It is now time for oral questions. I recognize the leader of Her Majesty's loyal opposition. Thank you, Speaker. Speaker, last week the government made an announcement that was so devastating, it literally led to physicians sobbing when they heard it. Doug Ford, of course, as we all now know, made decisions not based on public health. He made decisions not based on public health at all, but rather based on politics and polling. You know, his decisions, based on these kinds of factors, have really caused a ravaging of communities, a ravaging of families to COVID-19 in this province. So today he had a chance. Today he had a chance to do the right thing and actually implement the recommendations of the science table. Paid sick days for all workers, really, truly closing non-essential businesses and giving them the support they need, as well as their workers' need, to get through these next several weeks. Making sure that every hotspot has the vaccines that they need, that the priority goes there to stop the spread of this deadly, deadly virus. He didn't do any of those things today when he made his press conference, none. How much longer? Are Ontarians going to have to wait for their Premier to do the right thing, base his decisions on public health and science, and save lives, and stop the spread of this virus? Please take your seat. Government House Leader. Thank you very much, Mr. Speaker. Of course, that is exactly what we've been doing since the start of this pandemic, Mr. Speaker. As I mentioned the other day, Speaker, when we took office, we had a provincial lab system that could handle 5,000 tests a day. That is up to 75,000 tests because of the hard work of this government, Mr. Speaker. We had a long-term care system that was in peril, Mr. Speaker. We've made significant investments to increase that. We had a system that did not have, that has the lowest, one of the lowest ICU capacities per capita in North America, Mr. Speaker. We moved very quickly to upgrade that capacity and to put resources in place for health and human resources to cover those ICUs. We added critical care access to the system, Mr. Speaker. We're adding, we're bringing vaccines into hotspots. We're bringing vaccines into essential services, Mr. Speaker. We have vaccinated over 4 million people in the province of Ontario despite the fact that we have been having unreliable vaccine delivery from the federal government, Mr. Speaker. There is a lot of work that has been done. There is more to do, Mr. Speaker. And we will get the job done on behalf of the people of the province of Ontario. Supplementary question. Speaker, they haven't gotten the job done yet. There are 806 people with COVID-19 in our ICUs today, 806. It's a dire situation in this province. The only people that don't seem to get that is this government. Surgeries are now being cancelled. And you know, in response to what both the Minister of Health and the Solicitor General had to say yesterday, Shadi Asmala, head of the general surgery at Sunnybrook Hospital, said this. This is around the triage. They claim it isn't happening. But the doctors are saying this. There is triage. We are long past the point of standard of care. Dr. Nir Lipsman from Sunnybrook, a neurosurgeon at the Health Sciences Centre, said this. And I quote, man in his 20s with life-threatening brain hemorrhage, the most urgent of urgent cases, can't take to OR. They're full of patients waiting for ICU beds. Meanwhile, pressure grows, life slipping away. The crisis is getting worse day by day. When will a people of Ontario have a government that takes it seriously and acts on the recommendations of the science table? Mr. Hill. Thank you, Speaker. We do take the situation very seriously, have since the beginning of this pandemic, and have taken steps to build our hospital capacity. Since day one, since this started, we've built over 3,100 new beds in this province since the pandemic began, six community hospital size. We've also increased our intensive care capacity by 14%. We've initiated programs so that we can use the entire capacity of our health system by being able to do the patient transfers, which are happening on a daily basis, by redeploying staff to make sure that as we create more spaces, we have the staff to activate them and to work in them. We've also created two new field hospitals at Sunnybrook. We're also building one in Hamilton. We are creating the capacity that we need so that people in Ontario, if they need to be in an intensive care bed, there will be one there for them. And the final supplementary. Speaker, while this government is lost in a quagmire of internal politics and worried about polling, people are dying, and hospitals are in an absolute scramble. Nearly a week has gone by since the government first learned of the Science Table recommendations, right? Over a week, actually, since they learned of it. It's been a week since the failure of an announcement that they made on Friday. And it's been about three months since the Science Table has been warning this government about what would happen in the third wave if they didn't bring the right policies to bear. And of course, we all saw that they didn't. And so here we are. And yet the government still refuses to act on the recommendations of the Science Table. Well, people lose their lives while entire communities are aflame with COVID-19. How much longer, Speaker, before the government starts doing what they should be doing, bring in paid sick days, close down those non-essential businesses and give them the support they need, make sure that we're addressing the COVID fire in the hotspots. How much longer? Mr. Hill. Thank you, Speaker. Well, since the beginning of this pandemic, we have relied on the advice and recommendations given to us by Dr. Williams, our Chief Medical Officer of Health, and others by other medical experts, by other tables, including the Science Advisory Table. They have provided the critical data and modeling that has allowed us to be able to make the decisions that we have made up until now. They advised us to put the emergency break on, which we did do, and then recommended the stay-at-home order, which we did do. They also recommended that we reduce mobility, which we did do. We have taken their advice. They advised us we needed to increase hospital capacity, which we did do. We have followed the advice of the medical experts since the beginning, and we will continue to do that until we get, as everyone in Ontario vaccinated, who wants to receive a vaccination. That is what we will continue to do. Our medical experts are the one that are providing us with that advice and counsel, and have since the beginning. Thank you. The next question. Once again, the Leader of the Opposition. My next question is to the Deputy Premier. You know, this morning the Premier said the decisions aren't easy, but there are the right decisions that need to be made, and this government has not made them. You know, there's no doubt, as was mentioned by the government house leader, that the hospital system was in disarray, years of cuts and frozen budgets, cutbacks by this government to public health before the pandemic hit, a failure to listen to the public health advice warnings about COVID-19, especially the huge failure in February, when they were warned what needed to happen, to avoid exactly where we are now. They were warned by the Science Table. Now, people are dying in our emergency rooms, and an ICU doctor in Barrie literally just told his vice president, this situation is catastrophic. This is catastrophic. That's what the doctors on the front lines are saying. How can this government justify where we are? We didn't get here overnight for sure, but how can they justify not taking the actions that they should have been taking all along? Mr. Gull. Necessary actions have been taken all along since the beginning of this pandemic to grow our hospital capacity. We also set up the framework which we're following. We also set up the emergency break for the entire province, followed by the emergency stay at home order and the other emergency orders that we had to bring forward. It was recommended that we stop with our surgeries and procedures for a period of time, not because we wanted to, but because we knew we had to create the space in our hospitals to be able to care for COVID patients, as well as other patients that come in during an emergency. We also were advised that we needed to build up our staff, which we are doing with the redeployment of staff from Ontario Health and the former Lins. We are also receiving assistance from some other provinces in Canada with staff as well. We are doing whatever we need to do in order to create that capacity so that we