to accelerate in April 2020, worldwide supplies for performing tests had dwindled. Canada came up particularly short in swabs and testing chemicals. This forced provinces like Ontario to begin restricting testing early that month.

The first wave came to an end in May. At that point, Ford encouraged anyone who wanted a test to get one, regardless of if they were symptomatic. At the time, Global News reported the province was capable of doing about 25,000 tests per day, but was only actually completing around 11,000.

The summer was a relative downtime. In July, the provinces and territories signed onto the Safe Restart Agreement with the federal government, which provided more than $19 billion to provinces, part of which was dedicated to increasing testing capacity. In a response letter to that agreement, Ford wrote, “We are committed to establishing the ability to administer 50,000 tests per day by this fall. […]  This significant planned increase in testing capacity is in anticipation of greater demand due to re-opening sectors such as workplaces, schools and daycares; a potential second wave of COVID-19; and, a potential increase in symptomatic individuals (due to cold/flu).”

Ontario was at least aware cases would likely rise in the months ahead, and recognized the important part increased testing would play to mitigate the wave. Yet according to federal data, Ontario failed to improve testing capacity to the amount Ford predicted, reaching about 43,000 by October. By this point, the need for testing had increased a great deal due to rising infections and the return of in-person classes, so Ford was forced to ask people to only get a test if they had symptoms. Those that did go for tests often had to wait hours in line, and upwards of a week to get results back. Remember, in South Korea the testing process took about 10 minutes, and results were delivered within three days.

Ontario did manage to ramp up testing in the coming months, to a peak of about 76,000 in mid-January 2021. But later that month, it also reported to the federal government that it increased its capacity by nearly 50,000 tests per day to more than 120,000. That hasn’t turned out to be the case, and since the arrival of Omicron, testing across Ontario has collapsed.

The peak day of testing in this wave was Dec. 31, 2021, at about 75,000. But this total is incredibly out of sync with demand, which has risen so high that at the end of December, the province introduced new guidelines limiting PCR tests to symptomatic “high-risk” people, or those that already have severe illness. Everyone else has been left to assume that if they have symptoms, they have the virus and must therefore isolate.

If Ontario was capable of testing 125,000 people a day, why did it cut back on testing well before it ever reached that target? Passage asked the Ontario government to explain the gap, and was told the real theoretical capacity was for about 100,000 tests per day. The ministry couldn’t (or wouldn’t) explain what led to the gap between even that lower number and reality.

In the weeks since the directive to limit testing went out, the province has completely lost track of how many cases are actually circulating. So, while Ontario did increase its PCR testing capacity from the beginning of the pandemic, it has been nowhere near enough. Now, the system has effectively completely broken down.

Rapid Testing

Early in the pandemic, Canadian health officials setting policy looked down upon widespread rapid testing, viewing the tests as too inaccurate to be of any real benefit. This isn’t a view that was shared in most other countries, including the United Kingdom, which recognized the benefits of the tests, understanding that while they’re not 100 per cent accurate, they can be useful in catching asymptomatic cases, thereby taking them out of circulation. Outside experts in Canada also pushed for the government to hurry to approve and roll out tests to the broader public, and at the end of September 2020 they finally did, announcing they’d ordered millions.

Ford recognized the value of these tests, calling the federal government’s decision a “game changer,” and touting the ability for people to get tested in the community as important in taking some burden off the PCR system. The trouble is, the government never really gave tests out to people directly. Instead, they were given to businesses to perform screening of employees. The logic, if never explicitly stated as such, was that businesses needed to be able to continue operating, at the expense of everything else. If you wanted a rapid test as an individual, you were almost out of luck. All that was available were tests at pharmacies, which charged upward of $30 for a single one. And the issue wasn’t a lack of tests: by early December 2021, Ontario had received more than 35 million rapid-test kits, according to the federal government, but used just 27 per cent of them.

Finally, in mid-December 2021, the government announced it would begin handing out rapid tests at provincial liquor stores, as well as a small number of pop-up sites throughout the province. This turned out to be a disaster. Tests ran out within hours on the first day they were available. In some parts of the province, people lined up early in the morning, only for just a few dozen tests to arrive late in the afternoon. The liquor stores ran out of tests entirely the next day, and they weren’t replenished. Those looking for tests at the pop-up locations, meanwhile, were often met with long lines and limited supplies.

Ontario refused to use a tool that could have helped blunt the spread of infections throughout the pandemic until the last moment, and then absolutely bungled their distribution. As of mid-January, because of other testing failures, the province ceased handing out rapid tests to the general public, even though it had only deployed just 64 per cent of the approximately 53 million tests it received from the federal government. These tests will instead be saved for higher risk settings where frequent testing is necessary.

Vaccination

The arrival of vaccines in late-2020 was something close to a miracle. But delivering those vaccines into the arms of Ontarians proved to be a challenge for the government. There were many models the government could have used to create a vaccine booking system. For example, Quebec used a centralized system to allow residents to book through a single portal for both mass vaccine clinics as well as pharmacies. Ontario took a different approach: a provincial portal was established that most, though not all, regions could use, but appointments at pharmacies would need to be booked through other platforms.

