On a day when new restrictions set in for Toronto and Peel Region in an attempt to reign in record-setting daily COVID-19 cases in recent weeks, a palliative-care physician specializing in long-term care says he is “terrified” of growing case numbers in nursing homes as winter sets in.
“We know that coronaviruses are seasonal viruses,” said Dr. Amit Arya, director at large for the Canadian Society of Palliative Care Physicians and an assistant clinical professor at McMaster University’s family medicine department.
“We had months in the summer to prepare for this, to respond especially in long-term care where the greatest impact of the first wave was. So as cases and mortality start to accelerate in long-term care, it’s absolutely devastating to see and hear about,” he said.
“Winter is just starting. We’re not at the same point as we were in the first wave.”
Of 2,150 residents of Ontario long-term-care facilities who have died of the virus since the pandemic began, 305 have died since Aug. 1. (Ontario as a whole has reported 711 deaths overall due to COVID-19 since then.)
Meanwhile, Ontario’s local public health units reported 1,451 new cases of the virus Monday afternoon. Most of those cases originated in Peel Region (406), Toronto (331) and York Region (169), accounting for 62 per cent of the province’s new cases.
Here we present the Star’s weekly roundup of key indicators in our battle against COVID-19, including a look at how other provinces are faring, as well as expert commentary.
Peel and Toronto continue to drive up cases in Ontario
Together, Peel and Toronto accounted for about half of new cases in the province reported Monday afternoon.
Dionne Aleman, a University of Toronto professor and an expert in pandemic modelling, said Peel’s case numbers were “really very surprising considering that Toronto has a much larger population.” The region has 1.5 million residents, about half that of Toronto.
Aleman says it’s difficult to determine why Peel is such a hot spot, but that it could be due to a number of factors, including a reliance on public transit — which could mean more exposure to the virus — multi-generational living situations or even workplace settings.
“They might not have the luxury of being able to work from home as much as people who are living in the city,” said Aleman. “I’m really not sure that these current measures are really going to be enough to dampen that.”
During the first lockdown, when only essential services were open, the province had days in the summer when total new cases were below 100.
“The lockdown we had early in the summer was extremely effective,” said Aleman.
But she doubts this one will see such strong results.
Stores are still offering curbside pickup, which means employees in these settings are commuting to work, perhaps on public transit, while people who work in offices can also still go to work.
Toronto’s St. Lawrence Market is open, as is the Hudson’s Bay store on Queen St., as well as other large stores which sell necessities.
Aleman added that she’s hopeful the new restrictions on people’s movements will “clue a lot of people in to being a lot more careful and returning to how careful and cautious they were over the summer.”
The summer months also meant that kids weren’t in school. Aleman said if the numbers there get too high, the province could close schools, although the decision would be a difficult one.
“There’s a lot of concern about children’s development, and socialization and their ability to learn at home,” said Aleman. “That’s nothing to sniff at. You don’t want to just wave that away. And if our ultimate goal is to keep schools open for our children, then we just need to be that much more hypervigilant and restricted everywhere else.”
She says that given the current trajectory of the virus, the government’s projection that we could reach 5,000 or 6,000 new cases a day by December is realistic.
Growth in long-term-care homes
Ontario’s long-term-care homes continue to struggle to keep the second wave of COVID-19 from breaching their walls.
Arya, the palliative-care physician, noted that because of staffing shortages in long-term-care settings, staff members are unable to create bubbles in the facilities.
“It becomes impossible to do the job well because the sheer volume of medically complex (residents) is so high, and then you have too many contacts,” he said, adding that the ideal case would be for groups of health workers to have the ability to work on the same unit, looking after the same people, and for employees to be granted decent living wages, provided with sick leave and having the ability to work in just one home.
There were 528 active resident infections in Ontario long-term-care homes as of Nov. 22, down from a second-wave high of 721 on Nov. 13. On Aug. 1, there were just 10 COVID-19 cases among residents in Ontario long-term care. Staff cases now sit at 467, down from a second-wave high of 541 on Nov. 17.
