Toronto waking up to new reality amid 'evidence' of COVID-19 community spread

Life will feel a little different this morning.

You'll wake up to sunlight streaming through your windows, or maybe a jarring alarm clock, like always. You'll stretch, rub the sleep out of your eyes, like always. You'll turn on the radio. Make a coffee. Brush your teeth. Like always.

But for most people, that's about where the usual routine ends. 

By the time you're reading this, it's now after 12:01 A.M. on March 17, 2020, which marked the anticipated start of a new reality in Toronto based on public health recommendations to shut down much of the city.

It means you won't be stopping by your local brunch spot. You won't be heading to your favourite spin class. You won't be sitting in a busy bar to grab a pint for St. Patrick's Day.

All those pit-stops outside your house are on hold, and the hope is hitting pause on everyday life means Canada's largest city eventually gets to keep on living, without the pressure-cooker of a COVID-19 outbreak looming over our health-care system.

On Monday, the city's medical officer of health, Dr. Eileen De Villa, announced sweeping measures expected to start before sunrise on Tuesday: all Toronto bars, nightclubs, theatres, and restaurants — with the exception of take-out options — were asked to close, or risk facing a $25,000 daily fine under provincial health protection legislation.

Many other Toronto businesses have already shuttered voluntarily, from fitness centres to hair salons.

Update: On Tuesday morning, Ontario Premier Doug Ford declared a state of emergency in the province, which included mandating the closure of restaurants and bars, though those that can offer takeout and delivery can continue selling food.

The province is also prohibiting gatherings of more than 50 people, including at indoor recreation centres, theatres and concert venues, libraries, places of worship, private schools and daycares, until March 31.

The bold measures, echoing and similar efforts in other global cities, come as residents are facing a new, unsettling reality.

"We have some evidence of community transmission," she told reporters on Monday.

Community transmission refers to public health experts' inability to track a large number of confirmed cases along a clear chain back to an original source, according to the World Health Organization. 

In other words, this new coronavirus is no longer "over there," only entering Toronto's borders after hitching a ride on unsuspecting travellers.

Far more likely, it's now spreading, untraced, among residents, through the very interactions the city is calling on everyone to avoid.

'We're going to see more of it'

"We're going to see more of it," said noted global health specialist Steven Hoffman, director of the Global Strategy Lab at York University in Toronto.

"For every case that we can't identify where it came from, we know there are probably some others out there that we don't yet know about."

As of Monday night, there were three suspected cases of community transmission in Toronto, according to Toronto Public Health. The city is currently monitoring at least 96 confirmed cases in total.

The challenge, Hoffman said, is that finding out which cases are based on community transmission is both labour-intensive and time consuming. 

It goes something like this: someone likely shows symptoms; then seeks medical attention; then goes for a test; then waits for results.

 Then a positive result is sent to a public health team; then that team tracks the patient down; then asks them where they've been; then finds out who they've been in contact with.

"Every time we identify new cases, that actually represents information from a few days ago, right?" Hoffman continued.

"From the time someone is infected, shows symptoms, gets a test, several days have passed — so we're always, in a sense, looking at a shadow of the latest information."

For that reason, he said public health agencies across the country have already been treating the situation as if community transmission was a future certainty, if not already happening.

Ottawa, for instance, is bracing for the possibility of up to 1,000 cases of COVID-19 throughout the community, despite only confirming a fraction of that number.

"One case is typically resulting in two cases, and the doubling time is about four or five days," according to Dr. Vera Etches, Ottawa's medical officer of health.

She added the city likely hasn't caught all the initial travel-related cases coming into Canada.

In Alberta, officials say two new cases were acquired through community transmission from an unknown source, so it's not known how many people in the community may actually have COVID-19. And in Calgary specifically, seven cases have been tied back to a single gathering.

A growing chorus of experts warn not taking bold action quickly across the country could lead to a situation like that of Italy or Spain, where death tolls spiked rapidly, putting immense, sudden pressure on each country's hospital network and prompting draconian mass quarantines.

On Monday, De Villa stressed she didn't make the decision lightly to call for closures and hijack residents' daily routines. But it was needed, she said, to keep people apart and "protect the health of our city."

And so, Toronto residents are facing a new normal: no brunch, no spin classes, no bar nights.

Life will feel a little different for a while.

But if it works, then life goes on. Like always.