Things didn’t go well for the provincial portal when it first launched, with errors, endless wait times and generally poor design plaguing the system. These issues persisted as it opened up for more age groups to get their first shots, and weren’t even fixed in time for the rollout of second doses. And the problem was compounded by the government opening up eligibility for booking to large proportions of the population all at once, increasing waits and confusion. The system was so poorly designed that volunteers across the province came together to crowdsource vaccine appointments. Instead of producing a decent system, it fell to people across the province to fill the gaps and help each other find first and second doses in the patchwork system.

Moreover, because the province’s booking system encouraged registering at multiple pharmacy locations as well in the hope of getting a spot, people sometimes had to cancel several appointments if they found a better one. This required people to back-trace all their previous bookings through individual pharmacies, as well as the provincial system, and often resulted in unused appointments.

Eventually, the province was able to roll out a huge campaign, reaching a peak of nearly 270,000 shots a day in July 2021, with a peak seven-day average of about 240,000 per day. By September, just about 40,000 shots were being given out per day, and so mass vaccination clinics began to wind down.

In late- September, the United States approved Pfizer booster doses, and quickly began offering them to those who were eligible. It would take until early November for Health Canada to approve these boosters. Soon after, Ontario began to offer booster doses, but to just a small slice of the population, such as those at least 70 years old. When Omicron was discovered mid-month, it became clear that just about everyone was going to need a booster. Once again, the province dragged its feet, and those older than 50 were only able to begin getting their boosters on December 13, due to limited capacity for giving out shots. A big reason for this and subsequent delays is that mass clinics were wound down, and so there was no longer enough staff to physically administer the number of doses needed. In Ottawa, for example, the city’s top doctor said the vaccine rollout was hampered by staff shortages.

While demand for vaccines in October had declined, officials were aware that even without Omicron, there’d likely be a peak in demand over the winter. They should have used this time to maintain and even increase vaccine capacity. Instead, when Christmas rolled around, Ontario was caught flatfooted, and has never managed to recover.

School Safety

Students in Ontario have spent more time out of school since the start of the pandemic than in any other area in North America. The first closures came in spring 2020, when March Break was extended by two weeks. But what was supposed to be a temporary school closure was extended until the end of May, and then class was cancelled for the remainder of the school year.

Throughout the summer break, virtually nothing was done to improve the infrastructure of schools, despite researchers and organizations providing essential suggestions. In July 2020, for example, SickKids, the southern Ontario children’s hospital, put out a report arguing that, “Addressing structural deficiencies, such as large class sizes, small classrooms and poor ventilation, must be part of any plan to reopen schools.”

The government did allocate $50 million (or about $10,000 per school) to improve ventilation. But to give some perspective on how little that is, the backlog for general school repairs across the province was $16.3 billion in 2019, before the additional requirements for ventilation were imposed by the pandemic.

And the province failed to give any direction for how these improvements could be made because, according to Globe and Mail writer, Alex Bozikovic, fixing ventilation would require doing an audit of schools throughout the province to test their air quality, which would be sure to find issues thanks to decades of school neglect. As the Globe described, schools built in the 1980s and earlier have air systems that either require working windows to pull in any fresh air, or only pull in small amounts of fresh air — not nearly enough to make them safe in the pandemics.

So, it’s no surprise that when the government announced in late-July that school would be returning in the fall, their efforts were critiqued. At the time, Ontario Secondary School Teachers’ Federation president Harvey Bischof said, “The Ford government has had four months to come up with a serious strategy. It’s clear from today’s announcement that they have squandered that time.” And in late-August, Krista Wylie, co-founder of the group Fix Our Schools, told the Toronto Star of the province’s efforts: “The phrase, ‘too little too late’ comes to mind.”

When school did return, the restrictions put in place were limited and straightforward: students in Grade 4 and above had to wear masks; high school students in large school boards would attend in-person classes part-time, with the rest remote; and high school students in smaller boards were expected to be there in person at all times.

This past summer’s lull gave the provincial government yet another chance to prepare schools for the next year, and a likely increase of cases. In August, the government boasted of investing more than $625 million in school ventilation up until that point, which would “ensure that all occupied classrooms, gyms, libraries and other instructional spaces without mechanical ventilation have standalone [HEPA] filter units in place when students are back in class.” But this didn’t end up being the case, and these filters fail to deal with infrastructure issues anyways and can cause problems with existing ventilation systems.

And so, early this year, schools were closed once again, in this case by forcing students into remote learning for the first two weeks back after the holidays. The time before they came back was, once again, mostly wasted, with no structural changes made, despite providing some N95 masks to teachers.

Omicron has made things in Ontario much worse and was unexpected, to a certain extent. Still, at any of the points since the pandemic began where things calmed down, there was no reason to expect it would be over. Instead of planning for the next wave, the government wasted time, leaving us unprepared over and over again. The dire crisis we’re in is one they could have saved us from.