If Ontario’s hot-spot regions cannot get COVID-19 under control, stronger compulsory measures might be required to slow the spread and get a handle on the virus, epidemiologists warn.
It’s a stark message that came on a day Toronto reported a record 538 new infections, four deaths and 176 hospitalizations, including 42 people in intensive care — numbers Eileen de Villa, the city’s medical officer of health, on Monday called “alarming.”
“In my opinion, the walk-back of allowances has been insufficient to slow the spread in these regions,” said Raywat Deonandan, an epidemiologist at the University of Ottawa. “At the very least, targeted guidance is warranted in some regions. People must reduce their daily exposures, if not voluntarily then perhaps on a compulsory basis.”
Colin Furness, an infection control epidemiologist at the University of Toronto, echoed Deonandan’s comments and suggested a lockdown is the only tool Ontario would have left if hospitals inch closer to becoming overwhelmed.
“Mortality goes way up when health care gets overwhelmed and then it continues to get worse,” Furness said. “If other measures are not working then that’s the only thing left … a lockdown is failure.”
In Ontario’s hot spots — Toronto, Peel, York and Ottawa — cases continue to climb, with new cases in these regions making up 68 per cent of all of the province’s new cases Monday.
For the past week, daily new cases in Ontario have remained above 1,200 per day; the rolling, seven-day average is now 1,465 new cases per day.
What follows is the Star’s weekly roundup in chart form of key indicators in our battle with COVID-19 and what we might expect in the coming weeks, along with expert commentary.
Ontario’s COVID-19 hot spots
Toronto leads the way with the highest seven-day rolling average for the four hot spots at 479.9 new cases daily.
Laura Rosella, an associate professor of epidemiology at the Dalla Lana School of Public Health, told the Star that further restrictions, increased testing and community supports are needed to get spread under control.
“It’s too high to kind of hope that it’s going to … settle down,” she said, noting that while there’s not much left to shutter, any venues with mixed populations should be closed or highly restricted.
“I think we’re probably at a level where we need to think about anything that’s considered non-essential, and whether or not it needs to remain open and how it can remain open safely. The community transmission is just too high.”
In Peel, which reported 303 new cases Monday, the rolling seven-day daily average has risen to 407.6, up from 313.6 last week. In Ottawa, there were 51 new cases reported, and in York Region there were 138 new cases of the virus detected. The rolling seven-day daily average in those regions is 53 and 151.6 new cases per day, respectively.
Nonetheless, Furness said he believes compliance on measures such as masking remains high. “I think most people are actually being compliant or trying to be compliant,” Furness said.
“When I get on the subway, when I look around most people are actually out there” with masks on and practising physical distance. That said, where cases continue to surge, “the genie is really out of the bottle,” he said. “It’s out there in the community, and it’s going to go where we expect it to go.”
Cases requiring hospitalization continue to climb
Hospitalizations are on the rise in the province, with 500 people in hospital as of Monday across the province. Of those, 125 are in intensive care.
Despite the rise in hospitalizations, Deonandan said hospitals are still able to accept patients, and surgeries have not yet been cancelled — a metric that would show an overwhelmed health-care system.
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“In general, ‘there is room at the inn,’ ” Deonandan said. However, demand on nursing staff is high. “In some places, nursing staff is feeling overwhelmed. Our issue, as far as I can see, is staffing, not space.”
While new beds can be brought in quickly, there is a limit to the number of available health-care workers, he said. “ICU nurses in particular are in demand, as each COVID patient thus admitted requires hundreds of hours of dedicated care.”
Rosella said the province is on track to seeing hospitals forced to cancel elective procedures. Unlike the first wave, when elective and planned care was largely placed on hold, hospitals are generally busier with non-COVID cases, she said.
“I’d say that we should be concerned at the level of hospitalizations,” Rosella said. “I think that we’re at a point where we’re reaching the numbers that we almost saw in terms of total hospitalizations in the first wave when things are very bad.”
While some hospitals are already full, many remain able to accommodate patients, she said.
“Some hospitals, they’re really at the point where they’re overwhelmed and other hospitals … maybe aren’t feeling it quite yet,” she explained. “And so we have a lot more variability this wave.”
Deaths on the rise
Deaths have climbed steadily since mid-October. Deonandan said he expects the average daily death toll to exceed 20 per day within approximately the next week.
Current death numbers are nowhere near the peak the province saw in early May during the first wave. On Monday, 10 new deaths were reported in Ontario. On Sunday, there were 29 new deaths. The rolling seven-day average for daily deaths in Ontario is 16.1 as of Monday.
“One way to look at this is that some of the people infected during the Thanksgiving socialization spurt will enter the hospital system in mid-December, potentially showing a spike in deaths at the end of the year. It mirrors the trend nationwide,” Deonandan said.
In the first wave, the death rate was “really tragic,” Rosella said. This time, if we are able to protect vulnerable populations and avoid as much spread into older age groups, the death rate may be smaller, she said.
“At this point, though, we are still seeing long-term-care outbreaks and older members of families infected. So I’m not optimistic that the death rate is going to be dramatically different.”
Manitoba continues to experience accelerated spread and a test positivity rate of 13 per cent. In Ontario, that number is four per cent.
“Alberta is not reporting that figure due to their testing regime having been overwhelmed,” Deonandan said. “So most signs point to Ontario being in a better position.”
He said Ontario’s capacity to absorb cases is better, while the length of hospital stays has decreased since the spring and opened up more space. “But the increased cases (in Ontario) are consuming that buffer that the reduced length of stay has afforded us,” Deonandan said.
“I suspect we probably remain resolutely uninterested in learning from our data” in Ontario, said Furness. “Ontario is treating this like a political problem. COVID is a political problem and that leads to some really awful outcomes.”
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: [email protected]
Jenna Moon is a breaking news reporter for the Star and is based in Toronto. Follow her on Twitter: @_jennamoon
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