COVID-19 pandemic in Ontario

COVID-19 pandemic in Ontario

Disease	COVID-19
Virus strain	SARS-CoV-2
First case	Sunnybrook Hospital, Toronto
Arrival date	January 25, 2020 ()
Origin	Wuhan, Hubei, China
Deaths	11,298
Confirmed cases	1,021,436
Official website
Government of Ontario

The COVID-19 pandemic in Ontario is an ongoing viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first confirmed case of COVID-19 in Canada was announced on January 25, 2020, involving a traveller who had recently returned to Toronto from travel in China, including Wuhan. Ontario has had the largest number of confirmed COVID-19 cases among Canada's provinces and territories, but due to having the largest population, only ranks sixth adjusted per capita. Ontario surpassed one million lab-confirmed COVID-19 cases on January 24, 2022; one day before the anniversary of the first confirmed case on January 25, 2020.

On March 17, 2020, a state of emergency was declared by Premier Doug Ford. This included the gradual implementation of restrictions on gatherings and commerce.

From late spring to early summer, the majority of the deaths were residents of long-term care homes. In late April 2020, one out of five of all long-term care homes in Ontario had an outbreak and 70 percent to 80 percent of all COVID-19 deaths had been in retirement and long-term care homes. Following medical assistance and observation by the Canadian Armed Forces, the military released a report detailing "a number of medical, professional and technical issues" amongst for-profit long-term-care homes including neglect, lack of equipment and allegations of elder abuse.

Following a decline in cases, in May through August 2020, the province instituted a three-stage plan to lift economic restrictions. The state of emergency was lifted on July 24, 2020.

In early September 2020, the province showed a significant increase in new cases, beginning the second wave of the pandemic. Ontario began to reintroduce some restrictions and in early November, created a new five-tiered colour-coded "response framework".

From late November to mid-December 2020, the province began placing regions in rolling lockdowns, culminating in a province-wide shutdown beginning Boxing Day. In the post-winter holiday surge of new infections, Premier Ford declared Ontario's second state of emergency on January 12, 2021, which was lifted February 10, 2021, and a stay-at-home order effective January 14, 2021, which was phased out regionally between February 10 and March 8, 2021.

Following Health Canada's approval of various COVID-19 vaccines, widespread plans for vaccinations began during the week of December 14, 2020. Early vaccination efforts were highly criticized and a shortage of vaccine supply in late January and early February slowed immunization rollout significantly for a number of weeks. The rollout continued to be highly criticized for lack of equitability and clarity, which was significantly helped by volunteer groups like Vaccine Hunters Canada.

In mid-March 2021, the Ontario Hospital Association, and Ontario's Chief Medical Officer of Health declared the province was experiencing a third wave of the virus. Following the third wave surge, ICU numbers in late March climbed to their highest numbers since the beginning of the pandemic. On April 1, 2021, the government announced a second province-wide shutdown beginning April 3. Ford later issued a third state of emergency and stay-at-home order for the province beginning April 8, 2021, and ordered all schools to close on April 12, 2021 (public schools were in the middle of spring break, delayed from March to April). In order to ensure greater decline in the number of reported daily infections, the stay-at-home order was extended yet again to June 2, 2021, at which point it expired. Following the expiration of the stay-at-home order, on May 20, 2021, the provincial government released a three-step roadmap to reopen the economy based on vaccination rate goals.

In late summer 2021, the province began preparing for a fourth wave of the virus, which was now largely affecting unvaccinated individuals. After hitting a stand-still on vaccination rates, on September 1, 2021, Ontario became the fourth province to implement a proof of vaccination mandate for various non-essential functions, which went into effect on September 22, 2021. In January 2022, Ontario entered a partial lockdown (termed as a rollback to "Step 2" of the previous roadmap) due to record cases caused by Omicron variant, ordering the closure of most non-essential indoor facilities.

Timeline

Main articles: Timeline of the COVID-19 pandemic in Ontario (2020), Timeline of the COVID-19 pandemic in Ontario (2021), and Timeline of the COVID-19 pandemic in Ontario (2022)

Provincial government response

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Personal protective equipment donation tent at North York General Hospital.

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COVID-19 safety notice at a park in Vaughan

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Social distancing at a Shoppers Drug Mart store in the former city of North York

On March 15, 2020, Ontario Lottery and Gaming Corporation (OLG) ordered the closure of all provincial casinos. On March 17, 2020, Premier Ford declared a provincial state of emergency, prohibiting public gatherings larger than 50 people, and ordering the closure of all schools, child care services, libraries, indoor recreation facilities, dine-in bars and restaurants, and all cinemas, theatres, and concert venues. Ford stated the "vast majority" of businesses were not affected by the order, promising that "essential services and essential needs will be available to every individual and families.

On March 20, 2020, further measures were announced, including waiving the three-month waiting period for Ontario Health Insurance Plan (OHIP) coverage, the launch of an e-learning portal, and extended privileges for hospitals to re-deploy staff.

On March 23, 2020, Ford ordered all "non-essential" businesses closed by 11:59 p.m. A list of 74 "essential" businesses was published later in the day. On March 27, 2020, at 2:00 p.m. ET, Alert Ready was activated on all radio stations, television broadcasters and LTE wireless networks in Ontario, broadcasting an emergency alert warning those returning from international travel of their obligation to self-isolate for 14 days under the Quarantine Act.

On March 30, 2020, the Ontario government extended the state of emergency through April 13, 2020, and also ordered the province-wide closure of all outdoor recreational amenities, including beaches, playgrounds and sports facilities (several Ontario municipalities including Toronto, had already ordered similar closures of their recreational amenities several days prior to the province-wide order).

On April 3, 2020, it was announced the number of "essential" businesses would be reduced to 44 beginning 11:59 p.m. on April 4, 2020; this included Ontario Cannabis Store and the halting of most non-essential construction, including industrial construction, and residential construction that did not begin before April 4, 2020, but excluding "critical" infrastructure projects. On May 27, 2020, all existing public health orders were extended through June 9, 2020.

On April 27, 2020, Premier Ford released "A Framework for Reopening our Province", a roadmap detailing a "gradual" lifting of economic restrictions. The process was divided into three stages, with the first intending to allow reopening outdoor spaces, businesses that can "immediately meet or modify operations" to allow a larger number of participants in certain types of gatherings and allow the resumption of some non-elective medical procedures. Stage 2 would allow additional businesses and outdoor spaces to reopen, and increase the limit on participants in gatherings. Stage 3 would contain further relaxation of prior restrictions, although restrictions on large public gatherings will remain in place indefinitely. After the process began in mid-May, the entirety of the province reached Stage 3 in mid-August.

On June 12, Chief Medical Officer of Health David Williams issued guidelines for "social circles" — allowance for families to expand their interactions with up to 10 people (including themselves) from outside of their immediate household.

On September 17, in response to a surge in new cases in parts of the province, it was announced that the maximum size of "unmonitored social gatherings and organized public events" in the Ottawa, Peel, and Toronto regions would be reduced from 50 people indoors and 100 outdoors, to 10 indoors and 25 outdoors. Organizers of events that violate this restriction can be fined a minimum of $10,000, on top of the existing $750 fine for violating Ontario public health orders. Ford stated that the rule was primarily intended to target events occurring in parks and private locations, and that staffed facilities not targeted under the rule (such as banquet halls, cinemas, convention centres, and restaurants) have employed safety protocols compliant with the province's health guidance.

On September 19, the aforementioned restrictions on private gatherings were extended province-wide. On September 25, it was announced that effective September 26 province-wide, strip clubs would be ordered closed, and that all bars, restaurants and nightclubs would be required to end the sale of alcoholic beverages at 11:00 p.m. and close their dining rooms between midnight and 5:00 a.m. nightly.

On October 2, Premier Ford announced that the wearing of face masks would become mandatory province-wide in all public spaces and workplaces when social distancing is not possible, effective October 3. A number of health regions had already implemented similar mandates at the regional level.

In addition, new restrictions were introduced in the Ottawa, Peel, and Toronto regions; bars and restaurants must collect contact information from all patrons for contact tracing purposes, and are capped at a capacity of 100 people and six patrons per table. Event facilities were capped at a capacity of 50 people total (rather than 50 per room) and also subject to the six-person cap. Gyms are also capped at 50 patrons, and exercise classes were capped at 10.

