As new COVID case counts in Ontario continue to hover around 3,000 per day despite extreme lockdown measures, residents may be wondering what more they can do to mitigate virus spread until vaccine distribution picks up.

Health officials have warned of people still getting together with friends and family despite a moratorium on private indoor gatherings, and there's been a lot of shaming going on surrounding socializing and going on non-essential trips (and rightfully so).

But one Toronto doctor says that most citizens are indeed doing their best to follow stay-at-home orders, and that it isn't parties and deliberate rule-breaking that are necessarily contributing most to COVID transmission — things are more complicated than that.

"I've been wanting to write this thread for a while. It has been inspired by hearing a common thought: why can't people just 'listen'? If people just followed the rules, we wouldn't be in this mess. I think this is oversimplification of the problem with COVID," Trillium Health Partners infections diseases physician Dr. Sumon Chakrabarti wrote in a popular Twitter thread this week.

"We keep hearing over and over and over, stay home. There are diminishing returns with this advice, but also, most people who can stay home ARE. So what's the issue? There are a HUGE # of people who can't stay home because they work in essential jobs."

Many workers here go to work feeling unwell (when quite contagious) because the alternative is being off for several days and potentially not having money to pay for essentials. 7/

— Sumon Chakrabarti (@TorontoIDDoc) January 10, 2021

Numbers show that outbreaks in workplaces like factories and industrial settings have been a huge problem in Ontario, second only to long-term care homes and similar locations, with 233 total outbreaks compared to 507 in care settings.

Toronto in particular has seen 313 outbreaks in community and workplaces, versus 403 in healthcare institutions, including long-term care homes.

Migrant workers, staff at meat packing plants, those in the grocery and food service industry, construction workers, and other demographics have been particularly vulnerable to getting sick at work — and going to work when sick — while those in other sectors have the benefit of being able to stay home and isolate from others.

...some that we could act on (occupational safety, paid sick leave, isolation centres etc) and others we can't do much more about without getting heavy-handed (indoor transmission in private gatherings) 14/

— Sumon Chakrabarti (@TorontoIDDoc) January 10, 2021

The City of Toronto is now finally identifying businesses that have active outbreaks and working to implement even more health and safety measures for employers to follow, but the fact is that essential workers still have to go to work and maintain operations each day, and that this may be a key driver of recent case numbers.

Those businesses still open are busier than ever, whether it's supermarkets or online vendors like Amazon, with both settings potentially serving as prime grounds for spread.

Hundreds of staff at Amazon fulfilment centres across Canada, for example, have become infected with the virus and cite unsafe work conditions amid the pandemic.

Thus, "the pandemic is complex and much more than just people not listening," Dr. Chakrabarti writes. "We should think about things lockdowns/curfews don't address, like occupational exposure."

Other factors that have nothing to do with people gathering include the nature of the virus — "a resp virus which spreads best at and just before the onset of symps (often very mild) means that it's not something we could ever contain in most circumstances," Dr. Chakrabarti says — the season, and more.

4. There are many factors we can't control (e.g. weather) that play a big role, so to blame current situation squarely on failure on something we did or didn't do, is not accurate. 18/

— Sumon Chakrabarti (@TorontoIDDoc) January 10, 2021

In his opinion, for these reasons, things like curfews and more stringent lockdown restrictions on the general public that don't prioritizing essential workplace settings may not be the most effective.

"Ironically, a curfew could potentially worsen things if more people on average are gathering inside," he adds. "Unintended consequences are important to consider. A large intervention is often like squeezing a balloon."

As much as we all definitely need to keep staying home, avoiding gatherings and putting off non-essential travel, there may be a bit of a shift needed in how we look at where and why the virus is spreading, and how to best curb it.