have spaces for people in our emergency, people in our intensive care units. But it's also really important to blunt that transmission in response. That is why we had to bring the emergency stay at home order forward to reduce mobility, to get people to please stay at their homes, to please follow public health measures so that we can blunt the transmission of these variants, which is a totally different situation than what we were dealing with in the first wave. But we are dealing with it and we're asking people to please continue to follow those public health measures so that we will be able to curb that transmission as we are doing in hotspot areas. Thank you. Let's stop with my two questions. Speaker, it is beyond belief that this Minister of Health is still, to this very moment, not listening to what the experts are saying, not listening to the recommendation of the science table. Instead, they're belaming people. She just did it again. Belaming people. Stop belaming people. Stop closing parks. Stop bringing police powers into Ontario that everybody knows we're wrong. We need to have some focus here. We need a government that's doing its job. We need to close non-essential businesses and support them through. We need to move vaccines to the places they're needed most where COVID is raging. And we need paid sick days for every worker in this province. How long are Ontarians going to have to wait? Will they ever get the recommendations passed through this cabinet and this government to save Ontarians lives and stop this COVID spread? Thank you, Speaker. And through you, Speaker, I'd like to say the leader of the official opposition. Don't make suppositions about what you think I'm thinking of what I'm saying. I am not in any way accusing the public of anything. I am trying. I am working to protect the health and safety of the people of Ontario. And have since the beginning of this. That is why we have taken the steps that we've taken to bring the stay-at-home order forward. That's why we take the steps to reduce the surgeries and procedures, unfortunately for a short period of time, so that we will have the capacity in our hospitals. That's why we are having to move people around to places that they can be served using our entire health system capacity. That is why we've desegrated the hotspots because we know that's where we need to concentrate our efforts in order to reduce transmission across the entire province. That is why we're designating 25% of all the vaccines coming forward now into those hotspots where they're absolutely needed. That is why we're introducing the public clinics and extending hours so that people can get the vaccines that they need. The final supplementary. Well, Speaker, we heard the government house leader try to sluff off their huge error on Friday as a communications problem, as a communications mistake, that it was some small mistake that they made. Everybody knows that that's not true, and it was an embarrassment that the government tried to suggest that that's all it was, a communications problem. Hotspots still don't have vaccines at places like the Drift... Well, actually, some of them do, but the line-ups go for miles and miles. Places like the Driftwood Community Centre. The lines are huge. Families are still getting sick. Whole families are still getting sick from contracting COVID-19 at non-essential businesses.  Dr. Irfan Dalla from Unity Health said this, and I quote, how many lives would have been saved if we had provided paid time off in January or even better before the second wave? Does the Premier of the government have an answer to this? When are we going to get real, accessible, paid sick days for every worker in our province? APPLAUSE Good-bye to the government. Thank you very much, Mr. Speaker. And, of course, we are moving very quickly to ensure that essential and essential workers have access to a paid sick day regime. Look, as we said, we were very disappointed on Monday that the federal government did not honour the commitment that we thought we had in place to supplement a paid sick day. To fill in some of those gaps that had become very clear as a third wave started hitting across every province in the country, and some of the things that we saw, of course, in Europe and Germany, France, and a number of other jurisdictions that had been in a third wave before us. So we are working very diligently to ensure that a very comprehensive sick day, paid sick day program comes forward for the workers of the province of Ontario. And, Mr. Speaker, speaking just the other day to a good friend of mine, Mr. Baljeet Sierra, who I referenced the other day in the House, talked to me how hard his people have been working, how hard his workers have been working. He, of course, does provide sick pay benefits for his workers, but he gave us some great suggestions, Mr. Speaker, and very soon we're going to be bringing forward a very comprehensive plan to cover the gaps in the federal system. The next question, the member for the Gapkin Senate. Thank you. Good morning, Speaker. My question is for the Deputy Premier. Yesterday, Peele's Chief Medical Officer revealed that Brampton's positivity rate has reached a staggering 22.4%. That means that one in every five COVID tests is coming back positive, Speaker. Dr. Lowe said that community members who come into contact with one another should, and I'll quote, just assume that they might have COVID, end quote. Speaker, the Premier let the pandemic completely go unchecked in Brampton. They failed to provide equitable distribution of vaccines to our community. They didn't protect essential workers with paid sick days, and now community members and frontline workers are at more risk than ever. The COVID crisis has reached unthinkable levels in our community. Why is the Premier ignoring our pleas for help in Brampton? What's your help? We have been providing the communities across the province of Ontario, all 34 public health units, with an equitable distribution of vaccines based on population, also based on risk. Peele region definitely has a higher level of risk. We certainly recognize that as does Toronto. And that's why we have been expanding the solution for Brampton, particularly by taking 25% of all of the vaccines that are coming in in the future, going to hotspots in the province of Ontario. There are 11 postal codes in Brampton that have been identified as hotspots, and extra vaccines will be going there. We also have a variety of distribution channels. Speaker, I would say that William Osler has the Brampton Civic Hospital, the Chingakusi Wellness Centre, Trillium Health Partners, as Mississauga Hospital, University of Toronto, Mississauga. There are 18 hotspot pop-ups in Brampton and Peele. There are 61 pharmacies in Brampton right now that are administering vaccines. So Brampton will be getting an extra number of vaccines and will have those available in a variety of locations. Supplementary question. Speaker, what the government is allocating, 25% of the vaccines is still well below the 50% that the science table recommends. So I can appreciate what the Minister of Health is trying to say here, but we're still not getting our fair share.  It's bad enough that the Premier refused to provide them with paid sick days, but now he's refusing to provide access to vaccines that our community desperately needs. Yesterday, Mayor Brown had to make a public plea, begging for the Premier to expand vaccine access in our community because case counts and hospitalizations are continuing to rise. Speaker, we are experiencing some of the highest positivity rates in the province, nearly double what Toronto is experiencing. Why does our mayor and community members still have to continue to beg this government for assistance for vaccines? And what is this government going to do to help make sure that Bramptonians will get through this next wave? Mr. Hall. Our government already recognizes that there are concerns in Peel region and Brampton in particular. That is why we are concentrating an extra level of vaccines to be delivered to Brampton. There are 11 hot spots that have been identified in that area. We are providing extra vaccines there. And it's also important to note that in addition to the pharmacies that are providing them, 61 pharmacies in Brampton, that we've also worked with Shoppers Drug Mart for 20 locations to have 24-7 availability of vaccines to make it convenient for people to be able to come in whenever they are able, knowing that many people are working during the day and have to go to work. There are 20 locations that are offering these 24-7 vaccine clinics. And six of those 20 are going to be active in Brampton. So we recognize the difficulties there. We are sending more vaccines there. And we are making them more available. Thank you. The next question, the member for Sarnia Lampton. Thank you. To the Minister of Health and Deputy Premier. Mr. Speaker, my constituents, like all Ontarians are anxious to get their COVID-19 vaccinations. I hear from so many constituents who say that vaccination is the one hope they have been waiting for and the first step to returning to a somewhat normal life. My constituents also tell me they just want to feel safe on going out to do everyday things like grab a coffee or get some groceries. Can the Minister of Health tell this House what our government is doing to expand vaccinations across the province and help more Ontarians to feel the sense of relief? The Minister of Health. Thank you, Speaker. And thank you to my colleague from Sarnia Lampton for that important question. My Speaker, as we know, Ontarians are anxious to get their vaccines and we are anxious to get them to them. That's why this week, under the guidance of Health Canada, we announced that we were going to extend vaccine eligibility for the AstraZeneca COVID-19 vaccine at pharmacies and primary care settings for individuals over the age of 40. By doing so, we're able to offer the protection of the vaccine to more Ontarians earlier than anticipated. With the supply of AstraZeneca available at this time, this expansion significantly increased access to vaccines in hotspot communities. In fact, Speaker, yesterday, our pharmacies had a record-breaking day by vaccinating over 135,000 Ontarians with their first shot. Speaker, we will continue to work with all of our partners to ensure that everyone who wants a vaccine will get a vaccine as soon as possible. The supplementary question. Thank you, Speaker, for calling on me. And thank you, Minister, for that answer. I know also my constituents are thrilled to be able to access first doses and my pharmacists are happy to support our mass vaccination program. Mr. Speaker, like everyone else in this province, I've heard concerns about supply issues with the COVID-19 vaccines. Can the minister update this house on our progress of our provincial vaccination campaign? Thank you. Thank you. Minister Heller. Again, for that question and, Speaker, in addition to yesterday's record-breaking pharmacy numbers, we also hit a record for the total number of doses administered in a day by vaccinating over 130,000 people. This means that we have now administered over 4.2 million doses of the COVID-19 vaccination. Although we have faced vaccine shortages from the federal government, we are working with all partners to get as many vaccines into arms as possible. And finally, Mr. Speaker, I am pleased to report to the House that we are on track to vaccinate 40% of adult Ontarians with their first dose by the end of this month. Thank you. The next question, the member for Kiwet and on. My question is to the Premier. Speaker, we never should have gotten to this point where critical care triage become a possibility. But the government chose to put politics before public health has brought ICUs to the breaking point. In Ontario, we have seen again and again that anti-indigenous bias, anti-indigenous racism is systemic in our healthcare. We are often scared to get medical care we need because of racism. What protections are in place to ensure Indigenous and other racialized patients don't get wrongly triaged as a lower priority for intensive care when needed? Mr. Powell. Mr. Speaker, and I thank the member very much for the question. There has been no triage protocol that has been activated in Ontario as yet. What we are doing is building capacity in our hospitals so that anyone who needs to be in intensive care will have a space. But I can also advise the member that Chief Roseanne Archibald is a member of our vaccine task force. She has been a very ardent member in favor of making sure that First Nations people have their vaccines as soon as possible. That is why we implemented Operation Remote Immunity working with Dr. Tian of Orange to make sure that recognizing the vulnerability of many First Nations people to COVID-19, that they were amongst the first to receive their shots. We are looking at second doses now. And again, I can advise that... Response. Regional Chief Roseanne Archibald is a very valued and respected member of the vaccine task force. And we are listening to her issues and concerns on a daily basis. As a matter of fact, we had this conversation with her last evening. APPLAUSE A supplementary question. Back to Deputy Premier. Speaker, workplace conditions and the lack of paid sick days are driving essential workers who are often racialized people into intensive care units. I know the ICUs are full of black, brown, Asian and Indigenous people, essential workers. They are in the line of fire, Mr. Speaker. That means, once again, racialized people are the ones who are disproportionately impacted by physicians deciding who does and doesn't get light support. What urgent measures is your government taking so no one is given the power to decide who gets what precious medical resources and who does not? Minister of Health. Thank you. Well, thank you again for the question. Again, I will reiterate that no triage protocol has been initiated in Ontario. Everyone is receiving excellent care. We are making sure that there is no discrimination. There's no bias. There's nothing there. We have worked with our vaccine task force. We have bioethicists at the table. We have, as I told you, Regional Chief Roseanne Archibald. We are making sure that every person in Ontario who needs care will get the care that they require. That is why we are building capacity in our hospitals. To make sure that we have that capacity, we are transferring some patients from one hospital to another because we are looking at our entire hospital system as one system and we are using every resource available within that system to care for anyone who needs to be in intensive care. Thank you. The next question, the member for Ottawa Vanier. Thank you, Mr. Speaker. My question is for the Minister of Health. Mr. Speaker, the third wave has put us in the middle of a historic health care system crisis. Yesterday, there were 72 new admissions to critical care units. This week, we've learned that the government has ignored countless recommendations from the COVID-19 science table. The government failed to properly implement the six recommendations that experts believe will help us through this. And they further announced new restrictions that the science table, as explicitly said, won't work. The government also ignored the advisory group's recommendation regarding the allotment of vaccines to hotspot regions. So my question is, if the government is not following science, can the minister explain to Ontarians what process it follows in making decisions about their safety? Minister of Health. Thank you and I thank the member for the question. We have been following the recommendations of our medical advisors since the beginning of this pandemic. Dr. Williams, the health prevention group, as well as the science advisory table. We have taken their advice in terms of the recommendations to bring in the emergency break, to bring in the stay-at-home order, to increase capacity in our hospitals. We also received some modeling from them with respect to what would be the difference if we increased vaccine allocation from into the hotspot communities. We looked at several different scenarios. We have decided to increase to 25% of all of the vaccines that are coming in as we receive increasing supply very shortly to go into those hotspot areas because we have been advised by the medical experts that if we do that, we will be able to reduce transmission more quickly that will benefit all of the people across Ontario. It will also reduce hospitalizations, intensive care admissions, and prevent more deaths. Supplementary question. Thank you and again to the Minister of Health. I've said many times that the government is consistently failing to consult key players that could help in making effective and informed decisions. This week, Ottawa Public Health wrote a letter to the government to make specific requests about COVID-19 restrictions and enforcement. The Board of Health of the City of Ottawa Health Unit approved a motion requesting time sensitive actions in order to curb COVID-19 rates and transmission and lessen the burden on our healthcare sector. These specific requests are made with good intention to help the government make better decisions. So will the Minister commit to take these immediate and decisive actions to protect the health of Ontario residents as well as our healthcare sector's capacity to continue