Due to heightened cases in the regions, Peel, Ottawa, and Toronto were rolled back to Modified Stage 2 from October 10 to November 7, reinstating closures of indoor dining areas, casinos, cinemas and theatres, gyms, and personal care services that require the removal of face masks. All gatherings are capped at 10 people indoors and 25 outdoors, and team sports are restricted to practices only, with scrimmages and games prohibited. Wedding receptions were also prohibited following the Thanksgiving long weekend. Schools and places of worship will continue operations. On October 16, it was announced that York Region would also be placed under Modified Stage 2 beginning October 19.

On November 25, a report was released by Auditor General Bonnie Lysyk which found that Ontario's initial response to COVID-19 was "slower and more reactive relative to most other provinces and many other international jurisdictions" (in contrast to its response to the SARS outbreak). The report found that Public Health Ontario had a "diminished role" in the response, including the province's Central Co-ordination Table for COVID-19 consisting largely of deputy ministers rather than public health officials such as Chief Medical Officer of Health David Williams (who acted primarily on the advice of Ontario's Health Command Table), and ignoring recommendations made by public health officials.

Schools and daycares

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Notice of school closure at a YCDSB high school in Markham, shortly after the pandemic began in 2020. Note the stated reopening date in what was initially expected to be a brief lockdown.

On March 12, 2020, the provincial government announced that publicly funded schools would be closed for an additional two weeks after March Break until April 5. On March 24, Premier Ford announced that the reopening of schools would be delayed indefinitely past the original April 6 target.

On March 31, Premier Ford announced that in-person classes would remain suspended through at least May 4; in tandem, Minister of Education Stephen Lecce announced the second phase of its "Learn from Home" program, which would involve "teacher-led" instruction delivered via distance education.

On April 14, Premier Ford delayed the reopening of public schools once again. On April 26, it was announced that there were plans to resume in-person classes on May 31. On May 19, Premier Ford announced that all public schools would remain closed through the end of the semester, with plans to pursue in-person classes when the next school year begins in September 2020.

Fall semester 2020

For the next school year, Lecce presented three scenarios: full online learning, a hybrid of online and in-class learning, and a return to full-time in-class learning. On July 30, it was announced that elementary schools would return to class full-time, while high schools in 24 districts with higher enrollment would use a hybrid model, alternating daily between in-person and online instruction to reduce class sizes, with physical classes conducted in cohorts of 15 students each. Students in Grade 4 and higher would be required to wear a face mask, parents would have the option to opt out of in-person classes in favour of online classes, and high school students with special needs would be able to attend in-person daily if they are not capable of using remote learning. The province allocated $309 million in funding to cover the costs of additional cleaning supplies, protective equipment, and staffing.

The plan faced criticism from parents, educators, and health care professionals, noting that some schools had insufficient ventilation and that there was no reduction in elementary school class sizes—with only one metre of distancing specified between desks. Lecce stated that the distance of desks was in conjunction with the use of masks. The hashtag "#UnsafeSeptember" was used on Twitter to publicize concerns regarding the back-to-school plan. A poll conducted by Maru/Blue in mid-August suggested 38 percent of parents surveyed were not going to send their children back to school, and a majority believed they stood with teachers and that there should be a staggered start to the school year.

On August 26, details were issued regarding how positive cases will be handled. In the event of a positive case, the entire cohort will be dismissed and required to self-isolate for 14 days. Students may return to class if they have not developed symptoms during the 14-day period. However, they will not be required to receive a test. Schools may be shut down entirely if the local health unit determines that "potential widespread transmission" is occurring. The same day, the federal government announced a $2 billion funding toward schools in Canada, of which Ontario will receive $763 million with the first tranche of $381 million arriving in the fall.

The Toronto District School Board, Canada's largest, debated and later decided to delay the reopening of schools until September 15, one week later than the initial September 8 date. A survey by the board suggested 70 percent of students would be returning to in class school and 30 percent of students would be opting for learning from home.

On September 8, schools opened for many parts of the province, using preventive measures such as masks, physical distancing in classrooms, and remote learning. Teachers in a Mississauga Catholic school were reported as briefly refusing to work until proper personal protective equipment was provided.

On September 11, the Ontario government released a website to track COVID-19 infections in public schools and daycares.

By the end of the second week of school reopening, the government has reported 72 cases of COVID-19 in 60 schools and one school closure in Pembroke in Renfrew County in Eastern Ontario.

The last day of class for public schools in 2020 was December 18, the province closed the fall semester with 7,292 cases reported in public schools. Before the winter break, there more than 20 schools closed in addition to all public schools in the Windsor-Essex region.

Winter/Spring 2021 semester

Due to a province-wide shutdown, all public schools in the northern half of the province were closed to in-person classes until at least January 11, 2021, and the southern half of the province until at least January 25, 2021. Some schools in the north voluntarily remained closed as a precaution.

On January 12, the return to in-person classes in Hamilton, Peel, Toronto, Windsor-Essex, and York was delayed to February 10, 2021, as they were still considered hotspots. On January 20, it was announced that only seven school boards would resume on January 25.

On February 3, it was announced that most remaining schools outside of Peel, Toronto, and York would return to in-person class on February 8. In-person classes in Peel, Toronto, and York would return on February 16 after the Family Day holiday. On February 11, it was announced that March break would be delayed to the week of April 12 ("April Break") in order to prevent community transmission via non-essential travel and gatherings.

Amid the second shutdown and the third wave, the provincial government stated that it was its "firm belief" that in-person classes needed to continue, as they were "critical to student mental health", and that "due to our strong infection prevention measures, 99 per cent of students and staff have no active cases of COVID-19, however we must remain vigilant and keep our guard up in order to keep schools safe and open." However, on April 5, Peel Medical Officer of Health Lawrence Loh announced the closure of all schools in Peel Region for at least two weeks beginning April 6 (dates including April Break), in an order issued pursuant to Section 22 of the Health Protection and Promotion Act. Later that day, Wellington-Dufferin-Guelph Public Health announced that the Medical Officer of Health Nicola Mercer would issue a similar order on April 6. On April 6, Toronto Medical Officer of Health Eileen de Villa also issued a Section 22 for the same duration.

On April 11, Minister of Education Stephen Lecce stated in a letter to parents that most schools in Ontario would continue in-person classes after April Break, despite the new stay-at-home order. However, Lecce backtracked the next day, and Premier Ford announced that all schools in Ontario must close indefinitely. Private schools were required to transition to virtual learning by April 15, and public schools transitioned after April Break. Child care will remain available for non-school aged children and the school-aged children of essential workers.

On June 2, Premier Ford announced that all schools would remain closed through the end of the semester, but that he would allow in-person outdoor graduation ceremonies in all grades. In particular, Premier Ford cited safety concerns surrounding variants of SARS-CoV-2 as reasoning, stating that "It was a hard choice to make, but I will not, and I repeat, I will not take unnecessary risks with our children right now."

Ontario public school and childcare centre statistics

COVID-19 in Ontario public schools	#	Ref
Current number of schools with cases	1,097
Current number of schools closed	N/A (schools currently on Winter break)
Cumulative total (total number of cases reported in schools)	27,064
COVID-19 in Ontario daycare centres	#	Ref
Current number of childcare centres with cases	440
Current number of childcare centres closed	43
Cumulative total (total number of cases reported in childcare centres)	10,202

Data as of December 24, 2021

Lifting of restrictions after the first wave

On May 14, 2020, it was announced that Stage 1 of Ontario's lifting of restrictions would begin May 20, focusing primarily on "workplaces that are well-positioned to follow public health advice to maintain physical distancing, implement workplace safety guidance and limit gatherings". Certain outdoor recreation activities that are part of Stage 1 were allowed to resume on May 16, for the Victoria Day long weekend.

On June 8, it was announced that Stage 2 would be implemented across most of the province, excluding 10 Southern Ontario health regions primarily in the Greater Toronto and Hamilton Area and along the Canada–United States border (such as Windsor-Essex County) due to a large number of active cases. In addition, Ford announced that the cap on gathering sizes would be increased to ten province-wide regardless of phase, and that there would be a moratorium on evictions through the end of August of small businesses which are eligible for the Canada Emergency Commercial Rent Assistance program. On June 15, the Durham, Halton, Haldimand-Norfolk, Hamilton, Lambton, Niagara, and York health regions were allowed to enter Stage 2.

