"Ontario's hospitals take enormous pride in the role they play providing high-quality health services to the people of Ontario every day. During the COVID-19 pandemic, they have stepped up to take on additional roles and expanded services by supporting assessment centres and lab testing, assisting in long-term care homes, conducting research to better understand the virus, and increasing inpatient and critical care capacity. Now, thanks to the hard work and planning of the federal and provincial governments, hospitals will also play an important role alongside public health in the distribution of COVID-19 vaccinations. As they keep up with current needs, hospitals are also working diligently to catch up on approximately 150,000 scheduled surgeries cancelled in the first wave of the pandemic. Evidence is mounting that the hidden toll on human health from this disruption in scheduled services will be heavy. Our communities are tired, and so are those caring for them.

We cannot, however, avoid the reality. Ontario remains firmly caught in the grasp of a major second wave of COVID-19. Daily infection is now above 2,000 new cases per day. Hospitalization is increasing rapidly, as is the occupancy of intensive care units. A growing number of hospitals are grappling with outbreaks, and many have already had to cancel scheduled surgeries and other activity. Ontario's health care professionals are being asked to carry a very heavy burden. The average length of stay of COVID-19 patients has decreased, but hospitals are seeing more of them, which is accelerating demands on health care workers. They are mentally, physically and emotionally exhausted, but because of their calling, they carry on.

The situation is extremely serious. We are now in the holiday season and if members of the public choose to ignore public health measures and gather outside their households, the consequences risk overwhelming Ontario's hospitals. Every health care system has its breaking point.

That is why the Ontario Hospital Association is calling on the people of this province to remain steadfast in the fight against this pandemic. We are also recommending further decisive action by the Government of Ontario. We ask for understanding and support as we reluctantly and with deep regret recommend that as a minimum, the government implement and robustly enforce a four-week lockdown in every public health unit with an infection rate of 40/100,000 population or higher. This is in keeping with the criteria laid out in the government's COVID-19 Response Framework, and is necessary to protect the health and safety of the people of Ontario and to ensure that hospitals do not face a devastating surge in COVID-19 patients requiring hospitalization and intensive care in January. In the remaining public health units, the government must give priority to the reproduction rate and test positivity trends, in addition to the infection rate, when determining whether additional public health measures may be required. Finally, we also recommend that the grey lockdown zone of the province's framework be rapidly re-evaluated by independent public health and epidemiological experts to determine if additional, stricter provisions are necessary.

This expanded lockdown would provide a valuable opportunity for the Government of Ontario to reset and recalibrate the components of its response to ensure that we are able to gradually re-open safely. This includes a focus on high-risk workplaces and enhancements to the testing and contact tracing system, so that we do not slide backwards again after re-opening. To succeed, it requires that all levels of government work together to provide essential financial supports to businesses being asked to make sacrifices due to the lockdown, and programs such as paid sick leave and isolation accommodation for people with COVID-19 who do not have the financial means to avoid working outside the home. We must do everything possible to ensure that schools are the last organizations to close.

The arrival of COVID-19 vaccines means the end of the pandemic is in sight – watching health care workers receive the vaccine this week offered an uplifting light at the end of the tunnel. However, the last stretch of a marathon is the hardest. We must deal with today's crisis by bending the pandemic curve so that the vaccination program can proceed as quickly and effectively as possible. We are grateful to Premier Ford and his government for their strong support of Ontario's hospitals during this difficult year. As the Premier says, we are all on the same team. If we rally once again as a province and a country, we will beat this virus – and that will be the right time to celebrate together."

• The Ontario Hospital Association's Board of Directors:
• Sarah Downey, Board Chair, President & CEO, Michael Garron Hospital
• Anthony Dale, President and CEO, Ontario Hospital Association
• Roger A. Boyer II, Board Member, Grey Bruce Health Services
• Elizabeth Buller, President & CEO, Scarborough Health Network
• Janet Cosier, Board Member, Queensway Carleton Hospital
• Melissa Farrell, President, St. Joseph's Healthcare Hamilton
• Dominic Giroux, President and CEO, Health Sciences North / Horizon Santé-Nord
• Philip Griffin, Board Member, St. Joseph's Health Care, London
• Julia Hanigsberg, President & CEO, Holland Bloorview Kids Rehabilitation Hospital
• Helen Hayward, former Board Member, Sunnybrook Health Sciences Centre
• Lynne Innes, President & CEO, Weeneebayko Area Health Authority
• Carol Lambie, President & CEO, Waypoint Centre for Mental Health Care
• Christina Mack, former Chair, South Huron Hospital Association
• Neil MacLean, former Chair, Middlesex Hospital Alliance
• Lynn McDonald, Corporate Director
• Alex Munter, President & CEO, CHEO
• Murray Perelman, former Chair, North York General Hospital
• Gary Sims, President & CEO, Grey Bruce Health Services
• Andrew Williams, President & CEO, Huron Perth Healthcare Alliance