providing care to those who need it? Minister of Health. What I can certainly advise the member is that we do listen to the advice and the issues that are raised to us by local regional medical officers of health as well as Dr. Williams, who is in regular contact with them. We've also listened to the hospitals. We've listened to their concerns with respect to capacity. We have conversations with the vaccine task force with the local medical officers of health and with the heads of the hospital every two or three days. So we are very cognizant of the issues that they're raising, of the requests that they have from us, particularly through the Ministry of Health. We've always listened to them since the beginning and we will continue to listen to them because they are the ones that know the issues in their local geographic areas. They are the ones with the medical expertise, knowledge and judgment. And of course we rely on that in order to be able to make the decisions that we are making to continue to pursue the health and safety of all of the people of Ontario. We rely on them for their expert advice and judgment and we will continue to do so. Thank you. The next question, the member for Kitchen and Conestoga. Thank you very much, Mr. Speaker and I'm proud of the work our government has done to ramp up vaccine access to Ontarians. And of course this includes giving priority access to education workers, Mr. Speaker.  We know getting our educators vaccinated is a key step that will help ensure a gradual return to normalcy for our students. With that in mind, can the Minister of Education share some more details about this accelerated plan to keep kids safe? Thank you, Speaker. Mr. Speaker. Thank you very much, Mr. Speaker. There has been great progress in the province of Ontario and I was standing in sufficiency of vaccine supply in Ontario. Yesterday we had a new record of 136,000 doses, a minister that has progressed. And I'm proud of the many educators, those working with special education, those that live or work within a hotspot are able to get access to the vaccine. And I'm grateful for the leadership of the sister general and the Minister of Health in working to get as many frontline workers those vaccines that they need. I'm also grateful, Speaker, of the ongoing work being done to support frontline workers in the province. We extended emergency childcare to them, given this period of remote learning closure, because we want them to know, as the Premier has said, we have their back. We will care for their children as they have to report to work and do the really impossible work of keeping this problem safe within our hospitals, those that work within our grocery stores, our police, our fire paramedics, and of course those supporting the vaccine rollout. We'll continue to be there for all parents, specifically those working within our frontlines and we'll continue to work very hard to get these vaccines to all frontline workers across Ontario. The supplementary question. Thank you, Speaker, and through you, prioritizing education workers for vaccine is an incredibly important step that we need to take to ensure that they are, of course, safe and protected. We also know how important it is to be there for Ontario families, Mr. Speaker. While shifting to remote learning was necessary, given the spike in community cases, it nonetheless poses a challenge for moms and dads, including my own family, Mr. Speaker. We all know the importance of safe and accessible childcare. And most importantly, for our brave and frontline workers who depend on it so they can commute, so they can continue to perform their critical work, Speaker. I'm proud that our government is once again providing emergency childcare for these workers. Still, it can be a struggle for parents to keep up with the cost of living while trying to support their children's education amid the stress of this pandemic. Can the Minister of Education please share with this legislature what efforts are being taken to support parents at this time? Thank you, Speaker. Thank you very much. And to the work being done to support reducing childcare costs in the budget, Minister of Finance confirmed that there's a 20% top-up for the childcare tax credit. That's going to save an average family $1,500. It's going to make a difference. But in addition to all families out there, for children age zero, up to grade 12, province-wide, they'll be receiving a check of $400 per child within the province of Ontario. And I'm proud of this coming Monday, April 26th for all Ontarians who've applied before. They need not apply again. They will automatically start to begin, start to receive those checks within their accounts, which will make the system more seamless and really at a critical time while their kids are home. For those that have not applied in the past, you will be able to apply effective May 3rd to the 17th. This is part of a broader plan, roughly $2 billion in direct financial support in the pockets of parents where we believe it belongs. And we'll continue to do everything we can to support families through this difficult time. Thank you. The next question, the member for Davenport. Thank you, Mr. Speaker. This morning's CBC report is reporting that the Attorney General warned the Premier that his plan to expand police powers was unconstitutional. But the rest of the cabinet decided to ignore him. Yesterday, the Solicitor General refused to answer this exact question from reporters. My question through you, Mr. Speaker, to the Solicitor General, did you know this was unconstitutional? Yes or no? Mr. Solicitor General. Thank you very much. You know, when we introduced the regulatory piece on Friday, we didn't actually accurately capture our intention, and that was the importance for all Ontarians to respect the stay-at-home order and stop the spread of COVID-19. Although the vast majority of Ontarians have respected the public health measures put in place, individuals continue to put others at risk by gathering with those outside their household, which is why we re-scoped the regulation 8-slash-21 to make sure that the focus was ensuring police had the enforcement tools necessary and bylaw enforcement officers to enforce the order so that people stop gathering outside and in large gatherings, which is, as we all know, the cause of the variance of concern spreading so quickly through our communities. Thank you. Supplementary question. Here's the thing. Here's the thing. Finally, to the Solicitor General and the Premier ignore warnings from the government's top lawyers and from their own fellow cabinet ministers around the table, we also learned that the people responsible for this half-baked, unconstitutional, and outright ridiculous plan to make things worse for Ontarians were party insider-turned-lobbyist Corey Tennaiki and the Premier's personal pollster, Nick Kuvales. Surprise, surprise, Speaker. The same, too, concocted that harebrained scheme to tape off parks and picnic tables and turn playtime into criminal activity. So my question, Mr. Speaker, again, through you to the Solicitor General, why, when thousands of Ontarians are barely hanging on in ICUs across this province and more and more are getting sick every day, are you taking advice from the Premier's buddies instead of doctors, nurses, and health experts? Thank you. I remind the members to make their comments through the chair. The Solicitor General's order is to list your general reply. Well, the science table and medical experts have told us that actually limiting movement does improve our outcomes in terms of tamping down and ensuring that the variants of concerns do not continue to transfer and transmit the COVID variants of concern. It's pretty clear in the last number of months that those variants of concerns are far more deadly, are far more easily transmitted, and ultimately are leading to ICU bed capacities. Our priority has always been to address and discourage gatherings and crowds that violate that stay-at-home order. And we have to do these things in order to protect people. You know, I'm frankly shocked that the members opposite don't understand how critically important it is for people to follow the rules so that we can protect them and their babies. Okay, remember for Davenport, come to order. Remember for Hamilton, West Stony Creek, come to order. The Minister of Natural Resources, come to order. The Member for Don Valley East, come to order. The Member for York's Center, come to order. The next question, the Member for Don Valley East. Thank you, Mr. Speaker. My question is to the Premier. Paid sick leave is one of the most urgent concerns right now, and this morning we learned from a CBC story that after hours of debate