On June 22, it was announced that Peel and Toronto would be allowed to enter Stage 2 on June 24. Windsor-Essex was still excluded from Stage 2 due to outbreaks involving the agriculture industry. On June 24, it was announced that most of Windsor-Essex would be allowed to enter Stage 2 on June 25, excluding Kingsville and Leamington.

On July 3, Premier Ford stated that he did not have a specific timetable for Stage 3; "You see what's happening [in the United States] when you move too quickly, you see what's happening south of the border. We don't want that happening up here."

By August 12, after a region-by-region roll-out, all regions in Ontario had entered Stage 3. On September 8, in response to growing case numbers, the provincial government announced a moratorium on further lifting of restrictions (such as expansion of "social circles" and gatherings) for at least four weeks, besides those already ongoing (such as schools, and reopening of selected casinos on September 26).

Stages of Reopening (First Wave - 2020)

Stage	Effective date(s)	Restrictions lifted	Notes
1	May 14: Outdoor activities May 16	Stage 1 includes eased restrictions on the following: Industry/retail Construction Shopping (provided it has street-front access) Motor-vehicle dealerships Media operations Non-essential professional services Outdoor recreation Seasonal business (e.g. golfing) Individual sporting Care/household Services Non-emergency healthcare Services for animals Libraries (pick-up/delivery only) Indoor/outdoor household services
2		Province-wide, regardless of their stage or not, were given some looser restrictions. Social gatherings were extended to include up to ten people. Places of worship are allowed to operate at 30 percent of their normal capacity. Stage 2 allowed certain businesses to reopen, with heavy restrictions: Personal and personal care services Restaurants & bars (outdoor patio service only) Shopping malls & centres Photography Film & TV Tour & guide services Water recreational facilities Outdoor recreational facilities Beaches, parks & camping Outdoor recreational team sports Drive-in & drive-thru venues Weddings, funerals and similar gatherings Libraries Community centres Attractions & heritage institutions Small outdoor events (such as cultural celebrations, animal shows and fundraisers)
3		Gatherings capped at 50 indoors and 100 outdoors. Most businesses and activities not covered under Stage 2 (such as cinemas and theatres, dine-in restaurants, indoor gyms, recreation and attractions, etc.) are allowed to resume operations with social distancing and capacity limits enforced per industry, unless otherwise prohibited. Certain activities remain prohibited, including amusement parks, bathhouses, buffet service, casino table games, dancing at bars or restaurants, overnight children's camps, oxygen bars, saunas, steam rooms, and contact sports that involve "prolonged" contact.
Modified 2	October 10: Ottawa October 10: Peel October 10: Toronto October 19: York	The following restrictions were re-implemented: Gatherings and public events capped at 10 indoors and 25 outdoors. Casinos and gaming establishments, indoor dining areas, indoor cinemas, performing arts venues, and exhibits at museums/etc. that have a "high risk of personal contact" must close. Team sporting events are prohibited.

Second province-wide shutdown (December 26, 2020 – January 25, 2021)

On December 21, 2020, Premier Ford announced that in order to "save lives and prevent our hospitals from being overwhelmed in the coming weeks", a "strict" province-wide shutdown would begin in all health regions (regardless of their current status on the response framework) at 12:01 a.m. ET on December 26, 2020 (Boxing Day). This measure will last for 28 days. It was originally to last only 14 days in the northern regions of the province (north of Sudbury), but on January 7, 2021, it was announced that the province-wide shutdown will be extended in these regions to the same length as in Southern Ontario.

Indoor social gatherings that involve people from outside of one's immediate household are prohibited. Outdoor gatherings are limited to 10 people with social distancing. All non-essential businesses, retail outlets (which include all businesses deemed non-essential under the "Lockdown" tier of the response framework, as well as hardware stores and pet shops), cultural amenities, sports and recreation facilities (unless "being used by high-performance athletes and specified professional leagues"), and personal care services must close to the public. Essential retail businesses are subject to capacity limits stricter than those used under Lockdown (50% for supermarkets and pharmacies, 25% for liquor stores and allowable big-box stores that sell groceries). Bars and restaurants are prohibited from offering dine-in service. All drive-in or drive-through events are prohibited, excluding drive-in religious services.

All publicly-funded schools remained closed to in-person classes (resuming remotely after the holiday break) until January 11, 2021, in Northern Ontario, and January 25, 2021, in Southern Ontario. Elementary schools were originally slated to reopen in Southern Ontario on January 11, but on January 7, it was announced that this would be delayed.

Second stay-at-home order (January 14 – March 8, 2021)

On January 12, 2021, citing models forecasting that Ontario's health care system will be "overwhelmed" with cases and mortality exceeding those of the first wave unless actions are taken, Premier Ford declared a second provincial state of emergency and announced stricter province-wide measures, to take effect on January 14 at 12:01 a.m. ET and last through at least February 11. These measures upgraded the province-wide shutdown to a stay-at-home order; all Ontario residents were required to remain at their homes unless conducting an activity deemed essential. Essential activities include shopping at grocery stores or pharmacies, receiving health care, exercise, or conducing essential work that cannot be performed remotely. All employees were required to work from home if they have the capability of doing so. The province states that what is considered "essential work" is based on "[the] best judgement and common sense of employers". Performing arts facilities were required to cease all operations, even for virtual streaming concerts. All other restrictions enacted under the province-wide shutdown remained in force, and the colour-coded response framework was officially considered "paused" due to the declaration of emergency.

Certain businesses, such as liquor stores, hardware stores, and stores offering delivery or curbside pickup services, were required to close from 8 p.m. to 7 a.m. nightly. Non-essential construction activity was also suspended. Outdoor gatherings were limited to five people, and guidance now recommends masks be worn outside (in addition to the existing indoor mandate) if social distancing is not possible. The closure of schools in Hamilton, Peel, Toronto, Windsor-Essex, and York was extended further to February 10.

The Ontario Provincial Police (OPP), municipal police departments, bylaw officers, and provincial workspace inspectors, had the authority to issue tickets to enforce the stay-at-home order and mask mandate, however they will not have the authority to stop drivers or pedestrians for questioning. Premier Ford stated plans for a compliance "blitz" of retail store inspections beginning the weekend of January 15. Results of the inspection "blitz" revealed 36 of 110 stores visited in violation of COVID-19 measures, or 70 percent compliance rate. The measures faced criticism for disproportionately favouring big box retailers, by not restricting the times of day in which they may offer curbside pickup or delivery services, or preventing them from selling non-essential goods. It also does not include funding to cover paid sick leave for essential and low-wage workers.

On February 8, 2021, Premier Ford announced that the declaration of emergency would expire, but that the stay-at-home order would be extended in the majority of health regions to allow a gradual reinstatement of the response framework. The order was first lifted on February 10 in Eastern Ontario's Hastings Prince Edward Public Health Unit, the Kingston, Frontenac and Lennox & Addington Health Unit, and the Renfrew County and District Health Unit. The stay-at-home order was expected to be lifted in most of Ontario on February 16, excluding Peel, Toronto, and York (expected to occur on February 22), and any other area where the province believes it is not yet safe to lift the order. This was later amended to exclude York and include North Bay-Parry Sound.

Even as the restriction is lifted, the province still encourages residents to stay at home whenever possible, and discourages social gatherings and non-essential travel (including travel between regions with different levels on the response framework). On February 19, 2021, York region was announced to be moving to Red (Control) on February 22 while Toronto, Peel and North Bay-Parry Sound were to remain in a stay-at-home order until at least March 8. On March 5, 2021, the provincial government announced these last three regions would be moving to the response framework on March 8, officially ending stay-at-home orders originally in effect since January 14, 2021.

