Healthcare Graphics Need Help: Ontario’s COVID-19 Framework Needs Help

Here in Ontario, this is our COVID-19 restriction framework – a colour-coded chart:

We have much to criticize about it – the scope, the times they were implemented (closing too late and opening too soon), or the careless use of symbols that lead to double meanings.

But what we can’t get our eyes off of is the fact that a universally understood three-colour stop-light scheme (green, yellow, red) is being stretched to depict five different states of lockdown.

Quick question for Ontarians – without looking again at the image above, what does “Yellow” mean in the Framework?

We forget, too!

In public health, communications are the interface between instructions (laws, guidelines, requirements, operations etc.) and the people doing them. People performing infection prevention the right way and at the right time have saved lives in the past, and will continue to.

It can mean the difference between:

• An elderly person who doesn’t speak much English going out as normal VS wearing a mask correctly and washing their hands at the correct time – could save their life.
• A twenty-something person attending university and partying with friends in their dorm, VS taking a year off and connecting with their friends on ZOOM – could prevent thousands of cases both at the university and at home.
• An industrial machine operator with a mild cough losing their sense of smell and feeling fatigued, but going to work anyways VS them self-isolating and getting a COVID-19 test because they understand the symptoms – could both save their life AND prevent thousands of cases.

Understanding this, it’s crucial that the communications not miss anyone. Here in Toronto there are about 180 languages and dialects spoken, and while there’s a big effort to translate COVID-19 communications, someone will always be missed – whether it’s a dialect that wasn’t considered, or a gap in education (health literacy), or even just simple misinterpretation.

What would be better are communications that go above and beyond verbal languages, that are obvious rather than requiring explanation.

Which brings us back to the Ontario COVID-19 framework chart.

All benefit from using a stop-light colour scheme is eliminated by the added colours. Orange and yellow are both easily confused as “the middle colour” and grey comes out of left field. It would be simpler and easier to understand if the stages and their colours kept to the three colours we all know:

Then you would have a guide for the population that is understood by the population. It wouldn’t need explanations. It wouldn’t need clarifications. Red would mean “Stop”, green would mean “Go”, and maybe – according to an Australian think tank – Canada wouldn’t be in 61^st place for our handling of COVID-19.