The world marked the disturbing milestone of 40 million COVID-19 cases Monday, but that’s just the tip of the iceberg according to Colin Furness, an infection control epidemiologist at the University of Toronto.
With estimates that five per cent of the world’s population — almost 400 million people — has been infected to date, “we’re still just getting started,” said Furness.
“It’s only a fraction of the total number of COVID cases that must have happened worldwide,” he said. “I mean, if you’re COVID, the feast has just begun.”
Cases are shooting up in areas of Europe such as France, where new confirmed cases numbered 32,000 in one day. The country has imposed 9 p.m. curfews in Paris and eight other cities. Italy’s prime minister has given mayors the power to limit the hours when people can venture outside.
In Ontario, it will be at least another week before we know whether the results of the modified Stage 2 restrictions imposed Oct. 10, which include a ban on indoor dining, are having a positive effect.
“We’d have to look at least two weeks’ worth of data,” said Dr. Lawrence Loh, Peel’s medical officer of health, “but certainly I’m looking at what our case numbers do over this week and I’m hopeful that by this weekend we may see some changes that reflect the modified stage two measures that came into place.”
Meanwhile, health officials advised Monday against a traditional Halloween in four hot spots in Ontario, leading many to question the province’s logic given that students are still attending school where physical distancing is difficult.
In what follows we take stock of the current situation facing Ontarians and look across the pond to a brewing second wave in Europe.
The seven day rolling average of new cases in Ontario was 778 on Monday, down from 798 on Friday.
But epidemiologist Ahmed Al-Jaishi, a PhD candidate in health research methodology at McMaster University, said it will be a week before we know if the modified Stage 2 restrictions, which include a ban on indoor dining in four regions of the province, are having the desired effect.
Al-Jaishi said we should look for lower case numbers in the province in combination with a reduced reproduction number for the virus, which on Monday was 1.05, according to data from biostatistician Ryan Imgrund.
Al-Jaishi says an optimal reproduction number is around 0.8, which means each person with COVID-19 will infect less than one other person, and which will lead to a large decrease in the number of cases over time, he said.
Confusing things is a higher positivity rate, which refers to the proportion of tests that are coming back positive.
According to Public Health Ontario, 3.1 per cent of tests were positive on Oct. 19, which was 0.6 percentage points higher than the day before.
Al-Jaishi says the increase in positive tests is “pretty significant,” but he thinks the growth is due to a policy change by the government, which is now only testing symptomatic individuals at assessment centres, and not due to a higher prevalence of the disease in the population.
“It’s really hard to know whether (the increased positivity) is because of the restrictive policy or if it’s actual higher prevalence.”
Ontario’s chief medical officer, Dr. David Williams, advised Monday against trick-or-treating in four areas of the province under modified Stage 2 restrictions, which include Peel, York, Toronto and Ottawa.
The medical officers of health for each region agreed with him.
Together, the four areas accounted for nearly 70 per cent of the province’s 794 cases reported Monday.
“We do know that if it was perfectly done, in an ideal setting, we know that you could reduce the risk significantly, especially if people stayed apart,” said Loh. “But we also know that in the real world, it’s not always perfectly done.”
Loh said he remembers taking shelter in a neighbour’s house when it rained last year as he was out trick-or-treating with his daughters and family friends. It’s a situation that could easily be repeated this year.
“There is a possibility for gatherings to occur. There is a possibility for congregation. There is a possibility that people will not just trick or treat with their immediate household,” said Loh, “which leads us to say that probably overall, it’s best to just discourage the practice just for this year.”
Peel Region has logged more than 100 cases a day for the last two weeks.
Loh said the high numbers are driven by a “significant data drop from the backlog of tests” in the province last week, as well as a “triad” of transmission among people getting the virus at work or a social gathering and transmitting it to household members.
A large wedding on Thanksgiving weekend, which was exempt from the province’s new restrictions on Oct. 10 that limited indoor gatherings to 10, have added to the case numbers, he said.
“The challenge is, if (banquet halls) remain open — the whole business model is predicated on bringing large groups of people together, which is incompatible with trying to control a pandemic.”
York Region is also battling a spike in cases.
“York Region Public Health has recorded a sizable increase in the total number of COVID-19 cases over the last month,” said Patrick Casey, director of corporate communications for York Region in an email. “Our seven-day average as of Oct. 18 was 71 cases. For comparison, a month ago, Sept. 16, our seven-day average was 21.6 cases and on Aug. 16, our seven-day average was 3.6 cases.”
Casey said that a large proportion of cases have been in people younger than 40, largely due to close contacts and local transmission. But the region is also monitoring an increase among “older, more vulnerable populations.”
