As countries in Europe and other provinces in Canada begin lifting\u00a0COVID<\/a>\u00a0restrictions, some Ontarians may be wondering why they still have to live with them.<\/p>\n Unlike in Alberta, Saskatchewan and some U.S. states and European countries, there are no immediate plans to do away with mask or vaccine mandates in Ontario, Health Minister Christine Elliott said at a press conference Wednesday.<\/p>\n This is despite Ontario\u2019s COVID situation looking bright, according to Dr. Peter J\u00fcni, scientific director of Ontario\u2019s COVID-19 science table. Though it\u2019s hard to gauge the true presence of COVID in the province, as the speed with which Omicron spread became too much for our testing infrastructure, techniques like wastewater surveillance seem to show Ontario is on the other side of Omicron\u2019s peak.<\/p>\n \u201cRight now, we\u2019re actually in a really positive spot in Ontario,\u201d said J\u00fcni, who said the next week or so will be crucial. \u201cWe\u2019ve had a sustained decrease in case counts, based on what we\u2019ve seen in wastewater. This is associated with a decrease in hospital and ICU occupancy, and it can be expected to continue until roughly Feb. 20.\u201d<\/p>\n In Ontario, social gatherings are capped at 10 people indoors and 25 outdoors. Most indoor public spaces, including restaurants and movie theatres, are limited to 50 per cent capacity and require proof of vaccination at the door and that masks be worn by patrons unless seated.<\/p>\n If the virus continues to abate, and people continue to get vaccinated, capacity limits will\u00a0ease over the next month<\/a> \u2014 though mandatory masking and vaccine passports will remain.<\/p>\n \u201cThe trends are going in a good direction now but we can\u2019t sit back on our laurels and assume that it\u2019s going to always continue,\u201d Elliott said, adding that a new Omicron sub-variant, which \u201ccertainly appears to be more transmissible,\u201d has been detected in some parts of Ontario, a reason to be careful.<\/p>\n Choosing when to lift restrictions and mandates is complex, factoring in many metrics and subject to the varying tolerances of governments around the world for the spread of sickness and death among their people.<\/p>\n But across Europe, countries, particularly Nordic nations, have begun easing their COVID restrictions, for better or worse. Last week, Denmark became the first to lift all restrictions.<\/p>\n Experts say Denmark benefits from its high vaccine uptake, which grants it a more virus-resistant population that should burden the health-care system less.<\/p>\n But other countries with lower vaccination levels and higher death rates than Denmark, such as Sweden and the United Kingdom, are also easing restrictions.<\/p>\n So, when should Ontario lift restrictions? What benchmarks would it need to reach to make that decision reasonable? And what happens when countries open up too fast? The Star pulled COVID death, hospitalization and vaccination data and spoke with local health experts to help forecast the light at the end of the tunnel.<\/p>\n The factors that matter most when it comes to deciding to lift restrictions are test positivity, vaccine uptake, hospitalizations and hospital capacity, experts say. These are intertwined. A high vaccination rate means fewer severe cases, which means less stress on the health-care system. If two countries have similar hospital capacity, the more vaccinated country should fare better once restrictions are lifted.<\/p>\n Denmark and Ontario are comparable on two fronts: median population age, a good predictor of how disease-resistant a population should be, and percentage of their population that\u2019s double-vaccinated \u2014 80.9 per cent and 79.3 per cent respectively.<\/p>\n But two doses of the vaccine are no longer sufficient to prevent infection in the face of Omicron. It takes a third dose to provide notable infection prevention, and in that area the Danish soar above Ontarians, with 60.9 per cent having received boosters, compared to 45 per cent in Ontario.<\/p>\n J\u00fcni said boosters offer a five-fold decrease in risk of hospitalization or death in those infected with COVID as compared with two doses.<\/p>\n \u201cIn addition, third doses will further slow the spread of Omicron in the short term,\u201d J\u00fcni said. \u201cThe most important thing is to have as many people as possible, especially (over 40 years old), receive third doses, so that we don\u2019t have those people ending up in our hospitals, because they\u2019re more vulnerable.\u201d<\/p>\n Moreover, Denmark has more hospital beds per 1,000 residents than Ontario, which has fewer hospital beds per capita than any other province and some of the \u201cmost overcrowded hospitals in the developed world,\u201d according to the Ontario Health Coalition.<\/p>\n As a result of its vaccine uptake and greater hospital capacity, Denmark has seen fewer total COVID deaths than Ontario \u2014 although COVID deaths in Denmark in the last seven days have far outpaced those here.