stage 3: why it's too early to let your guard down

this story was updated on july 29.

• what stage 3 entails — and where it will start
• how to determine what is safe and minimize your risk of covid-19
• how to find the rt value in your community

two more regions of ontario are moving to stage three of phase two reopening on friday, july 31.toronto and peel region are moving into stage three on midnight this friday, joining 31 other health regions. windsor-essex county will remain in stage two.gathering limits will be increased to 50 people maximum indoors and 100 people maximum outdoors. however, two-metre physical distancing is still required as well as wearing face masks if physical distancing is not possible. strangely, staff at establishments such as casinos, live shows, performing arts and movie theatres do not count towards the gathering limit, even though they are as susceptible to covid-19 as any other person.the gathering limits apply to high-risk settings such as parties, fairs, weddings, funerals, concerts, convention centres, festivals, movie theatres, real estate open houses, sporting events, and gyms. for any event that’s partially indoors, the 50-people maximum indoor gathering limit applies. water parks and amusement parks are not yet allowed to open.“that number, 50, is an arbitrary number. i’m concerned because it’s a large number and i don’t want people hanging out with 50 people indoors,” says colin furness, assistant professor at the dalla lana school of public health. “economically, i understand the motivation, but from a public health standpoint, i don’t think it’s a great idea.”furness says that the fact that there still remains uncertainty around the safety of opening schools makes him wonder about the safety of opening bars, casinos, and escape rooms because that will elevate the risk of community spread, and affect the possibility of opening schools.“my biggest concern is that we’re not doing schools first,” he says. “once we get schools open and if we can have them fully open and do that for a month without suffering, then i would have a much better appetite for some of the things on the stage three list.”however, furness says he is heartened by ontario’s regional approach to reopening. the risk of community transmission in southern ontario is much higher than in other parts of the province. the few weeks of reopening bars and indoor dining in restaurants may lead to a spike in cases that show the rest of the province to slow down.but for communities up north, where there may not have been a case for months, going to a restaurant may not be that risky. but remember that covid can quickly spread in a short period of time, says dr. anna banerji, director of global and indigenous health in the faculty of medicine at the university of toronto.although she understands the need to reopen, banerji says it’s important to look at examples in the u.s. and globally to understand how covid-19 is not under control in most places around the world.“when we let down the guard, that’s when covid will resurface,” she says.“we have seen opening of bars and restaurants in the u.s. coinciding with giant spikes of cases,” says furness. “this is not an imaginary risk. this is very real.”

stage three is just another stage

“[stage] three is simply that: another phase. it does not mean a full reopening where we can resort to being complacent. we have seen what has happened in other parts of the world. we need to continue being diligent,” says ryan imgrund, a biostatistician at southlake regional health centre and department head of science at sacred heart catholic high school in newmarket, ont.“going into [stage] three, monitoring changes in the rt (i.e., the effective reproductive number) is particularly important,” he says. “this is the number of infections attributed to one individual. ideally, we would like rt to drop when we enter phase three but any number less than 1.0 is tolerable. personally, i’d like to see this number at 0.7 for a prolonged period of time.”imgrund, who is monitoring the rt value in all 34 ontario regions on twitter everyday, says ontario should be striving to keep all metrics green — which is a low transmission rate — but it may slip into yellow temporarily as numbers will likely increase with reopening.“if three weeks after opening a region is green, things are coming along well,” he says. “we just need to try and tame them.”

 

keep wearing masks but skip the gloves

of ontario’s 34 public health units, 26 have implemented mandatory masks. it’s especially important that we continue to follow these protocols — unless there is an age or medical exemption — as it’s been shown if, 80 per cent of the population wears a face covering, that could be enough to keep the rt value under 1.“it’s also important to remember that my mask protects you and your mask protects me,” says imgrund. “social distancing is still necessary even when masks are being worn. it may be difficult to wear a mask in places like a gym, but the difficulty in wearing them is exactly why we need to.”instead of wearing gloves, however, it’s more effective to simply wash your hands with soap. gloves can lead to cross-contamination as we touch multiple surfaces.

just because you can, doesn’t mean you should

everyone’s personal risk tolerance is different. what’s permissible for a healthy teenager may not be safe for an older person with pre-existing health problems. it’s also important to consider the risk you’re bringing to your social bubble (which remains 10 people maximum).imgrund recommends reading up on the policies of the businesses you plan to attend and asking questions about enforcement. “when it comes to your own health, when in doubt, talk to your doctor,” he says. “they’re the professionals when it comes to your health.”banerji says people should continue to wear a face mask and wash their hands, especially in large groups of people.

you can’t eat with a mask on

“that’s something you can do. you can’t control the ventilation of a place, we’re all just guessing,” she says. “you can’t wear a mask while you eat, but make sure you clean your hands, take off your mask when you eat your food, and put the mask back on. it’s about reducing your risk when there’s so much unknown.”

should you disinfect utensils?

it’s not necessary to disinfect forks and knives, but considering the amount of time someone else handles cutlery is minimal. it’s much more important to wash your hands before eating and avoid touching your face.

what are the rules around washrooms?

as for public washrooms, close the toilet lid when you flush to reduce aerosols from spreading and wash your hands thoroughly when you leave. and wait outside if the amount of people inside makes it hard to stat physically distant.“we can’t reduce every single risk, but we can reduce the risk to some degree,” says banerji.

crowds mean risk

the bottom line is that the more people you have around you, the higher your risk of being exposed to the virus. still, it’s not always easy to assess the safety of a situation. furness says it’s important to be aware of your surroundings and critically measure the potential risk.“check in with yourself,” he says. “does this feel safe to you? why does it feel safe? look around, be critical, and constantly interrogate whether a situation feels okay. always ask yourself whether it feels safe.”for more information on which regions will be entering stage three of reopening, see ontario’s stage 3 framework document here.diana duong is a writer and editor at healthing. find her on twitter @dianaduo.dduong@postmedia.comdon’t miss the latest on covid-19, reopening and life. subscribe to healthing’s daily newsletter: coming out of covid.