in cabinet last year, government determined no additional restrictions were required. And then hours later, all of a sudden, the government changed its mind and brought through a rushed, ill-conceived measures because pollsters told them the decision wouldn't fly. Mr. Speaker, it's because of accounts like this that no one has faith in this government anymore. Now the Premier comes out just an hour ago and says that he's working on a plan. Mr. Speaker, where is this plan? Will this plan include paid sick days and will this plan be ready on time? So my question back to the Premier is, does this government need to conduct another poll to tell it how to build a program for paid sick days here in Ontario to protect the lives of Ontarians? To reply for the government, the government house leader. Thank you very much, Mr. Speaker. Of course, as I've said on a number of occasions, we were, of course, expecting the improvements to the federal program on Monday's budget. That didn't materialize as we were promised, Mr. Speaker. So we are moving very quickly to ensure that there is a program in place for hardworking essential workers across this province who have really played a heroic role in making sure that this province continues to not only keep the economy going, Mr. Speaker, but to help us get past this pandemic once and for all. So of course, as the Premier said on a number of occasions, as all of this caucus has been working, we're going to have the back of essential workers in this province of Ontario like we have right from the beginning, Mr. Speaker. Thank you very much, Mr. Speaker. It really shouldn't take polling a week of public anger, sadness to get the Premier and this government to take ownership. There is no excuse for months of inaction by this government. It should have been yesterday. It should have been a year ago. In fact, this very afternoon, Mr. Speaker, I have a bill coming before the legislature, Bill 247, that is asking for 10 paid sick days. So this government can make a decision. So, Speaker, through you to the minister, since they haven't put anything on the table at this point, will they commit to the legislation that's being tabled today or being brought forward today to provide 10 paid sick days to all Ontarians? Government House Speaker. Mr. Speaker, as you would know, of course, the member opposite has chose to leave his seat and abandon the people of his riding so that he could seek office somewhere else, which means that, of course, that even if his bill was passed, Mr. Speaker. Order. Even if his bill was passed, it would die in the legislature because he is not here to support that bill, Mr. Speaker. So, of course, we will not. Member for Don Valley East will take his seat. Government House Leader will conclude his response. So even if the bill was to pass, Mr. Speaker, of course, it would not have life after the member left the chamber, Mr. Speaker. So what we will do instead is bring forward a very comprehensive program. For Don Valley East will come to order. The next question, the member for Sarnia Lamp. Thank you. Thank you, Speaker. To you and through you to the Government House Leader, my constituents, the Government House Leader, are hearing about shortages in Ontario's vaccine supply, and they're very worried. They're seeing great progress all across this province, but they want to see a ramp up, not a ramp back down. Can the government tell this House what they're doing to ensure our vaccine rollout continues to be the most successful in Canada? Government House Leader. Thank you very much, Mr. Speaker, and I appreciate the member for Sarnia Lamp for that question. He's a tireless worker on behalf of his constituents, Mr. Speaker, as you know. Mr. Speaker, we continue to ramp up capacity and expand our vaccine rollout to additional age groups and locations. Our greatest challenge remains, of course, stable and reliable supply of vaccines from the federal government. For example, Mr. Speaker, our next shipment of nearly 500,000 doses of Moderna was due to be received on April 19th and has now been delayed until the week of May 3rd. The shipment also, a further shipment of 200,000, the shipment, excuse me, is going to be reduced to 235,000 doses, not the 500,000 that we were expecting. An additional shipment of AstraZeneca vaccine has also not coming, Mr. Speaker. We were expecting it in mid-April. It has now been delayed until May, Mr. Speaker. This coming at the same time that we are expanding the rollout into pharmacies across the province, expanding them to well over 1,400, Mr. Speaker. So the delay in vaccine shipments from the federal government will obviously cause a delay in getting these vaccines into people's arms, Mr. Speaker. We need the government to be more... The supplementary question. Well, thank you, Speaker, and through you to the member, and thank him for that answer. I'm happy to hear that, despite the supply issues from the federal government, we are still on track to have an incredibly successful COVID-19 vaccine campaign. By building our vaccination system now, I know when the supply does become available, we'll be ready to go. Can the minister please update the House on the following? Come on, Mr. Speaker. Mr. Speaker, despite the challenge that we've been having with vaccine supply and the promises that have not materialized from the federal government, and I will say not always their fault, Mr. Speaker, but the challenges that we have when the federal government is unable to supply us with the vaccine's promise, as you can see it, it'll have an impact in our delivery to our pharmacy partners and to our other partners across the province in the 34 public health units, Mr. Speaker. But despite that, despite that, we've had over 4.2 million doses administered into the arms of the people of the province of Ontario. Yesterday, over 130,000 vaccinations were concluded in the province of Ontario, working with our public health partners across this province, Mr. Speaker. I'm told that fully 80% of, or 94% of long-term care residents have been vaccinated, Mr. Speaker. 90% of people over the age 80, Mr. Speaker. I can't tell you how happy my father-in-law was. I didn't know he was doing it, but he went out and got his own vaccine appointment. 92 years old, Mr. Speaker. The Stovall vaccine clinic, the drive-through being done by local physicians is at capacity, Mr. Speaker. We just need to ensure that we keep getting those vaccines. Progress is being made. I'm proud of what the people of the province of Ontario are doing and we're here to support them. The next question, a member for Algoma Manitoulin. Thank you, Speaker. My question is to the Premier. Insurance premiums are killing businesses left and right in Ontario. Small trucking businesses in Northern Ontario and across the province are facing brutal insurance costs, a shortage of drivers, and many of them are choosing to leave the business. John Gregoire from my writing in Algoma Manitoulin informed me after changing his truck, his insurance went up from $10,000 to $35,000 per year. He had no choice but to go work for another company. Will the government support my colleague, the MPP for Muskegawak James Bay, motion calling on them to commit to a truck owner strategy to tackle the truck driver shortage and the increasing truck insurance costs hurting truck operators across this province? Member for Willowdale. Thank you very much, Mr. Speaker. And I appreciate the question from the member opposite. It's certainly been a very difficult time and market conditions that exist for commercial insurance have provided challenges for businesses throughout Ontario throughout the pandemic. And so we are pleased that the Insurance Bureau of Canada and its members have launched a new business insurance action team to help find viable insurance solutions for small businesses in Ontario's many sectors, including our trucking sector. And I appreciate that there are unique challenges in different parts of this province. And I'm willing to work with the member opposite to help Don find a solution. And he knows that in that spirit of cooperation, we have collaborated in the past. And so if he wants to present the details of that particular case, I am happy to listen to that. Thank you. Member for Algoma Manitoulin, supplementary. Again, to the Premier. Insurance premiums are also hitting the tourism industry hard. Many businesses are forced to close or simply do not have the customers to stay afloat because people cannot travel. But regardless of their situation, there still have to pay liability insurance. Many of them have lost 90% of their clientele and revenues, but costly insurance expenses just keep adding and they're increasing debt every month. Will