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Why it's becoming more difficult to navigate Canada's conflicting COVID-19 guidelines

Christopher Ashby feels overwhelmed by the flood of messages every day from all levels of government. 

"Between nine o'clock in the morning and three o'clock in the afternoon, many decisions and many things have changed each and every day," the Toronto hospitality worker told CBC News. 

"There's so many messages coming through the course of the day between tweets and press conferences and what's in printed press and what's online — there's just an avalanche of information." 

With a member of his family who is immunocompromised, another who works in health care, a university student and an elementary school student, Ashby said he and his family struggled with what to do as Thanksgiving approached during the coronavirus pandemic.  

"Before the regulations had shifted and changed yet again, we as a family pretty much made the decision that Thanksgiving would be a pass this year," he said.

"There were just way too many variables to feel comfortable."

So instead of a large family gathering, he and his partner are opting for a quiet dinner together.

"We need to make what we feel is the right decision for us and we definitely err on the side of caution," he said. "This is not something that people should be taking risks over because it affects too many people." 

'Different communities have different issues'

Depending where you live in Canada, it's getting harder to navigate conflicting guidelines from various levels of government — because they can often seem completely out of sync.

"It's up to Canadians throughout the country to do their part, to wear their mask, to maintain physical distancing," Prime Minister Justin Trudeau said Monday. 

"Unfortunately, to not get together with their families and friends for Thanksgiving so that we can take control of this second wave, so that we can all celebrate at Christmas."

Canadians are trying to decipher confusing advice from public health officials about what kind of gathering, if any, is appropriate and safe for Thanksgiving. 1:57

That advice is especially relevant to Ontario and Quebec, Canada's Chief Public Health Officer said Monday. Daily case numbers and community transmission of COVID-19 in both provinces remain high, with strict public health restrictions on the number of people who can gather safely. 

"If you are in Ontario and Quebec, I think the most sensible thing to do is to keep to your immediate social circles," Dr. Theresa Tam said. "Because you've seen the epidemic curve and this is not the time to be complacent about anything." 

But social circles in Ontario haven't been in place since Oct. 2, while Quebec's hardest hit areas have banned visitors between households altogether.

"It is challenging for the public health authorities because the science and the circumstances are always changing," said Timothy Caulfield, a Canada Research Chair in health law and policy at the University of Alberta.

"So that makes it more challenging to come up with a clear public health message. This isn't like; wear your seatbelts, don't smoke, eat fruits and vegetables, exercise — the situation is in flux." 

Caulfield said confusion gets worse the higher you go, because federal officials need to speak on behalf of all Canadians — even in areas with very few cases like in the Atlantic bubble.

"Different communities have different issues," he said. "So there is going to be variation from rural Alberta to downtown Toronto."

Messaging in one area might not be relevant in another, but he said those messages can cut across the country, which "creates confusion." 

Making sense of guidelines 'incredibly challenging'

In Canada's hardest hit provinces, the messaging is no less confusing.

Quebec moved to close bars, casinos, restaurants, libraries, museums and movie theatres in its hardest hit red zones this month, while also banning home gatherings as cases spiked

But the province also prohibited outdoor gatherings like barbecues, despite permitting people to meet in public spaces as long as they stayed two metres apart.

Quebec also recommends that people avoid leisure time with anyone outside their household, whether indoors or outdoors.

In Ontario, residents are being urged to avoid gathering with friends and family, but restaurants, bars, banquet halls and even casinos remain open with much higher limits on occupants.

"Having a large number of unmasked people in an indoor, closed, poorly ventilated space is how this spreads," said Dr. David Fisman, epidemiology professor at the University of Toronto's Dalla Lana School of Public Health. 

"So if you say, 'Well, this only spreads when you're with your family, it doesn't spread when you're with random strangers.' It doesn't make any sense." 

Ontario Premier Doug Ford said Tuesday that making a comparison between the two types of gatherings was like comparing "apples and bananas." 

"When you go into a restaurant they're taking everyone's name, they have six at a table, they have dividers, they have protocols in place, and the rest of the people in the restaurant you don't know," he said. "That's the difference; at a family, you know the people." 

Ontario Premier Doug Ford said Tuesday that making a comparison between gathering with family at home or going to a restaurant was like comparing "apples and bananas." (Nathan Denette/The Canadian Press)

"Please, it's very simple," Ford continued. "There's rules and there's guidelines. The rules are very clear: 10 indoors, 25 outdoors. I would really, really discourage people from having 25 people even if it's outdoors. Stick within 10 people." 

Asked three separate times by reporters Tuesday to clarify whether he would visit with extended family on Thanksgiving, Ford first said he would only see 10 people, then said he would need to speak with his wife and follow up.

He later clarified on Twitter that he would only gather with those in his household.

"Sometimes the messaging isn't as clear as it should be and it all comes down to communicating with each other better and I think we all need to do a better job — even myself included," Ford said Wednesday.

"We have to just be a lot clearer, all levels of government and all chief medical officers, on the communication."

Municipal officials in Ontario want provincial guidance

Local public health officials in Ontario have been vocal about the need for clearer messaging and more concrete action from the province after cases hit a record high last week. 

Toronto's top doctor Eileen de Villa called for "immediate action" from the Ontario government Friday to stop the spread of COVID-19 as the city faces the risk of "exponential growth" of new infections.

She called on the province to instruct Toronto residents to leave their homes only for essential trips including work, education, health-care appointments and exercise and asked for an end to indoor dining in the city.

"If I had the power to do this, I would have done it," she said. "It's just this simple: I'm asking the province to do it or to give me the power to do it."

In Ottawa, Medical Officer of Health Dr. Vera Etches called on residents to only get together with those in their immediate home for Thanksgiving and said even gathering outside was a bad idea

"My recommendation is to stick to your household," she said. "Because we've seen examples where people gathered in a park and someone was sick and then more people got sick with COVID." 

While Etches didn't go as far as de Villa in calling for a ban on indoor dining in Ottawa, she did recommend people only eat out or go to a bar with those they live with.

Tam said public health officials in different parts of the country are trying to tailor their response to the realities of the situation on the ground. (Adrian Wyld/The Canadian Press)

Tam said Monday public health officials in different parts of the country are trying to tailor their response to the realities of the situation on the ground, which may account for some of the differing guidelines, but they are also "steering in uncertain waters."

"No one knows exactly what is going to work," she said. "So there's a grey zone and people are doing slightly different things." 

How can we blame individuals, when it's incredibly challenging to make sense of any of the advice?  - Dr. Andrew Boozary, executive director of health and social policy for Toronto's University Health Network

"This just drives confusion en masse when you see such discord between different levels of government, between different public health units, between what's being put out in the media, in press conferences," said Dr. Andrew Boozary, executive director of health and social policy for Toronto's University Health Network.

"How can we blame individuals, when it's incredibly challenging to make sense of any of the advice?" 

Caulfield said public health officials and politicians need to be more transparent about the uncertainty they're facing and the science informing health policies, because it signals to the public that the guidelines could change in the future. 

"Good public health communication is incredibly important, especially when it appears we're getting some sense that trust is starting to wane and people are starting to get more frustrated," he said. 

"It's a really chaotic information environment right now, but we have to get it right."

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source https://www.cbc.ca/news/health/coronavirus-canada-guidelines-confusion-1.5753679?cmp=rss

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