Regional advisory system

Response framework

Ontario COVID-19 Response Framework

Tier		Criteria	Description
1	Prevent	Weekly incidence rate per-capita (100,000) below 10 Test positivity under 0.5% Basic reproduction number(Rt) less than 1 "Stable" level of community transmission	Focused on promotion and education of indefinite Stage 3 health measures until effective treatment or vaccine is widely available.
2	Protect	Weekly incidence rate per-capita between 10 and 24.9. Test positivity between 0.5 and 1.2%, Rt approximately 1 "Repeated" outbreaks across sectors, or an increasing number of larger outbreaks.	Targeted enforcement and education is used to control increasing spread.
3	Restrict	Weekly incidence rate per-capita between 25 and 39.9 test positivity between 1.3 and 2.4%, Rt approximately 1 and 1.1, "Repeated" outbreaks across sectors and an increasing number of larger outbreaks and community transmission. Contact tracing and hospital capacity "at risk of being overwhelmed"	Enhanced compliance measures are enforced to mitigate a heightened risk of infection.
4	Control	Weekly incidence rate per-capita is 40 or higher Test positivity above 2.5% Rt is 1.2 or higher Increased community transmission Contact tracing and hospital capacity "at risk or being overwhelmed"	Broader public health measures are employed to mitigate a severe risk of infection.
5	Lockdown	Trends continue to worsen after measures from Control level are implemented.	Wide-scale public health measures, including business and organizational closures, are employed as a last resort to control worsened spread.
6	Shutdown	An "emergency brake". At the discretion of the government of Ontario.	Similar to lockdown category, with restrictions on certain amenities.

Use during the second wave from November 7 – December 26, 2020

On November 3, 2020, Premier Ford stated that future modifications of restrictions during the second wave will be performed regionally using a colour-coded "response framework". The framework went into place on November 7.

On November 11, it was reported by the Toronto Star that the Ford government had allegedly ignored recommendations by Public Health Ontario regarding the metrics used for the advisory system — which were four times narrower than what was actually implemented by the government.

Two days later, Premier Ford announced that the thresholds for each level would be decreased: for example, the criterion for the "Control" (Red) level was reduced from a weekly incidence rate of 100 or more per-capita, to 40 or more. Regions included in each tier were adjusted to match the new thresholds effective November 16. Ford stated that the original criterion was based on earlier models that had anticipated only 950–1,250 new cases per day by the time it was implemented and that he would not have used them if case numbers had reached the point they had on November 10.

Use during the third wave beginning February 8, 2021

Due to the declaration of emergency and a stay-at-home order issued, the response framework was officially considered paused from December 26, 2020, to February 9, 2021. On February 8, 2021, Premier Ford announced that the response framework would be gradually reinstated to replace the stay-at-home order, beginning with the Hastings Prince Edward Public Health Unit, the Kingston, Frontenac and Lennox & Addington Health Unit, and the Renfrew County and District Health Unit on February 10 (which reopened into the "Prevent" tier). Unlike the earlier revision, the "Lockdown" tier will allow for non-essential retail with capacity limits (unless the region is subject to a stay-at-home order).

The framework is now subject to an "emergency brake", where regions may immediately be placed back in the "Lockdown" tier as a circuit breaker if health officials believe that the incidence rate is increasing too rapidly and the healthcare system is at a severe risk of being overwhelmed. As of March 26, health officials may impose a stricter lockdown (equivalent to the earlier province-wide shutdown) under the emergency brake as well.

On March 20, further amendments to the response framework were implemented for restaurants; outdoor dining is now permitted in regions in the "Lockdown" tier, and capacity limits for restaurants in the "Control" and "Restrict" tiers were increased from 10 and 50 customers respectively to 50 and 100, or 50 percent capacity, whichever is lower. Additional modifications were announced on March 26; as of March 29, the "Lockdown" category began to allow outdoor fitness classes of up to 10 people. Personal care services were to be allowed operate by-appointment only at 25 percent capacity/5 people (whichever is fewer) in "Lockdown" regions beginning April 12. In addition, subject to physical distancing, capacity limits were removed for outdoor religious services (including funerals and weddings) in all regions.

Third province-wide shutdown and stay-at-home order (April 3 – June 2, 2021)

On April 1, 2021, amid rising new infections, particularly exacerbated by variants of concern and preceding the Easter weekend, Premier Ford announced a third province-wide shutdown beginning April 3. All regions were moved to a new sixth level of the response framework, "Shutdown" (white), re-imposing measures that were introduced during the first province-wide shutdown. This includes prohibiting all indoor organized events and gatherings, limiting outdoor gatherings to five people, capacity limits for retail (50% for essential retail, 25% for all other stores), and ordering the closure of all in-person dining (regardless of setting), daycamps, personal care services, sports and recreation facilities, meeting and event spaces, and cinemas, and capping capacity of religious services to 15 percent. All performing arts facilities must close, even for internet streaming events. The response framework is paused.

Premier Ford faced criticism over the new shutdown (which resulted in only minor changes for health regions already in the "Lockdown" tier), with Leader of the Opposition Andrea Horwath arguing that it was "a too little too late response by this government to what we knew was coming". On April 4, the medical officers of Ottawa, Peel Region, and Toronto sent a letter to the government requesting that a stay-at-home order be issued.

On April 7, 2021, Premier Ford declared a third state of emergency and announced that a third stay-at-home order will take effect at 12:01 a.m. ET on April 8, and last for four weeks. All Ontario residents must remain at their homes unless conducting an activity deemed essential. Essential activities include shopping at grocery stores or pharmacies, receiving health care, exercise, school, or conducting essential work that cannot be performed remotely. All employees must work from home if they have the capability of doing so. Ford explained that "the situation is evolving rapidly, hour by hour. And as things change, as we learn more about these deadly new variants, as we see new problems arise, we need to adapt. We need to move quickly and decisively. And right now, above all else, our plan is to get needles in the arms and protect our hospitals."

All shutdown restrictions and all other restrictions from the previous stay-at-home order apply. Furthermore, essential retail stores are only allowed to sell food, pharmacy items, and cleaning supplies, and all other non-essential goods are prohibited from being displayed or sold to in-store customers. In addition, retailers of assistive devices, automotive and equipment rental services, motor vehicle and boat dealers, vehicle and equipment repair services, prescription eyewear, safety supplies, and telecom services may operate at 25 percent capacity by appointment only. Following criticism of photos showing displays of cloth masks blocked by local Walmart stores, representatives of the government clarified that they were considered an essential good.

The order does not include paid sick leave; Premier Ford accused those advocating for paid sick leave of "playing politics", and not directing people to the Canadian Recovery Sickness Benefit (CRSB) instead (which is a retroactive payment), which he deemed sufficient.

Extension of the stay-at-home order and further restrictions

On April 16, 2021, Premier Ford announced that due to record high hospitalizations and cases, the stay-at-home order had been extended through at least May 20, and that several additional restrictions will also be imposed. Effective April 17, outdoor gatherings with anyone from outside of the immediate household are prohibited, all outdoor recreation amenities must close, allowable "big box" retail stores are restricted to 25% capacity, and all non-essential construction projects must be suspended. Beginning April 19, land travel into Ontario is restricted at the provincial border to essential purposes (transport of goods, medical care, work, and exercising treaty rights) only, and indoor places of worship are limited to 10 people. Furthermore, Solicitor General Sylvia Jones announced that police would receive enhanced authority to enforce the stay-at-home order, including being able to perform random stops of individuals they suspect are travelling in violation of the stay-at-home order. They could compel individuals to state their home address and purpose of travel; failure to comply with a request for this information would be a ticketable offence.

Premier Ford stated that "I have never shied away from telling you the brutal honest truth, never shied away from tough decisions and today I am here to do just that. My friends we are losing the battle between variants and vaccines", and that "we need to step up enforcement and we need to focus on those who are deliberately putting others at risk by ignoring the stay-at-home order."

The new measures faced criticism; the province did not introduce paid sick leave, the new police authority was criticized for resembling carding and having a disproportionate impact to non-Asian minorities, while a number of municipal police departments announced that they would not perform random stops under the measure. On April 17, Jones announced that the new police authority would be narrowed to only allow them to stop and ticket individuals they suspect are participating in a public event or social gathering. Despite the changes, the revised measures elicited continued concerns.

Criticism has also been raised over the prohibition of outdoor recreation, due to outdoor spaces being considered to have a generally lower risk of transmission over indoor spaces, and calls for the provincial government to promote outdoor recreation for physical and mental health. The province backpedaled on restricting playgrounds, but the remainder of the order remains in effect.