<\/p>\n \u201cI don\u2019t think what\u2019s happening in Europe is surprising at all,\u201d said Dr. Saverio Stranges, chair of the epidemiology and biostatistics department at Western University. \u201cIn Europe, they are gradually lifting public health measures because many countries are seeing a declining trend in new cases. Vaccination is really mitigating the impact of hospitalizations.\u201d<\/p>\n That trend is also observable in Ontario, which saw a decrease in both COVID cases and deaths this week as compared to last.<\/p>\n Unfortunately, J\u00fcni said, there has also been a decrease in booster shots administered. If more doses aren\u2019t administered, Ontario could see hospitalizations rebound, he added. As of Tuesday, J\u00fcni estimates Ontario is seeing roughly 30,000 COVID infections per day \u2014 only about 10 per cent of COVID infections are being caught, he said.<\/p>\n \u201cWe need to wait now, just another 10 days or so, just to understand where this is going, and not rush it, to not open blindly,\u201d said J\u00fcni.<\/p>\n Hospitalizations shooting up is always a concern in Ontario, where ICU capacity is perpetually pushed to the brink. High ICU occupancy is dangerous not just for people seriously ill with COVID, but anyone who might need critical care. Although the province has added more ICU beds throughout the pandemic, not all are equipped with ventilators necessary for COVID patients and not all hospitals have the staff to attend to all their ICU beds.<\/p>\n \u201cThe hospital capacity, in terms of ICU beds, we have in Canada is still not optimal, as compared with other western countries,\u201d said Stranges. \u201cEven in the pre-pandemic era, we worked at 90 per cent capacity, or above it.\u201d<\/p>\n Yet, one country with even worse hospital capacity and worse vaccine uptake than Ontario is loosening restrictions. Sweden, which has historically taken a lighter approach to COVID mandates than most countries, ends most restrictions Wednesday.<\/p>\n This is perhaps why, despite having 4.5 million fewer people than Ontario, Sweden has had twice as many COVID cases and about 5,000 more deaths.<\/p>\n \u201cSweden pursued the idea of herd immunity, it tried to really be soft with restrictions, and that\u2019s why it experienced much higher mortality per capita as compared to neighbouring countries,\u201d said Stranges.<\/p>\n COVID restrictions save lives. For many, they also degrade quality of life and bring economic hardship. This is the tug-of-war taking place among lawmakers around the world. Governments, Stranges said, make their values clear through their COVID restriction approaches.<\/p>\n \u201cIn the U.K. and U.S., I think it\u2019s very clear they prioritized the economy from the very early stages of the pandemic,\u201d said Stranges. \u201cIn Canada, we had a more balanced approach.\u201d<\/p>\n The U.K. has also\u00a0lifted restrictions<\/a>, including mask mandates in public places. Although it has better vaccination than Ontario \u2014 though less than Denmark \u2014 it\u2019s seen significantly more death throughout the pandemic, including in the last week.<\/p>\n And on Friday, the U.S. reached 900,000 deaths from COVID, by far the most of any country in the world. The U.S. has a total death rate per million of 2,736, and death rate per million in the last seven days of 44.8 \u2014 both among the highest in the world, and followed closely by the U.K.<\/p>\n Just as the removal of stringent restrictions needs to be done carefully, so too does their implementation, Stranges said. There is an emotional cost, and societies can only pay so much.<\/p>\n \u201cWe still have the tendency to just consider the importance of stringent measures without considering the side effects,\u201d he said. \u201cI don\u2019t think we\u2019re in a stage where lockdowns are sustainable anymore. School closures are not sustainable anymore \u2014 there is overwhelming evidence on the\u00a0negative impact<\/a>\u00a0it has on our kids, especially elementary schoolers.\u201d<\/p>\n Germany, which has one of the oldest populations in the world, and where infection numbers repeatedly hit\u00a0new milestones last month<\/a>, is planning to ease restrictions in some states, although federal Health Minister Karl Lauterbach\u00a0said Monday<\/a> that relaxing measures too quickly would be akin to \u201cpouring oil on the fire.\u201d<\/p>\n Lauterbach cited Germany\u2019s vaccination rate as cause for concern in terms of loosening restrictions. With 54 percent of its population boosted, it falls short of Denmark\u2019s population but is above Ontario\u2019s.<\/p>\n Germany also has one of the highest hospital capacities in the world \u2014 almost quadruple the hospital beds Ontario has per million people.<\/p>\n Ben Cohen is a Toronto-based staff reporter for the Star. Follow him on Twitter:\u00a0@bcohenn<\/a><\/span><\/p>\n