Ask the Pharmacist

Q) At work today, I heard some people celebrating that, when Ontario sort of reopens on February 16th, our region will be a yellow zone and not orange like so many of the areas around us. Then, I heard others lamenting that we were not deemed COVID free enough to attain a green designation like Kingston did. What exactly do these colours mean and how does one move from one to the other?

A) We do hear a lot about the different colour zones in all the forms of our media in this province. It is important to note that every province has their own systems when it comes to regulating activities so what we are going to talk about is unique to Ontario. Other than the basic colour coded zones (i.e. red is bad…) most of us do not really know that much about what exactly each of these colours actually mean. The principles that stand behind this system make sense given the health crisis we are in.

Foremost among these is responsibility. It is perhaps any governments primary duty to keep its citizens safe, in particular those most vulnerable which include our elderly. The government’s website also outlines that they have a responsibility to keep both child care centres and schools open if safe to do so. This makes sense both in terms of allowing our essential workers, and the rest of the economy depending on the zone, to do their jobs as well as protect our children’s futures along with ours as prolonged disruptions to education may have long-term negative consequences.

Other principles include that all decisions will be evidence based (let’s hope although political futures can get in the way of sound decision making at and times), pro-active, graduated and responsive. Lastly, the plans and responsibilities for both individuals and businesses should be made abundantly clear to them with respect to the level they are at. Whether that has been implemented as well as it should have should be questioned as there seems to be lots of confusion when it comes to the differences between the zones. There are five zones all together and each one has been given both a colour and associated name.

The zone with the least restrictions is the Green zone, also known as the moniker Prevent. In these zones, the weekly incidence of Covid-19 is less than 10 per 100,000 people and that the testing results in a positive test less than 0.5% of the time. The effective reproductive rate (Rt) of the virus is a measure of the average number of other infections that one already infected person will cause in the general population.  A value greater than 1 means the number of cases is increasing daily.

In the Prevent zone, the Rt is judged to be less than one and there is lots of room in local hospitals and ICU’s to accommodate those who get most sick. Maximum capacity for social gatherings tops out at 10 people indoors and 25 outdoors unless it’s a public organized event in which case the numbers are 50 and 100 respectively. Restaurants can be open as long as they can maintain a 2m distance between tables and fitness centres can have up to 50 people at a time. Retail locations are allowed to get by with passive screening only.

The next zone is the Yellow or Protect zone (where we are at currently in Grey Bruce). In this zone, the weekly incidence of Covid-19 is between 10 to 24.9 cases per 100,000 people and our positive test rate is somewhere between 0.5 to 1.2%. Once again our hospitals have plenty of capacity left and the number of community transmitted cases is either stable or increasing but the effective reproduction number is approximately 1. As far as life on the ground goes there are a few more restrictions in place such as liquor can only be sold/ served until 11PM, face coverings are required at recreation facilities (unless exercising) and some establishments are required to keep contact information of their patrons although most retail stores still require only passive screening measures.

Next is the Orange or Restrict level. In this zone, the weekly incidence rate of new cases is between 25 to 39.9/ 100,000 and the odds that a test will be positive

increases to between 1.3 to 2.4% of the time. The Rt is approximately 1 to 1.1 and likely there has been an increasing number of large outbreaks within the zone. There is still excess capacity in the hospital but occupancy may be increasing. At this level the capacity at events is reduced to a maximum of 50 people per facility, hours for businesses are limited and personal care services that require the removal of a face mask are prohibited. There are enhanced screening measures at various businesses and some may have their capacity limited further.

The Red or Control zone is where most of the large cities we know and visit (London, Waterloo, Guelph…) are in. Pertinent numbers here are a weekly incidence of 40 or more cases per 100,000 people and a positive test rate of 2.5% or more. The Rt has now climbed to at least 1.2 and most critically the hospitals and ICUs are at risk of being overwhelmed. Some of the new restrictions that occur at this level include reducing attendees at any social gathering to a maximum of 5 people indoors and 25 outdoors. Our restaurants and gyms cannot have more than 10 patrons at a time (which makes for a very challenging business model in every respect) and cinemas and performing arts spaces are closed. “Essential” businesses such as supermarkets and pharmacies can only operate at 75% capacity and all other retailers are reduced to 50% of their usual number of patrons which must be posted outside of the establishment.

The last zone is the Grey zone or Lockdown which has as its sole occupant the Niagara region. Here the raw numbers are similar to the Red zone but the incidence of weekly cases and positive tests continue to increase and there are increasing outbreaks among vulnerable populations such as at long-term care facilities. Hospitals remain at risk of being overwhelmed as does public health’s ability to perform contact tracing. Restrictions involved with this designation include a prohibition on all indoor social gatherings, dining at restaurants (regardless of whether it is indoors or outdoors), all personal care services (i.e. hair salons…) and a closing of indoor and outdoor sports and fitness facilities. Outdoor public events are capped at 10 people and pharmacy and grocery retailers are now reduced to 50% of their stated capacity with other retailers

reduced to 25% of this number. Mask wearing and physical distancing is now mandatory (with limited exceptions).

Toronto and surrounding area as well as the North Bay/ Parry sound district will remain in the “emergency stay at home order” and are therefore considered to be outside of the colour/zone system. Only those jurisdictions that have the emergency order lifted are able to go to the colour/zone system.

So, just what are we allowed to do in the restricted zones? Apparently Netflix viewing is allowed but perhaps you have exhausted your choices with the binge watching over the last few months and are now looking at other streaming services.

It’s great that our region is now yellow. It will allow us to enjoy ourselves and possibly resume activities that were curtailed and we are all overdue for that. But let’s not mess this up. The new variants are here to stay and they are more contagious. Let’s enjoy our newfound freedom without forgoing the smart decisions we have made as a population that have allowed us to “achieve” this level. For more information about this or any other health related questions, contact your pharmacist.