On April 20, 2021, Peel Public Health issued a Section 22 order effective April 23, requiring any business that has been linked to five or more COVID-19 infections within the past 14 days to shut down for 10 days. All employees of the business must self-isolate for the duration, and it is "strongly recommended" that impacted employees be provided with paid leave. Peel Public Health stated that "workplace exposures in Peel Region continue to drive the region's high case counts of COVID-19. Expedited closure will also allow Peel Public Health to investigate workplace exposures without risk of continued spread." This order will not apply to healthcare, schools, or other "critical infrastructure". Toronto Public Health subsequently issued a nearly identical order.

On April 22, 2021, in his first public appearance since April 16, and while self-isolating due to being a close contact of a positive case within his staff, Premier Ford admitted that the new enforcement measures announced last Friday "went too far". He also announced that Ontario was working on developing a paid sick leave benefit, arguing that they needed to fill "gaps" in the CRSB that were not fulfilled by the 2021 federal budget, and that they planned to make it "the best program in North America". The province officially announced the temporary "COVID-19 Worker Income Protection Benefit Program" on April 29, providing up to three paid sick days for full-time or part-time workers, and paying up to $200 per day. Employers will be reimbursed via the Workplace Safety and Insurance Board (WSIB). The program will last through September 25, 2021 (the last day of the CRSB), and is retroactive to April 19.

On May 13, 2021, the stay-at-home order was extended by 14 days through June 2. Premier Ford stated that the additional time was necessary in order to ensure that "most normal July and August possible", but that this would not allow large public gatherings such as concerts or sporting events.

Transition from stay-at-home order and Step 1

On May 20, 2021, alongside the announcement of a new roadmap for lifting restrictions, Ford announced that beginning May 22, outdoor recreation amenities would be allowed to reopen, and outdoor gatherings of up to five people would also be permitted.

On May 21, 2021, with warmer weather, splash pads were opened ahead of the Victoria Day weekend.

On June 2, 2021, the stay-at-home order officially expired, leaving the province with some restrictions, bans on outdoor activities like camping stayed closed.

On June 7, 2021, it was announced Ontario would enter Step 1 on June 11 at 12:01am.

Three-step roadmap for reopening

On May 20, 2021, Premier Ford announced a three-step plan to reopen the economy, based on vaccination rate goals. Initially, the province was to stay in each Step for a minimum of 21 days before moving onto the next. However, each reopening step was put in place before 21 days had passed.

Ontario COVID-19 three-step roadmap for reopening

Step	Start date	Vaccination requirement	Description
1	June 11, 2021	60% of adults (18+) have received at least one shot of COVID-19 vaccine	Sectors reopening: Outdoor gatherings 10+ Outdoor dining for tables of up to 4 people Non-essential retail at 15% Essential retail at 25% Socially distant outdoor religious services, rites and ceremonies Outdoor sports and fitness of up to 10 people Day camps Campsites and campgrounds Outdoor zoos, landmarks, historic sites, and botanical gardens Outdoor pools and wading pools Short-term rentals Ontario parks Outdoor horse racing and motor speedways Retail stores in malls closed unless the stores have a street-facing entrance
2	June 30, 2021	70% of adults (18+) have received at least one shot of COVID-19 vaccine and 20% have received full vaccination (both doses)	Sectors reopening: Outdoor gatherings of up to 25 people Small indoor gatherings of up to 5 people Outdoor dining of up to 6 people per table Essential retail at 50% Non-essential retail at 25% Personal care services where face coverings can be worn at all times Outdoor meeting and event spaces Outdoor amusement and water parks Outdoor boat tour operators Outdoor county fairs and rural exhibitions Outdoor sports leagues and events Outdoor cinemas, performing arts, live music, events and attractions
3	July 16, 2021	70–80% of adults (18+) have received at least one shot of COVID-19 vaccine and 25% have received full vaccination (both doses)	Sectors reopening: Private indoor gatherings of 25 people are permitted and outdoor gatherings of 100 people are permitted Essential and non-essential retail capacity is based on social distancing of two metres Indoor religious services, rites, and ceremony gatherings capacity is based on physical distancing of two metres Indoor meeting and event spaces at 50% capacity or 1,000 people maximum Indoor dining is permitted with no table size limits, capacity limited to physical distancing of two metres Indoor sports and recreational facilities are permitted to open at 50% capacity Museums, galleries, historic sites, aquariums, zoos, landmarks, botanical gardens, science centres, casinos/bingo halls, amusement parks, fairs and rural exhibitions, festivals are permitted to 50% capacity indoors and 75% capacity outdoors Concert venues, cinemas, and theatres permitted to operate at 50% capacity indoors or a total of 1,000 people for seated events, or 75% capacity outdoors or a total of 5,000 people for standing-room events Personal care services that require the removal of face coverings are permitted as long as physical distancing of two metres can be maintained Real estate open houses as long as physical distancing of two metres can be maintained Nightclubs at 25% capacity or 250 people maximum
Beyond Step 3	To be determined	Further relaxation of restrictions was put on hold due to the Delta variant.	Relaxation of capacity and social distancing restrictions except in certain cases (such as hospitals and health clinics) however the mask mandate will continue to be in effect.

Proof of vaccination requirements begin (September 22, 2021–present)

On September 1, 2021, despite having initially been against the concept as to not create a "split society", Premier Ford announced that the province would mandate the presentation of proof of vaccination in order to access certain non-essential indoor businesses, effective September 22, 2021. The province announced plans to also develop a verifiable digital credential in QR code format. Ford criticized Prime Minister Justin Trudeau for not developing a domestic vaccine passport at the federal level, despite him having only previously called for one to be developed for international travel.

Patrons 12 years of age or older must present proof of full vaccination in order to access the indoor areas of the following settings, unless otherwise noted:

• Restaurants and bars (dine-in service)
• Nightclubs (including outdoor areas), strip clubs, bathhouses, and sex clubs
• Entertainment and gaming venues such as cinemas, concert halls, casinos, etc.
• Sports and recreation facilities, such as pools, gyms, and fitness centres, and the seating areas of indoor sports venues.
  • There are exceptions for persons under 18 years of age that are participating in organized sports activities. However, some health units (such as Windsor–Essex County and Toronto) have revoked this exception and require all participants to be fully vaccinated, regardless of age. Effective December 20, 2021, this exception will be removed province-wide.
• Meeting and event spaces
  • There are exceptions for the attendees of a funeral service or wedding ceremony. However, receptions are still subject to mandate.
• Racing facilities

Patrons must present the Ontario COVID-19 vaccination receipt and valid photo identification. Valid medical exemptions include adverse reactions to the first vaccine dose, or life-threatening allergies to vaccine ingredients, and must be issued by a doctor. On October 14, 2021, Ontario began to roll out proof of vaccination expressed as a QR code. They can be checked by businesses using the Verify Ontario mobile app. The app was developed in partnership with Maple Leaf Sports & Entertainment (MLSE).

Following the implementation of the proof of vaccination system, on September 25, 2021, certain venues where vaccination is mandated were given increased capacity limits. Most indoor facilities' capacity limits were increased to 50 percent or 10,000 people (whichever is higher). Certain outdoor venues where people stand were increased to 75 percent or 15,000 people (whichever is higher) and for outdoor venues where people are seated, this was increased to 75 percent or 30,000 people (whichever is higher).

On October 8, 2021, ahead of the opening of new seasons in the National Basketball Association (NBA) and in the National Hockey League (NHL), Premier Ford announced that capacity limits would be lifted for certain venues and events where proof of vaccination is required, including cinemas, theatres, and concerts, the seating areas of sports, recreation, and racing facilities, meeting and event spaces (subject to social distancing), and the studio audiences of commercial film and television productions.

This decision faced criticism from the restaurant industry for being a double standard, noting that indoor arenas would be allowed to operate at full capacity with nearly 20,000 spectators, but restaurants are still subject to capacity limits. An Ontario government spokesperson stated that restaurants were deemed a higher-risk setting due to patrons not wearing masks for prolonged periods. The involvement of MLSE—owner of most of Toronto's professional sports teams—in the development of the Verify Ontario app was also scrutinized by the industry, who accused the provincial government of favouring the interests of larger corporations over small businesses. Ford denied the accusations, stating that the changes impacted multiple industries beyond just sports. MLSE stated that they were being a "good corporate citizen", and their involvement primarily involved refinements to a beta version of the app. They also highlighted other contributions they had made in support of the pandemic response, including use of their facilities as homeless shelters and vaccination sites.