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“We have seen rising cases in institutional settings and workplaces as well,” he said.
Toronto had 268 new cases on Monday, and added two neighbourhood maps to its online dashboard showing rates of testing as well as per-cent positivity.
“While trick-or-treating is often outdoors, it’s also a situation that brings too many people into close contact and one where it’s far too possible to mix closely with others and let your guard down,” said Dr. Eileen de Villa, Toronto’s medical officer of health.
Ottawa’s medical officer of health, Dr. Vera Etches, also encouraged residents to find alternatives to the traditional trick-or-treating.
In a special statement to city council last week, Etches noted that her city has had the highest rate of COVID-19 infection in Ontario.
“Between Oct. 4 and 10, Ottawa sits at number one with approximately 70 individuals testing positive for every 100,000 people,” Etches said in the statement. “We are seeing COVID-19 affecting all age groups across the entire city, and what is perhaps most concerning is the increase of people testing positive in long-term care homes. Testing volumes are high compared to other large cities in Ontario and the percentage of people testing positive continues to increase.”
Europe on fire
After appearing to get a handle on the spread of COVID-19 in the summer, Western Europe is once again experiencing surges of the virus.
Health authorities are now scrambling to enact restrictions to halt the spread, but whether they will be effective remains unclear.
Despite the enactment of new rules, countries such as Germany, France, Italy and Poland have seen recent spikes, as cases in the continent sit around 7 million, with close to 250,000 deaths.
Spain leads the way with the most overall cases, at 936,560, according to the European Centre for Disease Prevention and Control, followed by France (897,034), the United Kingdom (722,409) and Italy (414,241).
Furness said he believes the current surge in cases was unavoidable after members of the European Union began to promote and allow tourism and travel over the summer.
He said the philosophy behind the Shengen area, the 26-country zone that has abolished passport and border control, is at odds with staying safe during a pandemic.
“In a pandemic, what you really want to do is isolate and limit travel and do exactly the opposite of what the EU’s ideals are,” he said.
A curfew requiring people to stay at home between 9 p.m. and 6 a.m. came into effect Saturday in Paris and eight other major French cities as the country grappled with a record 32,427 new COVID-19 cases reported that day (and 25,086 the day before). To enforce the curfew, which affects more than 20 million people and is expected to last four weeks, 12,000 police officers have been deployed.
At the same time, the country is not instituting travel restrictions in an effort to avoid a full lockdown, while dining out has been limited to a maximum of six diners per table. Many public spaces, such as cinemas and theatres, remain open with modified seating and a requirement for everyone over the age of 11 to wear a mask. The government is also advising, but not requiring, people to work from home as much as possible.
On Sunday, Italy recorded 11,705 new COVID-19 cases, setting a record for single-day cases (and beating the previous day’s record of 10,925).
In an effort to avoid a complete lockdown, Prime Minister Guiseppe Conte has announced new restrictions, which include giving mayors the power to close public areas after 9 p.m., mandating that bars and restaurants close by midnight, cancelling festivals and conferences, and changing school hours.
While Germany has considerably fewer COVID-19 cases than many of its neighbours, the economic powerhouse has seen an uncharacteristic surge of infections in recent days, with Chancellor Angela Merkel warning of a “disaster” if the spread isn’t curtailed.
The country of 84 million people recorded a record 7,830 new infections on Saturday, up from the previous record set the previous day of 7,334 new cases.
In areas with more than 35 new infections for every 100,000 residents, Germany has instituted limits of 15 people in private gatherings and set a curfew of 11 p.m. for bars and restaurants.
In response to surging numbers in Poland — which could see as many as 15,000 to 20,000 new daily cases if infection rates continue to increase at the current pace — the government is taking the unprecedented step of turning its national stadium in Warsaw into a field hospital.
The country reported 7,482 new cases Monday, for a total to date of 183,248.
The Associated Press quoted Michal Dworczyk, the head of Prime Minister Mateusz Morawiecki’s office, saying the hospital at the stadium will initially have 500 beds, 50 of which will be for patients requiring intensive care, with the eventual goal of accommodating 1,000 patients.
“This is the first time we are doing something like this in Poland. It is a great challenge for us,” Dworczyk said.
Furness noted that with an R-value (the basic reproduction number) that hovered around one during the warm weather of the summer months, people were able to get away with increased contact.
“But as soon as the weather flips just a little bit, COVID gets a foothold,” Furness said.
“Then the problem is what’s called the force of infection takes over, which is to say the more virus that’s around, the less exposure time you need to get sick. That’s mathematically what it means. What it means conceptually is the harder it is to avoid getting sick at all. In other words, it picks up momentum.”
With files from the Associated Press
Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: firstname.lastname@example.org
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: email@example.com
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