this government help struggling tourism-based businesses with their insurance liability payments and their increasing debt, or will they just simply continue to let the industry suffer? And the Member for Willigale and Parliamentary. Thank you very much, Speaker. And this is a challenging situation for the tourism sector as well. Of course, commercial insurance rates are challenging market conditions are provided for that sector also. So I encourage those in Algoma Manitoulin, throughout the province, to go to businessinsurancehelp.ca to see some other solutions that have been provided, put forward by the many insurance companies in Ontario. But I also want to remind the Member that there has been announced $624 million in additional supports in our recent budget to help the tourism sector, including a grant program for those in the tourism accommodation sector, recognizing that that industry has indeed been hit very, very hard. And so to the Member Opposite, who I respect very much, I hope that in third reading of this budget, never too late to do the right thing and to all NDP members, please, let's vote in favour of getting these supports out to the tourism sector that has been hit hard. Let's support these small businesses, Ontario, until COVID-19 is far behind us. Thank you. Thank you. The next question, the Member for York Centre. Speaker, my question is to the Minister of Health. And it's with respect to ICU capacity. So hopefully she won't talk about last year's 3,100 acute beds again. A few days ago, we learned an astonishing revelation from the Health Minister that in the entire year since the pandemic began, despite all threats of our ICUs being overwhelmed, that our provincial ICU capacity had only been increased by 14%. Why? When space is ample, when most of Ontario's ICU trained doctors are underemployed or don't have full-time work, when she was firing nurses in her own writing of Newmarket last September, when it only takes four months to train a nurse to become an ICU nurse, in a pandemic year, they only increased ICU capacity by 14%. What is the Minister's excuse for this ineptitude? To reply, the Minister of Health. Thank you, Speaker. Well, I recognize that we are in a difficult situation with our ICUs right now. We have increased by the 3,100 beds that you don't want me to speak about, but that's really important. That's equal to six. Member for York Centre is warned. If I have to speak to you again, you will be named. Oh, order. Minister of Health to reply. That is equivalent to the size of six community hospitals. Building the intensive care capacity by 14% is a significant increase over 285 beds. We are also building the field hospitals at Sunnybrook and Hamilton. But what the member might not appreciate is the fact that we also need the health human resources. That's been one of the biggest limiting factors. We have been moving forward. We have brought in the nursing extern program, which is now going to bring in another 3,200 people with nurses, respiratory therapists, and others to add to the mix. But there are those two components, the building of the beds, but having the people to be able to operate them. And we're working on developing both. Supplementary question. Speaker, according to critical care services Ontario, last night, the province of Ontario had 1,975 patients in ICU. The province of Ontario has 2,412 ICU beds. Divide 1,975 by 2,412, and you get under 82% ICU occupancy. Only 82% of the province's ICU beds are occupied. That's better than in the last four years. Yes, three or four GTA hospitals are at capacity. That's nothing new. That's hallway healthcare. And sure, we're transferring patients between the hospitals. It's called management. That's why they have 6,000 employees at the Ministry of Health. Why, Speaker? Is this minister locking down the entire province, ordering us to stay at home, keeping kids out of school, under threat of the province's ICU's being overwhelmed when the provincial ICU occupancy is under 82% or better than in the last four years? Minister of Health. Thank you. In fact, the ICU capacity is stretched to the limit right at the moment. It is much higher than 82% in many, many parts of the province, especially in the hotspot areas. That's why we have taken the steps that we have with the emergency orders that we have, with the reduction of the scheduled surgeries. I won't call them elective surgeries because they were scheduled surgeries. And I know that's disappointing to many people. And we want to get back to that as soon as possible. But that's why we've also been deploying extra staff from Ontario Health, from the former Linn's. We are looking at other areas where we can deploy more staff and why we've had to do the patient transfers as well. What we are trying to do is use all elements of our healthcare system, looking at it as one system right now to make sure that every possible space that we can use in our hospitals is going to be available for the people that need it. The next question, the member for London wants. Thank you, Speaker. My question is to the Deputy Premier. Speaker, five months ago, I tabled my bill to bring paid sick days to Ontario workers. On March 1st, with the disastrous third wave modeling projections already known, this government voted against it. They said Ontario couldn't afford it, that paid sick days weren't necessary, that it would be a duplication, that it was double dipping. Speaker, we are in some of the darkest, deadliest days of the pandemic and things keep getting worse for essential workers.  Why did it ignore urgent pleas from municipalities, healthcare professionals, business and labour advocates? And as we found out this morning, 83% of Ontarians who all understand that provincial paid sick days are the right thing for Ontario workers. Questions? Government House Leader. Thank you very much, Mr. Speaker. Again, as I've said on numerous occasions, of course we are bringing forward a very comprehensive plan following the disappointment of Monday's federal budget, which did not enact some of the things that we were expecting with respect to improvements to the federal paid sick program, Mr. Speaker. Of course, this was the initial program, which was a program negotiated by a number of the premiers which provided pay for many workers. Speaker needs to be improved and that's what we are doing, but at the same token, I would ask the member opposite if she could help us. The sick pay benefit that was negotiated in the first place, of course, was contingent on support of the federal NDP, Mr. Speaker. They thought it was a great program that was put in place and that's why they supported the federal government. We have been working with the federal government to improve that program. They didn't come through on Monday, Mr. Speaker. That's fine, Premier, and this government will move quickly to ensure that those holes that we've identified for a number of months are filled, Mr. Speaker, and that our essential workers are protected like we have been doing since the beginning. Mr. Speaker, that's a question. Speaker, last summer, the Premier did all he could to derail the very federal program that his government later defended as all that workers needed. He said bluntly, and I quote, I don't support it. We have legislation that protects jobs that people, if they don't feel safe, they don't have to go to work. Speaker, the Premier fought the federal program until it became a condition for federal restart dollars. He then tried to take credit for it and spent months attacking anyone who pointed out its shortcomings. We understand that he has now had an 11th-hour change of heart. Speaker, can he guarantee that Ontario workers will get the paid sick days program that they need to reduce the spread of this virus? Yes, of course, Mr. Speaker. We have been saying throughout the week that we, how disappointed we were that the federal program, the federal budget, a budget that was delayed by two years, Mr. Speaker, and that had some 20 billion dollars of unspent COVID-19 pandemic supports that did not go, utilize, Mr. Speaker. We said we were disappointed. We thought there were going to be improvements in that budget. That's why I'm so surprised to see that the federal NDP are going to continue to support that budget, Mr. Speaker, but failing, but because of the failure of the federal government to improve it, Mr. Speaker, we are going to move quickly to ensure that our essential workers, whether they're in Brampton, Markham, and across this province who have worked so hard to keep our economy going, to ensure that the people of the province of Ontario had all of the products that they needed, Mr. Speaker. We're going to work really quickly to ensure