On October 22, 2021, Premier Ford announced a long-term plan to eventually lift the remaining public health measures;

• On October 25, 2021, capacity restrictions were lifted for most facilities where proof of vaccination is presently required. This does not apply to specific "high-risk" settings, such as food and drink establishments (including wedding receptions) with dance floors, nightclubs, strip clubs, and sex clubs. Personal care services can operate at full capacity if all customers are fully vaccinated.
• By November 15, 2021, capacity limits were to be removed at other facilities and venues that are "high-risk" but require proof of vaccination.
• By January 17, 2022, the proof of vaccination requirement was to be removed for restaurants, sports facilities, and casinos. The requirement could be lifted from other venues over time.
• By March 28, 2022, all remaining province-wide health orders issued pursuant to the Reopening Ontario Act were to be revoked and lifted. Officials have stated that health measures may be reintroduced on a regional basis if needed.

On October 28, 2021, restrictions on the capacity of general admission indoor concerts were lifted, including the requirement that all patrons be seated. This was moved ahead from the original second step on November 15. On November 10, 2021, the lifting of capacity restrictions for "high-risk" venues was delayed for at least 28 days out of an abundance of caution due to rising indicators. On December 7, 2021, this was delayed indefinitely.

Omicron variant and rollback to Stage 2 (December 10, 2021–present)

On December 10, 2021, citing the spread of the Omicron variant, Ontario announced upcoming changes to the proof of vaccination requirements, which have henceforth been extended indefinitely. Beginning December 20, the previous exemption to the proof of vaccination requirement for youth under 18 years of age participating in organized sports was removed. Beginning January 4, 2022, only a certified QR code is accepted as valid proof of vaccination or medical exemption. Notes from physicians are no longer accepted effective January 10, 2022.

On December 15, 2021, Premier Ford announced that due to the Omicron variant, a 50 percent capacity limit would be reintroduced for meeting and event spaces, indoor sports venues with a capacity over 1,000, and indoor entertainment venues. On December 17, Ford also announced that permissible social gatherings would be reduced to 10 people outdoors and 25 outdoors, and most indoor settings will be restricted to 50 percent capacity (unless being used for a faith-based ceremony). Mingling and dancing at bars and restaurants is prohibited. All venues will be subject to a 10 p.m. last call for alcohol sales, and all bars, restaurants, and strip clubs must close to dining at 11 p.m. In addition, all event venues and casinos will be prohibited from serving food and beverages.

On December 30, 2021, Ontario further restricted venues to a maximum of 1,000 spectators or 50 percent capacity, whichever is less. MLSE announced that all Toronto Maple Leafs and Toronto Raptors home games will be played behind closed doors while this restriction is in effect.

On January 3, 2022, Premier Ford announced that to protect the hospital system, Ontario would be rolled back to modified Step 2 beginning January 5, 2022 for least 21 days:

• All employees must work from home if they have the capability of doing so.
• Social gatherings are restricted to five people indoors and ten people outdoors.
• All schools will return to online learning through at least January 17, 2022.
• Retail, libraries, and personal care services are capped at 50 percent capacity.
• Bars and restaurants must close to in-person dining.
• Elective procedures at hospitals will be suspended.
• Indoor meeting and event spaces, indoor sports facilities, indoor recreational fitness facilities (except for use by training Olympic and Paralympic athletes, or athletes of specified professional and elite amateur sports leagues), indoor entertainment facilities (including cinemas, concert venues, theatres, museums, etc.), landmarks, historical sites, and festivals must close, with some exceptions for outdoor events.
  • This effectively mandates that indoor sporting events must be held behind closed doors.
• Indoor weddings and funerals are capped at 50 percent capacity.

On January 20, the province announced plans to ease some of these restrictions beginning January 31:

• Beginning January 31
  • Social gatherings are restricted to 10 people indoors and 25 people outdoors.
  • Indoor bars and restaurants (without dance floors), indoor meeting and event spaces, indoor sports facilities, indoor recreational fitness facilities, indoor entertainment facilities, landmarks, and historical sites may reopen at 50 percent capacity.
  • Theatres, concert venues, and indoor arenas may reopen at a maximum capacity of 500 people or 50 percent capacity, whichever is less.
  • All proof of vaccination requirements remain in force.
• Beginning February 21
  • Social gatherings are restricted to 25 people indoors and 100 people outdoors.
  • Indoor public venues subject to proof of vaccination may operate at full capacity.
  • Indoor public venues without proof of vaccination must restrict capacity to allow two metres social distancing.
  • Indoor religious ceremonies without proof of vaccination requirements must restrict capacity to allow two metres social distancing.
  • Theatres, concert venues, and indoor arenas may operate at a maximum capacity of 50 percent.
  • Indoor "high risk" settings subject to proof of vaccination may operate at 25% capacity.
• Beginning March 14
  • Social gatherings are restricted to 50 people indoors, and no longer limited outdoors.
  • Capacity restrictions lifted for religious services.
  • Capacity restrictions lifted for indoor public venues.
  • All proof of vaccination requirements remain in force.

At least 21 days must elapse between each phase.

Vaccines

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See also: COVID-19 vaccination in Canada

COVID-19 vaccination in Ontario began in December 2020, when the first doses of the Pfizer vaccine were administered. In February 2021, shipments for both the Pfizer and Moderna vaccines increased significantly. By May, over 50% of Ontarians had received their first dose.

Hospitals

Throughout the pandemic, a concern about hospital capacity, and critical care like intensive care unit beds has become a major issue at the peak of the three waves. During the third wave, ICU capacity has reached near critical capacity.

COVID-19 in Ontario hospitalizations	#	Ref
Number of patients currently hospitalized with COVID-19	3,439
Total patients in ICU due to COVID-19	597
Total patients in ICU on a ventilator due to COVID-19	386
Number of funded Adult ICU beds in Ontario	2,343
Number of funded Paediatric ICU beds in Ontario	105
Percentage of provincial ICU beds occupied by COVID-19 patients	25.48%

Data as of January 27, 2021

Long-term care homes

See also: Operation Laser and Impact of the COVID-19 pandemic on long-term care facilities

On April 15, 2020, the Ontario Nurses' Association released a statement saying that long-term care (LTC) homes pre-COVID-19 were already understaffed, but now they are in "crisis" mode. Prior to the pandemic, long-term care home staff who were part-time or casual staff were allowed to work at multiple locations, increasing the risk of transmission and spread between LTC homes. The province issued a new Emergency Order on March 28 that introduced temporary additional staff members to help in the facilities and allowed homes more flexibility in staff deployment. Many LTC homes in Ontario are considered old and small and feature shared bedrooms, increasing the difficulty in isolating sick residents from those who are well.

Inspections

On April 15, 2020, CBC reported that the Ontario Ministry of Long-Term Care had conducted resident quality inspections (RQI) at only nine out of 626 long-term care homes in the province in 2019, down from a bare majority in 2018 and larger proportions from 2015 to 2017. RQIs are proactive, unannounced and more comprehensive than the other main category of care home inspections in the province, complaint and critical incident inspections, where facilities know of the impending scrutiny in advance; the 2018 Long-Term Care Homes Public Inquiry noted that "focusing only on specific complaints or critical incidents could lead to missing systemic issues." As of 15 April 2020, 114 care facilities in Ontario had experienced COVID-19 outbreaks, and those that had multiple COVID-19 deaths last had their RQI in 2018 or earlier.

Outbreaks

On April 7, 2020, Ontario reported that there are 51 long-term care homes in the province that are experiencing COVID-19 outbreaks, and by April 10, 2020, it had surged to 69 LTC homes in Ontario. Some LTC workers pointed to a lack of personal protective equipment as a cause of the outbreaks. By April 21, 2020, 121 outbreaks have been reported in long-term care homes.

On April 8, 2020, the Ontario Ministry of Health released directives to ramp up coronavirus testing and infection control. Also, new residents entering a home must be isolated for 14 days and tested within that period. The directives also require that all long-term care home staff and essential visitors for gravely ill residents wear surgical masks, "whether the home is in outbreak or not." LTC homes are expected to take "all reasonable steps" to follow the new long-term care rules. Prior to this directive, LTC staff were not required to wear masks or other PPE, and testing levels were considered low for at-risk seniors and LTC staff.

