Peel’s medical officer of health is “running out of ammunition” to control the epidemic in his region and warns of further restrictions if the curve doesn’t begin to bend.

Dr. Lawrence Loh said additional “closures or curtailments” to reduce person-to-person interactions are being considered and may be implemented in the coming days if Peel’s daily COVID-19 cases remain the same or continue to rise.

The warning comes as Peel region reports a COVID-19 test positivity rate of 11.8 per cent — by far the highest in the province and more than double the provincial rate.

“We’re running out of time,” Loh told the Star. “I’m running out of ammunition.”

In the last two weeks, Loh has beyond provincial controls, including a ban on wedding receptions and social gatherings in businesses like banquet halls, and that could see employers face fines of $5,000 per day for not co-operating with outbreak investigations.

He has also repeatedly urged Peel residents to only leave home for essential reasons and to not socialize with anyone outside their household.

Yet the , putting hospitals, long-term-care homes and other vulnerable populations at risk, Loh said.

“We need people to hunker down over the next two to four weeks to cut down on the number of interactions,” he said. “But at a local level, I’m running out of ways to manage a decrease in the number of interactions in my community.”

Premier Doug Ford on Wednesday can be expected Friday for Peel, Toronto and York, saying “the virus is spreading at an alarming rate in these areas.”

Mississauga Mayor Bonnie Crombie echoed Loh’s concerns at a Wednesday press conference and also hinted at further public health measures, saying Peel is facing a “sobering reality” with widespread COVID-19 transmission where “the virus is controlling us.”

Crombie said Mississauga’s current test positivity rate shows nearly eight per cent of COVID-19 test are coming back positive. She also pointed to a rise in COVID-19 hospitalizations in Peel and the growing number of outbreaks in congregate settings as among her top concerns.

Peel currently has 11 long-term-care homes, five retirement homes and four group homes in outbreak, Crombie said. One long-term-care home currently has more than 90 residents and 60 staff who have tested positive for the virus, she said.

At Trillium Health Partners, the two-hospital system is nearing capacity and is caring for 42 patients with suspected COVID-19 and 60 confirmed COVID-positive patients, 12 of whom are in intensive care, she said.

“That’s 114 rooms being used for just COVID,” she said, adding that staff are preparing for more cases, and that while elective surgeries have not yet been cancelled that prospect is “a growing concern.”

Crombie called the situation at William Osler Health System, which includes Brampton Civic Hospital, “even more dire,” saying the hospital is in gridlock with a total of 120 patients who are COVID-positive or who are awaiting COVID tests.

Osler president and CEO Dr. Naveed Mohammad said the hospital system is facing less pressure this week after starting on Nov. 6, and postponing some elective outpatient surgeries at its Peel Memorial Centre for Integrated Health and Wellness.

“We are holding our head above water but we’ve had to manage and move things around on a day-by-day basis,” he said. He added that he shares Loh’s concern about Peel’s local epidemic and supports Peel Public Health’s recent additional measures and restrictions.

Mohammad said the recent small drop in COVID-19 cases in Peel might be related to the three-day closure of one of Brampton’s busiest testing centres after it was damaged in a weekend windstorm. The centre, which reopened Wednesday, typically processes more than 600 tests a day, with a recent test positivity rate of 19.8 per cent.

“Even though we transferred some people to Peel Memorial (to be tested), some of the lower case numbers in the last couple days may have been the result of that testing centre’s temporary closure. My fear is that because we were hampered for the last three or four days, cases may have been artificially low.”

At a Wednesday morning press conference, Loh said there are nearly 2,000 active COVID-19 cases in Brampton, with the city adding 200 new cases a day.

“This deeply concerns me. If even 10 per cent of those individuals require hospitalization our hospitals will continue to be challenged.”

On Friday, Peel Public Health abandoned some aspects of its contact tracing after facing a growing backlog of new cases, Loh said. Since mid-October, shore up its tracing but even that wasn’t enough to keep up, he said.

The new streamlined process, which focuses on high-risk exposures and asks some people to notify their own close contacts, is reaching people with new COVID-19 infections more quickly and has cut the backlog by 30 per cent, Loh said.

Colin Furness, an infection-control epidemiologist at the University of Toronto, said Peel creates the perfect storm for COVID-19 with its high proportion of large households, and some areas of the region densely populated with essential workers.

“It is not about local public health leadership and it’s not about residents not caring,” he said. “We knew by May where COVID spreads and how COVID spreads. We could have, as a province, taken steps with increased mobile testing and community engagement, and the province didn’t.”

Furness suggested it might be time for Peel to ask the federal government for more supports, beyond the voluntary it committed to earlier this month, rather than wait for provincial help.

Loh said he wrote a letter two weeks ago to Ontario’s chief medical officer of health, Dr. David Williams, to highlight that paid sick leave “would be a significant assistance to reducing transmission” in Peel region.

The Greater Toronto and Hamilton Area mayors and chairs on Tuesday said more supports are needed to ensure workers without sick-pay benefits can be tested for COVID-19 without fear of losing income.

Crombie on Wednesday told reporters that Peel has had 116 workplace outbreaks since September and currently has 80 active workplace investigations. Crombie said she is calling on all levels of government and all private sector leaders to come together to “find a way to give workers confidence so that they won’t be penalized for getting tested, getting sick or self-isolating to stop the spread of COVID-19.”

With files from Ed Tubb

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: