As cases of COVID-19 continue to rise in hot spots in the province, experts are once again warning that hospitals may have to cancel elective surgeries in order to cope.
There are parts of the province — Mississauga, Etobicoke and North York — where nearly 25 per cent of patients in intensive care have COVID-19, said Anthony Dale, president and CEO of the Ontario Hospital Association.
Although hospitals still have beds available, Dale said the province’s intensive care units typically operate close to capacity, which means a surge of COVID-19 patients might push them over the edge and threaten elective surgeries once again, similar to what occurred during the first wave.
If elective surgeries are cancelled, “it’s people who need cancer and cardiac care and other kinds of elective activity that risk paying a price here,” he said.
A hospital in London, Ont., has already had to postpone non-emergency and non-urgent surgeries because of an outbreak.
The outbreak, at University Hospital, part of the London Health Sciences Centre, has hit seven units, including cardiology, acute care and multi-organ transplant. More than 140 staff and patients have tested positive.
In a public statement Monday, Toronto’s medical officer of health warned residents that we need to protect our health-care system.
Dr. Eileen de Villa said the aggressive spread of the virus will mean an increase in hospitalizations, which will endanger hospital staff and front-line workers, including paramedics, as well as slow the rate of care for other illnesses.
On Monday evening, the province’s regional public health units reported a record 2,006 confirmed or probable cases of COVID-19, the third daily record of new cases in a row. This brought the rolling, seven-day average for Ontario to a new high of 1,877 cases per day.
Here we present the Star’s weekly roundup of key figures in the province’s fight against COVID-19, including a look at how regions that saw their restrictions tightened Monday are faring, along with expert commentary.
Numbers keep climbing in hot spots
Toronto reported 651 new COVID-19 cases on Monday and three new outbreaks — one in a health-care institution and two in community and workplaces settings.
There were nine new deaths for a total of 1,671 deaths since the pandemic began.
In a public address, de Villa pleaded with residents to cancel in-home festivities this year, which she called “risky.”
“The more we can do — those of us who are well — to stay that way, the more we do to protect these vital resources,” she said. “We owe it to the health-care system, which we all treasure.”
Dionne Aleman, a University of Toronto professor and an expert in pandemic modelling, said it’s still too early to see the effects of the restrictions in Toronto and Peel.
“It’s been exactly two weeks since these new measures went into effect so we generally would expect to not see the effects of any measures until at least two weeks have passed,” said Aleman.
“Whatever we’re seeing in the numbers now is infections that were happening before the restrictions were put into place. Hopefully, in the course of this coming week, we’ll start to see some positive changes in the daily infection numbers.”
Aleman says she thinks case counts may be driven by people with COVID fatigue, who are hosting private gatherings or going out when they can. And she notes that 20- to 40-year-olds may not have the opportunity to work from home and are being exposed to the virus in the workplace or even on the TTC.
Aleman expects to see a bump in the numbers after the winter break.
“How big it is just depends on how much of the population gets the message that they need to be careful,” she said.
While new case numbers are continuing to grow, Colin Furness, an infection control epidemiologist at the University of Toronto, says some impact of the lockdown can be seen in the lack of exponential growth of COVID-19.
“We’re never prepared for exponential growth. We never think of it. It’s never on our minds. But the fact that we don’t have 5,000 cases a day, that’s what we should be happy about,” he said. “Is the number going to creep up? Yes it is.”
He said cases will continue to creep up for two reasons: one, we’re headed into winter, when respiratory viruses thrive; and two, there is a certain amount of acclimation to the situation by which people have become less diligent when it comes to physical distancing measures.
“I’m afraid that January, February and March are going to be really awful because those two factors are going to continue to cause cases to climb up,” Furness added. “Eventually you’ve got that tipping point where hospitals can’t function properly and, when that happens, then mortality goes up. Then people who would have survived easily if treated aren’t getting treated. Then you have this really awful spiral of avoidable deaths. Is that inevitable? No, but it is plausible.”
Meanwhile, Peel Region continues to have the highest rate of new cases, a total of 222.7 per 100,000 population from Monday to Sunday of last week. The good news? The region’s health unit said there has been slower growth in cases in recent weeks.
At the same time, the region has a per cent positivity — the percentage of people tested for COVID-19 and found to have it — of about 10 per cent as of Nov. 30, according to the data hub howsmyflattening.ca. The rate is the highest in Ontario. Toronto follows in second place with about six per cent positivity.
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“If you look at some of the test positivity rates, they’re much too high for comfort; that really indicates something is out of control in those regions,” said Todd Coleman, an epidemiologist at Wilfrid Laurier University.
York’s rate was third in terms of new cases, with 112.1 per 100,000 population.
Windsor Essex continues to struggle with the virus, with 17 outbreaks affecting schools, hospitals, long-term-care homes and workplaces in agriculture, health care, finance and insurance, and manufacturing.
The area has the fourth highest rate of new infections: 91.5 per 100,000 population for last week.
Three health units face more restrictions
On Monday, three areas of the province were moved into new categories of the government’s COVID-19 response framework, resulting in further restrictions to stop the spread of the virus.
Middlesex London moved to the “restrict” category, or orange, with 47 new cases per 100,000 people from Monday to Sunday of last week, a rate which ranks it 10th out of the 34 health units in the province.
In recent days, new cases of the virus in Middlesex London are nearly double what they were at the height of the first wave.
An outbreak has been declared at University Hospital, part of London Health Sciences Centre, where 72 patients and 61 staff and health-care providers have tested positive for the virus, according to the Middlesex-London Health Unit.
Thirteen deaths are tied to the outbreak, which started Nov. 10. Numerous floors and units of the hospital are involved including cardiology, the multi-organ transplant unit and acute care.
Hospital officials note the virus is circulating in the community and that not all of the new cases are the result of transmission within the hospital.
Thunder Bay has also moved to the “restrict” category, which means private social gatherings are limited to 10 people indoors and 25 outdoors, although crowds of up to 100 can still gather for organized events outside, or 50 inside, which is also the maximum number of patrons allowed in restaurants.
The area had 44.9 new cases per 100,000 population for the week ending Sunday, 11th highest in the province.
Case counts were low in Thunder Bay all summer — zero on most days — but cases suddenly picked up around Nov. 7, after which Thunder Bay reported new cases every day save one.
In a public statement, Mayor Bill Mauro urged residents to be cautious.
“Rising numbers represent an increased health risk to our population and, if it continues, could ultimately further impact the operation of municipal facilities and lead to a shutdown of our local economy,” said Mauro. “We all need to do everything we can to contain continued spread, especially with the Christmas season and associated family gatherings soon to occur.”
Three-quarters of the cases occurred through close contacts, according to statistics on the Thunder Bay District Health Unit site.
The Haliburton, Kawartha, Pine Ridge District Health Unit moved from the “prevent” to “protect” category, or yellow, which has the same gathering limits as the restrict category.
The rate of new weekly cases in the area was 18.9 per 100,000 people as of Sunday, a rate that ranks it in the bottom third of the health units.
“There’s a significantly large proportion of people who have no known epidemiologic link. So there’s still a lot of uncertainty about where people are getting this from, at least from the data we are being presented with,” said Coleman.
“We’re still left with a lot of uncertainty about what’s driving transmission because the province’s sort of driving these lockdowns and we’re not seeing much of an alleviation of the numbers.”
ICU capacity decreasing
As of Monday, there were 213 patients with COVID-related illness in Ontario intensive care units and, of those, 121 were on ventilators, according to the Ministry of Health.
Of the province’s 2,136 baseline critical care beds, 1,689 or 79 per cent were in use, as of Sunday, according to Critical Care Services Ontario, a provincial agency that helps the health system manage critical care resources. Six of the province’s 14 Local Health Integration Networks or LHINs are above 80 per cent critical care bed baseline capacity, according to CCSO.
To put this into context, overall COVID-related ICU admissions are currently about 75 patients below where they were during the height of the first wave in April, while the number of patients on ventilators in ICUs is about half of what it was at that time.
Aleman says the current ICU occupancy numbers mean that regular elective surgeries for things unrelated to COVID-19 will have to be paused. She said it’s not surprising hospitals are facing this situation given that lockdown measures for Toronto and Peel, the two regions responsible for most new daily cases of the virus, didn’t go into effect until the number of COVID-related ICU patients passed 150, a key threshold that the province’s own projections say could result in cancelled elective surgeries.
“If you wait until then to implement restrictions, and then it takes you two weeks to see the effects of those restrictions, of course those ICU numbers are going to continue to increase at that same rate,” she said. “Which means, of course, we’re going to blow past the 150 ICU threshold in no time at all, which is exactly what we’ve seen. You could see it coming a mile away.
“So you have to be very proactive about putting restrictions in place to make sure you don’t get to these thresholds where our health-care system is in a very precarious position.”
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