On April 28, 2020, Chief Public Health Officer Theresa Tam stated that as many of 79 percent of Canada's COVID-19 fatalities occurred in long-term care homes, with Ontario and Quebec accounting for most of the cases.

As part of Operation Laser, assistance from the Canadian Armed Forces at five Toronto-area nursing homes, beginning in April, led to a report by the Brigadier General in charge documenting extreme conditions and abuse. The Ontario Ombudsman announced the launch an investigation into long-term care facilities on June 1.

During the second wave of the pandemic, LTC homes began to experience outbreaks again. Tendercare Living Centre in Scarborough for example has experienced 43 deaths related to COVID-19. On December 25, 2020, North York General Hospital took over control of the home.

COVID-19 in Ontario long-term care homes	#	Ref
LTC homes currently with an outbreak	358
LTC homes with resolved outbreaks	197
Active cases of COVID-19 amongst LTR residents	2,569
Active cases of COVID-19 amongst LTR staff	4,088
LTC home resident deaths	4,174
LTC home staff deaths	13
Percentage of overall provincial deaths in LTC homes	38.25%

Data as of January 21, 2022

Variants of concern

The Ontario government has become aware of a number of variants of SARS-CoV-2 arriving in Canada due to travel, many of which have been linked to a higher transmission rate and potentially increased fatality rates.

The first confirmed case of the Alpha variant was announced on December 21, 2020, infecting a Durham Region couple initially with no known travel-related contact exposure. The couple, Dr. Martina Weir and Brian Weir, who both work in healthcare, were later charged for lying to contact tracers, admitting later they had met with a traveller from the United Kingdom, who should have been in quarantine. Dr. Weir was later fired from her role. The variant was later identified in a mass outbreak causing 71 deaths at a long-term care home in Barrie.

The first confirmed case of the Beta variant was announced on February 1, 2021. The case had no known link to travel.

The first confirmed case of the Gamma variant was announced on February 7, 2021, in Toronto. The patient, who was later hospitalized, had recently returned from travel in Brazil.

On April 23, 2021, Public Health Ontario announced that there were 36 cases of b.1.617 in Ontario. By June, the government announced that it was speeding up vaccine doses for people living in Delta-variant hot spots such as Toronto and Peel.

A study in Ontario found that the Pfizer vaccine was 95 percent effective to prevent hospitalization or death from the Alpha, Beta and Gamma variants seven days after the second dose. The Moderna vaccine was 94 percent effective against Alpha seven days after the second dose. The Moderna vaccine appeared to be highly effective against Delta.

A preprint study from epidemiologists David Fisman and Ashleigh Tuite, at the University of Toronto, found that the Delta variant of SARS-COV-2 had a 120 percent greater risk of hospitalization, 287 percent greater risk of ICU admission, and 137 percent greater risk of death compared to variants which are not of concern.

The first two confirmed cases of the Omicron variant was announced on November 28, 2021, in Ottawa. Two Ottawa residents with recent travel history to Nigeria had tested positive for the variant, which was first detected in South Africa.

Confirmed cases

Confirmed variant of concern cases in Ontario	#	Ref
Alpha	146,509
Beta	1,503
Gamma	5,233
Delta	38,662
Omicron	2,326

Data as of December 30, 2021

Statistics

Geographical distribution

Public health unit	Cases	Cases per m	Resolved	Deaths	Deaths per m
Algoma	2,922	25,839	2,359	21	186
Brant County (including Brantford)	8,294	61,525	7,222	44	326
Chatham-Kent	5,120	50,175	4,312	44	431
Durham Region	46,112	71,396	39,164	396	613
Eastern Ontario (Stormont, Dundas and Glengarry-Prescott and Russell)	11,140	54,941	9,339	151	745
Grey-Bruce	4,855	29,973	4,399	36	222
Haldimand-Norfolk	5,687	51,800	4,827	75	683
Haliburton, Kawartha, Pine Ridge District	5,165	28,841	4,272	73	408
Halton Region	36,184	65,977	32,119	268	489
Hamilton	41,709	77,682	36,580	431	803
Hastings Prince Edward	5,109	31,697	4,030	24	149
Huron-Perth	4,527	33,264	3,958	78	573
Kingston, Frontenac and Lennox & Addington	7,928	41,001	7,055	26	134
Lambton County	7,748	61,182	6,610	94	742
Leeds, Grenville & Lanark District	4,871	28,781	4,233	67	396
Middlesex-London	25,985	57,044	22,599	270	593
Niagara Region	28,391	63,389	24,871	463	1,034
North Bay-Parry Sound (including most of Nipissing District)	2,281	18,422	1,982	9	73
Northwestern (Most of Kenora District, Rainy River District and part of Thunder Bay District)	2,647	34,622	2,072	11	144
Ottawa	53,067	56,802	47,045	648	694
Peel	154,083	111,514	141,116	1,049	759
Peterborough (City and County)	4,355	31,504	3,647	38	275
Porcupine (Cochrane District, Hornepayne, James Bay communities, Timiskaming panhandle)	3,780	44,893	3,251	33	392
Renfrew County & District	2,329	22,482	1,881	17	164
Simcoe-Muskoka	28,285	52,355	24,604	296	548
Southwestern (Oxford, Elgin, St. Thomas)	9,102	45,546	8,016	128	641
Sudbury & Districts (including Greater Sudbury)	7,634	38,860	6,053	67	341
Thunder Bay District (including First Nations communities in the far north)	5,658	37,252	4,744	72	474
Timiskaming (including Temagami)	854	25,840	697	5	151
Toronto	252,101	92,292	228,441	3,792	1,388
Waterloo Region	34,544	64,550	29,442	327	611
Wellington-Dufferin-Guelph	15,774	55,452	14,209	131	461
Windsor-Essex County	31,229	78,277	27,559	521	1,306
York Region	88,612	79,837	80,365	900	811

Updated as of January 16, 2022

Demographic distribution

Age range	Cases	Cases per m	Resolved	Male	Female	Gender diverse	Unspecified sex	Deaths	Deaths per m	Lethality (‰)	Male deaths	Female deaths	Male deaths per m	Female deaths per m
19 and under	89,882	28,625	45,099	46,141	43,083	6	652	5	1.6	0.004	2	3	1.2	2.0
20-29	117,274	56,382	67,634	61,482	54,723	8	1061	27	13	0.02	19	7	18	7
30-39	90,306	45,725	51,400	45,593	44,064	7	642	62	31	0.04	42	16	43	14
40-49	79,292	42,861	45,945	37,939	40,904	6	443	148	80	0.14	97	49	108	52
50-59	78,134	37,929	47,202	38,287	39,472	4	371	468	227	0.49	305	160	299	155
60-69	48,887	28,757	29,543	25,321	23,344	2	220	1,101	648	4.45	726	367	875	412
70-79	24,324	22,316	14,642	12,090	12,141	1	92	1,935	1,775	8.39	1,181	748	2,316	1,290
80-89	16,602	32,553	10,451	6,605	9,904	0	93	3,188	6,251	19.74	1,573	1,595	7,282	5,389
90 and over	8,651	66,546	5,426	2,380	6,223	0	48	2,477	19,054	28.97	848	1,611	21,200	17,900
Unknown	97		66	32	24	0	29	1	0	0	0	0	0
Totals	553,450	37,999	317,408	269,803	268,066	34	3,651	9,412	646	2.14	4,793	4,556	666	618

Updated as of August 10, 2021

Testing

Public Health Ontario has six testing laboratories to which samples can be sent. The main laboratory is the top four floors of the MaRS Centre in the Discovery District of downtown Toronto. As of early April 2020, accounting firm KPMG has been contracted to organize all the labs in the province that are capable of microbial testing. In addition to the six public health labs, this includes ten hospital networks and three private lab networks, including Dynacare and LifeLabs.

Access

Access to testing is set by Public Health Ontario who publishes a guidance document that defines the conditions for an individual to be tested. Conditions have included close contact with a test-confirmed case, recent travel, admission to hospital for serious symptoms, healthcare worker, longterm care home resident, etc. The set of conditions has been updated repeatedly from January to April 2020, at times reducing access and at other times increasing access to testing. Starting in March, the public health units across the province have opened over 70 assessment centres, which members of the public can visit if directed by a health professional. These range from mobile units, to walk-up locations, to drive-through locations. This diverts potentially infected people from hospitals and doctors' offices. If warranted, the centre will collect a swab from a visitor for testing. Swabs are also collected at hospitals and by public health officials, for example, at long-term care facilities.

Since many cases are not tested, the number of test-confirmed cases, which are the infection numbers reported by the Ontario government, should not be misconstrued as the actual number of infections, which have been estimated to be substantially higher. Unlike some countries, the number of suspected or probable infections is not reported by the Ontario government.

In an effort to reduce a burden on provincial assessment centres amid a continued surge in cases, Ford announced on September 23, 2020, that it would expand testing of asymptomatic people by-appointment into pharmacies across the province, beginning with 60 locations by September 25, 2020. He also announced plans to deploy saliva-based rapid testing at three hospitals in Toronto. Accordingly, the province announced on September 24, 2020, that it would discourage asymptomatic patients from receiving tests at assessment centres.

Due to the surge of the Omicron variant in mid-late December 2021, effective December 31, 2021, PCR testing would be limited to high-risk individuals who have symptoms and workers in high risk settings.

Amount of testing

File:COVID-19 Ontario Testing Rates.png

The COVID-19 testing rates in Ontario from March to May 2020. Points are data and lines are a 4-day moving average. Source: data.ontario.ca

In late March and April 2020, Ontario was performing the lowest number of tests per capita of all the provinces. As of early May 2020, among the larger provinces, Ontario is second to Alberta and ahead of British Columbia and Quebec in daily tests per capita.

In mid-April 2020, polling firms Forum Research and Mainstreet Research released results of a pair of surveys about COVID-19 symptom prevalence and testing. Four to five thousand Ontario households were randomly selected. Of them, 2 percent of households contained someone who had been tested by April 12, 2020, increasing to 5 percent on April 19, 2020, whereas the incidence of COVID-19 symptoms in a household decreased from one in five to one in seven households. The second survey indicated that one-third of Ontarians report an underlying condition that might aggravate a COVID-19 infection.

Testing capacity

Since January 2020, Ontario has been increasing its capacity to perform testing based on RT-PCR. Various factors have impeded this increase, including shortages of reagent chemicals for the RT-PCR machines and shortages of validated swabs. To tackle these challenges, labs have adapted. In particular, RT-PCR machines from multiple manufactures have been obtained, each of which takes different sets of chemicals. New suppliers of swabs have been found but each must be tested and validated to perform properly. Returning tests results to individuals is automated with an online portal.

Testing capacity projections

Date of projection	Stated current capacity / day	Projection of testing capacity / day
March 13, 2020	2,500	5,000 by unspecified date
March 26, 2020	2,500	Each week, an increase by 3 to 4,000 tests per day and 19,000 by April 17
April 9, 2020	13,000	19,000 by April 29, 2020
April 10, 2020	14,000	8,000 by April 15, 2020, 14,000 by April 29, and 16,000 by May 6, 2020
May 12, 2020	unstated	20,000 by unstated date
May 29, 2020	18,525	16,000
May 29, 2020	18,525	20,900 by unstated date
October 2020	35,000 – 40,000	50,000 by unstated date
December 10, 2020	62,000 (record number of tests completed by the Province)	90,000 by unstated date

Backlogs

On March 18, 2020, the Toronto Star reported that test results announced by the provincial government were several days old, with turnaround times increasing from 24 hours to 4 days, leading the government to "making decisions based on old information". The province was only able to process around 2,000 tests per day by March 19, which caused the backlog. The backlog increased to over 8,000 unprocessed samples on March 24 with patients waiting at least four days for results, partially due to fact that private and university laboratories are not allowed to process samples.

More backlogs emerged in September and October 2020 amid increased demand for tests and a heightened caseload, reaching 68,000 by the weekend of October 4. On October 5, CBC News reported that COVID-19 tests administered at pharmacies were being sent to Quest Diagnostics laboratories in California for processing by means of the local partner for the scheme, In-Common Laboratories (ICL).

Management of testing in Ontario

Officials for Public Health Ontario include the following individuals:

• Dr. Vanessa Allen, chief of medical microbiology with Public Health Ontario
• Dr. Peter Donnelly, president and CEO of Public Health Ontario (on leave as of April 9, 2020)
• Colleen Geiger, interim president and CEO of Public Health Ontario (as of April 9, 2020)
• Dr. David Williams, Ontario's chief medical officer
• Dr. Barbara Yaffe, Ontario's associate chief medical officer of health

In early April 2020, the Ministry of Health brought in a multinational accounting firm KPMG to assist in the organization and optimization of testing capacity in Ontario. Premier Doug Ford said on April 8, 2020, that he was losing his patience with Ontario's inadequate testing numbers, showing testing capacity was not being fully utilized. Later that day, the province appointed a former Toronto public health head, Dr. David McKeown to troubleshoot and rethink the province's response to the pandemic. The following day on April 9, amid mounting criticism of the province's testing, the president and CEO of Public Health Ontario Dr. Peter Donnelly temporarily stepped down for medical reasons and was replaced in the interim by Colleen Geiger, Public Health Ontario's chief of strategy, stakeholder relations, information and knowledge.

Criticism

Initial response

Regional public health experts suggested that Ontario's initial incremental response — adding new voluntary measures piece by piece — had been ineffective. Businesses of all sizes remained open, and unnecessary social contacts continued. Describing Ontario's efforts to battle COVID-19 as piecemeal and ineffective, Dr. Shanker Nesathurai, who was one of Ontario's 34 regional medical officers of health, urged his colleagues to band together and use more powerful measures to contain the pandemic than provincial leaders had endorsed by the third week of March 2020. In an email, Dr. Nesathurai, who worked for Haldimand Norfolk Health Unit, wrote on March 19, 2020, that Ontario's response had undermined the province's attempt to contain the outbreak, as businesses remain open and travellers ignore advice to self-isolate.

Protests

File:Canadian COVID-19 protesters (cropped).jpg

An anti-lockdown protest in front of the Ontario Legislative Building in Queen's Park, Toronto, April 25, 2020

See also: COVID-19 anti-lockdown protests in Canada

On April 25, 2020, there were small protests totalling 200 protesters in front of the Ontario Legislative Building in Queen's Park, Toronto, demanding that Doug Ford end all emergency measures. Some of the protesters consider the coronavirus a hoax. Ford called them "a bunch of yahoos."

On May 2, 2020, there was another protest with 100 protesters in front of the Ontario Legislative Building.

On January 15, 2021, Roman Baber, Member of Provincial Parliament for the Toronto riding of York Centre, was removed from the caucus of the governing Progressive Conservative Party of Ontario after publishing an open letter to Premier Doug Ford criticizing Ontario's lockdown restrictions. Baber continued his anti-lockdown advocacy as an independent member of the legislative opposition. On January 23, 2021, an anti-lockdown rally took place at Yonge-Dundas Square which resulted in arrests and charges being laid by Toronto police.

Since early March 2021, there have been protests held in Barrie, Ontario at Meridian Place, with one protest on April 10 drawing a crowd of 300 people. The person who led the protests was fined $800 by the Barrie Police Service. On April 17, People's Party of Canada leader Maxime Bernier attended the protests and gave a speech in front of a crowd of hundreds of protesters.

On the afternoon of April 17, 2021, approximately 300 anti-lockdown protestors gathered in the area of Main Street East and Kenilworth Avenue North in Hamilton, Ontario. Police were present for public safety and enforcement.

Paid sick leave

The Progressive Conservative government has largely resisted calls to implement paid emergency leave for workers that fall ill due to COVID-19, and blocked legislation proposed by the opposition Ontario NDP. Premier Ford stated that affected workers should use the federal Recovery Sickness Benefit (CRSB), which is retroactive and delayed, and argued that NDP leader Andrea Horwath wanted to "double dip into people's pockets when there's a program working and working well now".

See also

• COVID-19 pandemic in Ottawa
• COVID-19 pandemic in the Regional Municipality of Peel
• COVID-19 pandemic in Toronto
• COVID-19 pandemic in the Regional Municipality of York
• COVID-19 pandemic in Canada
• Economic impact of the COVID-19 pandemic in Canada

External links

• The 2019 Novel Coronavirus (COVID-19)
• COVID-19 cases in schools and daycares - Ontario