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Meanwhile, the number of homes with active outbreaks as of Nov. 22 was 101, up from 20 on Aug. 1, with a high of 108 reached on Nov. 16. The facility with the highest number of current resident infections is Rockcliffe Care Community, a 204-bed facility in Scarborough, with 53 active cases, followed by the 160-bed Harmony Hill Care Community in East York, with 36 active cases.
Arya noted that even though many residents of such facilities survive COVID-19, “their lives are changed forever by the virus.
“We can imagine how bad that would be for someone who is already elderly and suffering from some other illnesses. After they get COVID, maybe they’re not counted in the mortality statistics, but they’re bed-bound,” said Arya, who witnessed the virus’s spread first-hand while working in GTA facilities during the first wave. “People, regardless of whether they survive COVID-19, have a right to care and they have a right not to suffer.”
Newfoundland and Labrador, P.E.I. leave Atlantic bubble
For the past four-and-a-half months, Canadians in Atlantic Canada’s four provinces have been permitted to travel across those provincial borders without the subsequent need to quarantine in what became known as the Atlantic bubble.
But on Monday, that all changed with announcements from the premiers of both Newfoundland and Labrador and Prince Edward Island.
Newfoundland Premier Andrew Furey said Monday he made the tough decision to “implement a circuit break” as his province leaves the bubble for two weeks.
A while later, P.E.I. Premier Dennis King announced his province would also be leaving. The moves mean visitors to these two provinces, including those from the other Atlantic Provinces New Brunswick and Nova Scotia, will have to self-isolate for 14 days upon arrival. In addition, travel to and from these provinces will be limited to essential travel for two weeks.
Newfoundland currently has 23 active cases of COVID-19, including two new confirmed cases announced Monday. P.E.I. reported its first new case of the virus in nearly two weeks on Monday, and has had a total of 69 cases since the pandemic began.
Newfoundland shut down schools in the area which had the most recent cases for a couple of days, in order to understand what was happening, said Aleman; students in one class were placed into isolation for two weeks.
“They’re really taking very swift and prompt action, which will help return them to a place of having zero cases,” said Aleman, who contrasted the situation in these two provinces with an Ontario region like Peel, which has seen hundreds of new cases every day in recent weeks.
“It becomes virtually impossible to respond quickly to every single one of those cases,” said Aleman. “As we know our contact tracing has been put more or less on hold in Toronto and Peel because there are just too many cases to contact trace. So we can’t really know for certain where people are getting infected. Is it at their workplaces? Is it at schools? Is it at the gym? Is it retail?
“If we don’t know where people are getting infected, then we can’t execute really targeted restrictions,” said Aleman. “We really only have left to us this one tool of the lockdown.”
Alberta open for business
Cases are spiking in the western province, but it’s not surprising given Alberta is pretty much open for business.
The province had 12,195 active cases as of Sunday, nearly as many as Ontario, despite having a population one-third the size of Ontario.
“The numbers are crazy,” said Jim Kellner, a pediatrician with a subspecialist in pediatric infectious diseases and a professor at the University of Calgary. “They’ve really taken off. Our rates of new cases per day are extremely high … It’s not surprisingbut it’s very distressing.” Cumulative cases total 46,872.
The province has implemented some restrictions, such as banning indoor fitness classes, shutting down liquor sales after 10 p.m. at restaurants and banning residents from socializing with people outside their household.
But Kellner said people can still go to gyms — although he said there’s not much evidence that gyms or restaurants are a problem — and people can gather in groups of 15 outside the home in restaurants and other venues, as well as in cohorts of up to 50 when it comes to sports teams or the performing arts.
Kellner said the province was doing extremely well in the early part of the pandemic, when it was on top of testing and contact tracing. And deaths are still lower on a per-capita basis than Quebec and Ontario.
But he said hospitalizations are rising, and positivity rates are around six per cent, much higher than they were from June to October, when the rate hovered around one per cent.
Classroom sizes are also unchanged and ventilation is an issue in school, although students from kindergarten to Grade 12 are wearing masks. But some schools have had large outbreaks with as many as 40 cases.
He said cases in schools may be a reflection of community spread, but suggested a longer holiday break would be better than doing nothing to control cases in schools. Contact tracing in Alberta has also fallen behind, he said.
“Too many contacts are being allowed,” said Kellner. “It’s as simple as that, in a desire to keep the economy open.”
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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