KITCHENER -- Region of Waterloo's top doctor said a lockdown is a "real possibility" as the spread of COVID-19 continues in the community.

During a Board of Health meeting, Medical Officer of Health Dr. Hsiu-Li Wang said workplaces and businesses are driving a lot of the spread in the region. However, she added that outbreaks in long-term care, retirement homes and schools are mostly controlled right now.

According to Dr. Wang, there's been a concerning trend of employee-to-employee spread at some workplaces. She said there's also concern about client spread in sports and fitness facilities where people aren't wearing masks to work out or maintaining physical distancing.

Hospital capacities are strained, Dr. Wang said, as hospitalizations and ICU admissions increase.

Dr. Wang said there are no set criteria for moving into lockdown and regions may move into that tier if the situation gets worse in the red tier. While things have worsened since moving into the red tier, Dr. Wang said officials need more time to decide if the measures are working.

"We need to monitor the situation in Waterloo Region very closely and most importantly we, as a community, need to act now," Dr. Wang said. "Many of us have already taken these actions. We need many more of us to take these actions."

She urged people to stop all non-essential contacts with people outside of their households, including holding events like birthday parties, sleepovers and coffee dates, to get the situation under control.

"We have one of the highest rates in the province," she said. "We have to no longer gather socially."

Regional Coun. Michael Harris also asked the region to request more contact tracers from the provincial and federal governments. Dr. Wang agreed that they need more case investigators to help better map out the spread of the disease.

The board approved Harris' motion and will advocate for more help.

In a news release, the region said Dr. Wang has requested more case and contact tracers, along with continued support for enforcement through the Ministry of Labour.

“As we have only been in the Control - Red level for a little over a week, our request for support is urgent and timely to help us slow the spread,” Dr. Wang said in a news release. “Additional case and contact and enforcement personnel will allow us to be more successful under the current restrictions and ideally slow the spread to avoid a future lockdown.”

The Ministry of Labour said it will respond to the region's request on Friday.

Infectious disease specialist Dr. Abdu Sharkawy said residents should behave like they're already in lockdown.

"I think it's naive to expect to border on an area that is already going through a very difficult time controlling numbers and to expect you are going to remain immune," he said.

Municipal leaders have acknowledged the difficult decisions public health officials have needed to make, including a possible lockdown.

"It's been a very long nine months for all of us," Kitchener Mayor Berry Vrbanovic said. "But the last little while has been particularly challenging for you and your team."