that they're protected, Mr. Speaker, despite the fact that the federal government didn't step out the way we thought that they would. The next question, the member for Guelph. Thank you, Speaker. My question's for the deputy premier. People are frustrated and angry because there seems to be a disconnect between the government's decisions and the science. This boiled over with the incomprehensible measures announced last Friday. Because if we have any hope of getting ahead of this virus and saving people's lives, people need to be able to trust their government. People need to know that the government is listening to, understands, and is acting on the science. So, Speaker, I'm asking through you to the deputy premier, will you commit today to publicly release all recommendations from the science advisory table, not just modeling data recommendations before, before the government announces any new or changes to public health measures? Minister of Health. Thank you, Speaker. And I thank the member for the question. What I can't advise is this information is already available. We have regular modeling that is presented to us by the science advisory table. Dr. Brown and others come forward publicly to release this information as soon as it's available to indicate to the members of the public, to the other members of this house, exactly what they are seeing and what the recommendations are. This is available, this information is registered on the website. Dr. Brown is available to answer any questions. Members of the science advisory table have already come out with their own views about issues as well. There's no indication, there's no gag order they have to sign. They are free to talk about the recommendations and they are already doing that. Supplementary. Speaker, I realize this is called question period and not answer period, but right now I think the people of Ontario need an answer. On February 11th, the head of the chair of the science advisory table said we were headed to a disaster if the government lifted restrictions. We're facing that disaster today. Last Friday when we needed people, when we needed people to take public health measures seriously, people were just like dumbfounded by what was announced and they were trying to say like, is the government really following the science table's advice? And so that's why I'm asking speaker, I'm asking because we need everybody in this province right now at this critical moment to work together and that requires trust and confidence. And so the people of Ontario need to know through you speaker to the deputy premier, will you release the modeling data we know is released but will you please release the science table's recommendation so people know that they have confidence that the government is following those recommendations. Minister of Health. Thank you speaker. This information is already available. The science advisory table as you know issued a document several days ago that contained their recommendations. I'm not sure what else the member would like to have released, but that is what was released. We have been following the recommendations. We have been told that we need to limit mobility because that is how this is being transmitted. We are doing that with our stay at home order and with the other orders that we brought forward. We have been told that we need to build our hospital capacity. We are doing exactly that including with our intensive care beds. We have been told that we need to use the system as a whole. We are doing that with the order of transferring patients from one location to the other and using the entire system as a whole. The science advisory table is providing recommendations that we have been following.  That is our responsibility as government to make some of those decisions. But we are following the advice that we are receiving for Dr. Williams, the chief medical officer of health, the public health preventive measures table, the science advisory table. Thank you. Thank you very much. The next question, the member for Davenport. Thank you, Mr. Speaker. This question is for the deputy premier. Speaker, the Canadian Pediatric Association has written to the premier to raise real concerns about the devastating impact this pandemic is having on children and youth. Their letter echoes concerns that we have been raising on this side of the house since this pandemic began. And they're asking the questions that parents across this province have. Speaker, students province-wide are back at home in emergency remote learning this week after this government failed to make schools safe, after this minister of education sent a memo around 24 hours earlier saying, don't worry, everything's okay. They failed to deliver small class sizes. They failed to deliver comprehensive in-school testing. They dragged their feet on prioritizing teachers and education workers for vaccination. And their only plan to help our kids after nearly two years of disrupted learning is summer school, summer school, Speaker. Instead of charting a path forward with a recovery that centers our children and youth, the minister of education is... Thank you. To reply, member from Davenport will take your seat. To reply, the minister of education. Mr. Speaker, the pessimism of the member ops is not going to get us through this pandemic. What we need is a united resolve to overcome the challenge. It's why the premier announced a plan of $1.6 billion in schools, upgrading 96% of air ventilation systems within the province. 7,000 more teachers hired. Hundreds of mental health support extended. The single largest investment in mental health, $52 million for children facing adversity as a consequence of being home. But what the member leaves out in her question is that if it was left up to the Democrats and Liberals, they would have kept schools closed in all of 2021. That just is the truth, exacerbating the mental health challenges. That is a fact. And the members on this side of the House and our premier know that children are best to be in schools. We are working hard with the chief medical officer to do that. We're realizing that we've taken action province-wide to reduce transmission in the community to get our kids back. Thank you. The second period is concluded. This House stands in recess until 1 p.m.


I'm pretty jealous of the celebrity endorsements that Nick had in his. Unfortunately, I wasn't able to find anyone that had this particular disorder, but I think it'll still be interesting. So as I've already been introduced, my name's Scott Buticofer. I'm a visiting fourth-year student from the University of Washington School of Medicine and I'm going to be presenting a case today that I worked on with a resident at the University of Washington. This was also with the support of two faculty members at the UWI Institute and this is a case of endobacter cloacae, post-surgical endophthalmitis. And I'm going to start by briefly discussing the case, presenting the case, and then I'll discuss a little bit more about post-surgical endophthalmitis, particularly with this organism. So our patient was a 67-year-old man who presented with very typical signs of bilateral cataracts. He had blurry vision and glare. His past medical history was significant for diabetes and hypertension, but he didn't have any past ocular history. The right eye was 20 over 60, left eye 20 over 100. And so we went ahead with a plan in place to perform intraocular surgery, removing and replacing the lens, and that went forth without any complications. So on post-operative day number one, he presented in the morning with a visual acuity of 20 over 100. And on SlitLamp exam, there were signs of anterior chamber inflammation, so mildly increased intraocular pressure, but there's no hypopian present, and so he was instructed just to use prednisolone drops and present again in the afternoon for re-examination. Six hours later, he had subjective worsening of his vision. Visual acuity was now 20 over 300. The SlitLamp exam now showed one millimeter hypopian and also corneal edema. So he was presumed at this time to have endophthalmitis and was promptly tapped and injected with vancomycin and septazidine, broad-spectrum antibiotics covering for gram-positive and gram-negative organisms. He was also instructed to use a topical antibiotic, set home with prednisolone, to continue, and was also started on a daily oral levofloxacin. So unfortunately, post-operative day number two, the patient did not return due to a miscommunication, but he presented again on day number three, and his visual acuity was now counting fingers at three feet. The SlitLamp exam revealed that most of his signs were resolving. There was decreased inflammation in the anterior