London-area now under 'red' restrictions. Here's what that means

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London and Middlesex County are entering the red-control restriction level, the province announced Friday, the highest level before a lockdown.

The announcement comes days after the London area entered the orange, restrict category, the middle of the province’s five colour-coded COVID-19 restriction levels.

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“This is our last chance to avoid lockdown. We need to get it right and we need to get it right now,” Middlesex-London Health Unit medical officer of health Chris Mackie said Friday.

“I don’t think anyone is happy about being here, but this is where we are and this is what is needed. . . . These restrictions are the right restrictions and if people follow them, we will wrestle this wave to the ground. If people choose not to, it will continue to spread and cause deaths.”

Windsor-Essex is being pushed from red into the grey, lockdown level, one day after the area’s medical officer of health cancelled classes one week before the Christmas break.

The London-area will move into the red zone Monday Dec. 14 at 12:01 a.m. Here’s a rundown of what the move means and how we got here.

ABOUT RED CONTROL:

• Organized public events and social gatherings are capped at five people indoors and 25 outdoors. While the outdoor capacity is the same as before, the new indoor cap is half the previous level
• People should only leave their homes for essential reasons, including work, school, grocery shopping, exercise, caregiving or health care.
• Families should avoid social gatherings, not visit any other household or allow visitors into their home. People should work from home if possible.
• Maximum of 10 people allowed to dine indoors at a bar or restaurant. Live music and dancing aren’t allowed.
• Indoor shopping malls can remain open, but the 10-person indoor dining limit applies to food courts.
• Movie theatres are closed, but drive-in screenings are permitted.
• Performing arts facilities are closed to spectators. Singers and wind or brass instrument players must be separated by an impermeable barrier.
• Capacity capped at 10 people indoors and 25 outdoors at gyms and fitness facilities, casinos and event spaces.
• No games allowed for team sports, only training is permitted.

WHAT STAYS THE SAME:

• Weddings, funerals and church services can have 30 per cent capacity indoors or 100 people outdoors.
• Schools, child-care services and post-secondary institutions remain open.
• Restaurants and bars are still required to close by 10 p.m. with no alcohol sold after 9 p.m.
• Personal service settings — including spas, salons and tattoo parlours — remain open but can’t provide services that require a client to remove their face mask
• All the routine public-health guidance about physical distancing, handwashing and staying home if you’re sick and getting tested if you have COVID-19 symptoms still holds.

HOW WE GOT HERE:

There are seven criteria for moving a region into red, control restrictions. The decision is made by the province’s chief medical officer of health in consultation with local medical officers of health.

Here’s how the London area stats stack up to the red thresholds:

Weekly incidence rate is 40 cases per 100,000 people or greater

The London area has broken four daily case count records so far this month, a surge in cases that is pushing its incidence rate higher. Broken down by day, about 28 new cases daily would put the region in the red. In December, London and Middlesex County have had eight days with more than 30 cases, including a record 52 cases Thursday.

The percentage of tests coming back positive is 2.5 per cent or higher

The London-area does not meet this red, control threshold, but this metric is a little skewed because of the massive volume of routine testing on long-term care workers in the area. This precautionary testing floods the local data with people who are asymptomatic and less likely to test positive. The positivity rate for the week of Nov. 29, the latest data available, is 2.1 per cent in Middlesex-London.

The Rt, or effective reproduction rate, is 1.2 or more

The reproductive rate (Rt) is the number of people, on average, a positive case infects. An Rt of greater than one means the outbreak is growing. In London and Middlesex County, the Rt is 1.2, according to data from How’s My Flattening, an online pandemic dashboard produced by a team of experts from the University of Toronto. The local Rt is not included in the Middlesex-London Health Unit’s daily COVID-19 update.

Repeated outbreaks in multiple sectors or increasing number of large outbreaks

London and Middlesex County reported two long-term care COVID-19 outbreaks this week, the first ones declared in that sector since Oct. 31. University Hospital is dealing with four outbreaks spanning nine floors, an unfolding situation that has killed 14 patients since the first death was reported Nov. 23. Five outbreaks were declared in London schools this week. Smaller clusters, including one at a south London restaurant, have been reported in the last week.

Level of cases with no known origin increasing

Of the 13 largest health units in Ontario, the Middlesex-London Health Unit has the lowest per cent of new cases with no epidemiological link, provincial reporting released Thursday shows. About six per cent of recent new cases have no traceable origin. The local focus on contact tracing, and its redeployment of staff to help, may be a factor in the low percentage, the city’s top doctor has said.

Hospital or intensive care capacity at risk of being overwhelmed

The ongoing outbreak at University Hospital has caused LHSC to halt admission to affected units and open extra beds at Victoria Hospital. Mackie has said hospital capacity is holding for now, but is at risk if cases continue to surge.

Health unit contact tracing capabilities at risk of being overwhelmed

Health unit contact tracers have had to contend with more than 365 cases so far in December, more than April’s total case count. While staff are managing, the health unit has had to redeploy scores of employees from other programs to make it happen.

IN THE REGION:

• Windsor-Essex County Health Unit is moving into the province’s grey, lockdown level, the highest of the five, tiered, restriction categories, Monday. The region entered the red, control zone on Nov. 30.
• Windsor and York Region are the latest areas of Ontario being pushed into lockdown, a move that closes gyms, salons and other non-essential businesses. The two regions join hard-hit Toronto and Peel in the highest restriction category.
• Elgin and Oxford counties are remaining in the orange, restrict category despite a sharp increase in cases. Southwestern Public Health reported a record 30 cases Friday, its third straight day of double-digit increases. “We are concerned with the case counts, it has been a busy week at the health unit,” medical officer of health Joyce Lock said Friday. “The last two days have been quite high. If it continued this way there is a chance it will go into red.  We’ll see how next week goes.”
• An assessment centre set up at East Elgin secondary school in Aylmer earlier this week began testing students and staff for the coronavirus on Wednesday. After 300 COVID-19 tests, conducted over two days, Southwestern Public Health reported two new cases at the school.