Amidst record-high numbers of new COVID-19 cases across Ontario in recent days, the province’s already-crowded hospitals can expect increasing demand for beds from new coronavirus patients while long-term care homes will continue to see more cases among residents, experts warn.
The rolling seven-day average of new cases of the virus Ontario-wide set a record Monday with 908.3, up from last Monday’s average of 777.7 daily cases. The growth was driven primarily by new cases in the province’s so-called “hot spots” — Toronto, Peel, York and Ottawa, with notable increases also occurring in Durham and Halton regions.
“If you ask around the hospital, are we nervous? Absolutely, because right now our hospitals are 100 per cent full,” said Dr. Samir Sinha, director of geriatrics at Sinai Health System and University Health Network in Toronto, adding the current numbers reflect the spread of the virus two weeks ago, namely Thanksgiving.
“I don’t get the sense that everyone out there is really adhering to the guidance as we should,” Sinha said. “I just think the situation we’re slowly walking towards is a situation that will be more dire in a couple of weeks.”
In the meantime, here is the Star’s weekly check-in on how the province is faring in its battle against COVID-19.
On Monday evening, Ontario’s local public health units were reporting 927 new COVID-19 infections, with Toronto leading with 300 cases, followed by Peel with 172, York with 94 and Ottawa with 76. Durham and Halton each reported 47 and 18 new cases respectively.
Neither Durham nor Halton are under the modified Stage 2 rules that the other regions are in.
Health Minister Christine Elliott told reporters Monday that Halton “has been sort of on the edge for a period of time,” and that any decision to impose restrictions on that region would be based on a number of factors, including medical evidence, discussions with the local medical officer of health and the ability of the public health system to follow up with testing, tracing and isolating.
“There’s a number of factors that need to be considered and Halton will be considered as with any of the other areas that we’re concerned about right now,” Elliott said.
Last week, Premier Doug Ford said he hoped to have a decision on whether to send Halton back to a modified Stage 2 by the beginning of this week, but no announcement was forthcoming Monday. This, after a group of politicians from the region, including Halton Region Chair Gary Carr and MPP Parm Gill, sent a letter to Ontario’s chief medical officer of health, Dr. David Williams, asking for measures that target activities and locations that pose the highest risk of transmission, rather than more general blanket measures.
Experts say it’s likely we are still not getting a true sense of the spread of the virus in Ontario because not enough people are getting tested. Even though the province’s testing capacity is close to 50,000 samples per day, just 28,652 were completed Sunday and just under 39,000 the day before that.
Following long lineups at assessment centres shortly after the start of school, the province eliminated walk-in tests and switched to an appointment-only system, a move some say may discourage people who aren’t technologically savvy or who don’t have internet access from getting a test.
Todd Coleman, an epidemiologist at Wilfrid Laurier University, said changing the rules, which the province has done several times, has led to a “a really big lack of clear communication about what’s involved in testing.”
“Who’s eligible for testing? Where do you get tested? And changing it up every few weeks or so isn’t helping the situation. We should be testing at full capacity, especially when we see the number of active cases go up this high,” he said.
Peel’s medical officer of health, Dr. Lawrence Loh, confirmed Monday that the region is in its second wave of the pandemic.
“Firstly, we’re seeing a significant decrease in our doubling time and rapid growth of cases,” he explained. The seven day rolling average of cases in Peel was 192 on Monday, up from 87.7 a month ago.
“And secondly, in our preliminary investigation of those cases, we are now starting to see cases identified outside of known chains of transmission,” he said. “So this is suggesting we are having more widespread transmission in the community.”
Loh said that in the last 48 to 72 hours, symptomatic people are turning up at the region’s assessment centres who haven’t been referred by Peel public health. Previously, most people who were tested were referred to the assessment centres because they were contacts of known cases, he said.
Loh said people should limit close contacts to immediate household members and essential supports such as caregivers.
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“At this time, with wider community transmission we know that it is more important than ever that people are curtailing their in-person interactions and sticking to the precautions as much as possible,” Loh said.
Dr. Karim Kurji, York Region’s medical officer of health, had a similar message on Monday.
In a public statement, Kurji said that people can be infectious up to two days before symptoms and because of that, residents should be “limiting severely the number of contacts we have with people outside our own households.”
Cases in York are at an all-time high and there are a number of outbreaks in workplaces, said Kurji, as well as 50 schools under surveillance. The region is averaging more than 90 cases a day and has a four per cent positivity rate, which means four per cent of tests for COVID are coming back positive.
Halton’s medical officer of health has also recommended public health measures that include keeping close contact to household members, limiting non-essential activity and avoiding team sports, indoor fitness classes and dining with anyone who isn’t a household member.
Although the province didn’t move Halton to modified Stage 2 restrictions on Monday, Dr. Hamidah Meghani, Halton’s medical officer of health, announced last week that the region has had more than 25 cases per 100,000 — the threshold for restrictions according to the province’s science advisory table, she said — for two weeks in October.
In a public statement, Meghani said cases started to “sharply increase” in September in those under 60, but this month they are also beginning to rise in older age groups, a trend she called “troubling.”
“The relaxation of restrictions and individual attention to public health measures over the summer has led to a resurgence of COVID-19 cases, creating a concerning upward trend this fall,” said Meghani in an email Monday. “Although daily COVID-19 case counts fluctuate, in Halton and elsewhere, the overall trends in Halton remain concerning.”
With 300 new cases announced by Toronto Public Health on Monday, the messaging wasn’t much different.
Dr. Eileen de Villa, the city’s medical officer of health, said people should leave their homes only for essential activities or for fresh air and exercise.
Meanwhile, Ottawa’s seven day average of rolling cases was 78.3 on Monday, down from more than 100 nearly two weeks ago.
The public health unit said it monitors “longer term trends over several weeks rather than peaks and valleys of daily data,” which are available on its website, including the research surveillance related to COVID-19 levels in wastewater.
“It is still too early to identify trends and make assessments based on the provincial restriction changes that recently came into effect,” said a spokesperson with the health unit. “We will continue to monitor the data available and will make public statements about noticeable trends if detected.”
While hospitalizations due to COVID-19 are nowhere near where they were during the peak of the first wave in the spring, they are slowly creeping up. Since Oct. 1, the number of patients in ICUs has risen from 17 to 27, while the number of people on ventilators has more than doubled to 51. There are a further 217 people in non-ICU hospital beds.
One of the reasons we’re not seeing as many hospitalizations this time around is due to the fact that recent infections have largely been occurring in young people, who tend to have more asymptomatic presentations of the virus, Sinha said.
The challenge, he said, is that younger, healthier people who contract COVID may interact with people with compromised immune systems or older adults who are more vulnerable.
“As that starts spilling over into these more vulnerable populations, you will indeed see hospitalizations rise,” he said. “What worries us right now is that we’re all working in hospitals that are currently 100 per cent full.”
With files from Ed Tubb
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: [email protected]
Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: [email protected]
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