chamber. And the cultures that were collected were now growing gram-negative rods, which is an ominous sign, as will be shown later in the presentation, as gram-negative rods are usually associated with a much poorer outcome from endophthalmitis. On post-operative day number four, those cultures were then found to be positive for enterobacter resistant to ampicillin and sensitive to septazidine. By post-operative day number six, his symptoms and signs had resolved. And after a 14-day course of levofloxacin, the best corrected visual acuity of 20 over 60 was obtained. So now a little bit more information on post-cateric endophthalmitis. The overall incidence is somewhere between .05 and .68 percent. Many studies report different rates on this. It is a rare occurrence. And there are several risk factors that have been identified for a poor outcome. The first being earlier onset, typically associated with the worst outcome. The worst vision presents as the worst that typically ends at the end. And also, cause of organisms other than coagulase negative staphylococcus tend to have a poor outcome. And as you can see on this table that I put together, gram positives represent the vast majority of organisms that cause endophthalmitis. And this is thought to be because these are normal ocular flora that are present before and after surgery. While gram-negative organisms, including entrobacter, represent less than 10 percent in both of these studies of the cause of endophthalmitis. To speak a little bit more about entrobacter cloacae specifically, it was first reported by a Dr. Rose in 1966. This is a gram-negative, rod-shaped, facultative anaerobic. And it's present in about 40 to 60 percent of normal human GI flora. It has become an important nosocomial infection in the last couple of decades because it has resistant to multiple disinfectants, multiple antimicrobials. But it's still very rare in endophthalmitis cases, which is why I wasn't able to find any celebrity endorsements, unfortunately. There's only been 14 cases reported in the literature. And in all of these reported cases, the outcome has been uniformly poor, one achieving only hand motion, one achieving light perception, and 11 with no light perception, even despite treatment. Now, this table, though entrobacter is too rare to accurately determine its incidence alone, other studies have reported that the outcomes associated with the various infectious organisms and their final visual acuity. And as you can see here, coagulase-negative stapolococcus, the majority, about 60 percent in this study by Lawani, were able to achieve greater than 20 over 40 final visual acuity, with very few, only two, less than five over 200. If you go down the chart, particularly gram-negative organisms, you see that there's a much less likely incidence of achieving a final visual acuity of greater than or equal to 20 over 40. And here, I've compiled the results from a few studies. The endophthalmitis filtrectomy study in 1996, Lil'Wani was at Basco Palmer in 2008, and Kijil from the Netherlands in 2009. And this slide, again, shows that with coagulase-negative stapolococcus, they're pretty uniform in their results, achieving about a 60 percent rate of 20 over 40 final visual acuity. However, when you go down the chart, you see that there's much more spread that begins to occur. This is likely because these are, you know, rare causes of endophthalmitis, which is already a very rare disease. So the sample size is very small. It's hard to accurately assess just, you know, how often we can achieve different, a visual acuity of greater than or equal to 20 over 40 in these organisms. Now, whenever we find an infection, we want to start treatment as early as possible, hoping to minimize the damage to the eye and achieve a better result. Kijil reported that the percentage of patients who presented with endophthalmitis, signs within three days of surgery by the organism, was, that was cultured from the vitreous taps. And as you can see here, grand positive coagulase-negative staff, about 38 percent of the cultures that grew this were able to, they began to present with signs of endophthalmitis within three days of surgery. On the other hand, 100 percent of the cultures that grew gram-negative rods presented within three days of surgery with signs of endophthalmitis. This finding and the finding above that showed worse visual acuity outcomes with gram-negative organisms is the data that's used to link together the fact that there's a connection between early presentation and worse outcomes. However, Kijil found that there was no significant association of time from surgery to signs of endophthalmitis with a final visual acuity of greater than or equal 20 over 40. So now there are some hypotheses as to why organism type leads to these very different results. The first being organism virulence. And virulence is really a general term that is often used. It's describing the specific endotoxins and proteases that each of these organisms create a very unique milieu with. And as a result, there's widely different results both in the progression of the disease and in the final visual acuity reached. The condition of the eye at presentation also reflects the violence of this organism, but also reflects the duration of the infection and the hostability to respond to the infection. And as shown in the Kijil case, there is an unclear picture of the importance of early treatment to achieve a final visual acuity of greater than 20 over 40. Early onset indicates that there might be an increased virulence of the cause of organism and therefore an expected worse outcome. But rapid diagnosis is also associated with more rapid treatment. So the results are kind of muddled and it's, though there is a general consensus that early treatment will lead to improved sight, there is not clear evidence that it will lead to a final visual acuity of greater than or equal to 20 over 40. Of course, the last important factor in why different organisms cause greater or less damage to the eye is due to the susceptibility or resistance of two antibiotics of each organism. And Han and his group took the endophthalmitis filtrectomy study and they tested the isolates for susceptibilities to commonly used broad-spectrum antibiotics. All of the grand positives tested were susceptible to vancomycin and about 89% of the gram negatives were susceptible to amicacin and septazidine and 11% were resistant to both. In reports by Merza and his case series of entrobacter cloacae endophthalmitis, his isolates were found to be resistant to gentamycin and cephasolin, which unfortunately were the drugs that he chose to treat his patients with and likely contributed to the very poor outcomes that he saw. So in summary, identification of the infecting organism is important because it has an impact on the presentation and also the final visual outcome. But it's better to be lucky than to be good. And what I mean by that is saying by treating with broad-spectrum antibiotics quickly, we can treat against most infectious organisms and have a good chance at a positive outcome. But it's difficult to accurately measure how organisms other than coag negative staff, which is common, respond to the appropriate treatment due to the small numbers reported. The minimal inhibitory concentration, even for partially resistant organisms, is likely orders of magnitude lower than the concentrations that are reached in the eye after intravitural injection with antibiotics. So even though you may not choose the ideal antibiotic for the organism that's infecting the eye, there's a good chance that you'll be covering the organism and still do a good job at treating the eye. When the culture returns, the broad-spectrum antibiotics that you've already started your patient on will likely have done more for the final visual acuity than any changes you might make to your treatment based on the susceptibility reports that you get back. So the only thing I'll say in conclusion now is that even very virulent organisms, such as entrobacter, can be treated and have a good outcome with effective early treatment and a little bit of luck. I would like to acknowledge Jason Dottori, who's the resident who performed the surgery and also saw this patient clinic and worked with me on developing this case report, as well as the expertise of Dr. Vemmela Khand and Dr. Slebaugh, who helped us with this. Thank you. You have very rare complication. So I don't want to jump to conclusions too quickly. Yeah. The fact that they did the right thing on task. Right. So I'm happy to be lucky. Right. So that raises the issue. If you have a leaky wound. Thank you very much. Thank you.


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