PUBLIC HEALTH RESPONSES
State of Emergency Extended – Ontario
Ontario has extended its state of emergency an additional 28 days to May 12th, 2020.
Premier Ford stated that students will not be returning to school on May 4th, 2020.
Long-Term Care and Retirement Homes
Nearly half of the COVID-19 deaths in Canada are linked to long-term care homes.
In Ontario, there are outbreaks (meaning 1 or more confirmed case) in 114 long-term care homes (approximately 14%) and 44 retirement homes (approximately 5%). Ontario will soon be launching a new action plan to enhance responses to COVID-19 in long-term care homes. On April 14th, 2020, the Premier stated this plan will include a directive for every long-term care home worker to restrict work to one home, supports for the homes to secure additional staffing and resources required, and plans to deploy hospital teams into the homes when needed.
The Ontario Ministry of Health is working to develop updated guidelines for Long-term Care Homes. Guidelines are posted on the Ministry of Health website as they become available. They can be accessed here: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx
In Ontario, nearly 40% percent of COVID-19 infections are in people aged 60 or older. Data in the province suggests that people over the age of 80 who contract the virus have a 16% mortality rate. Global evidence suggests, however, suggests a 20% mortality rate for those over the age of 80, and 10% mortality rate for those over the age of 70.
Long-Term Care and Retirement Homes – Canada
On April 8, 2020, the Government of Canada published new directives for long-term care homes in response to COVID-19. This directive includes new rules and restrictions for staff and visitors to long-term care homes, as well as guidelines for response in the case of an infection or outbreak. These guidelines are available here: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevent-control-covid-19-long-term-care-homes.html
Canada is working with the provinces and territories to implement this directive.
Travel
At midnight on April 14, 2020, the Government of Canada will implement a strengthened quarantine directive. Everyone arriving in Canada by air, land, or sea must self isolate for 14 days whether they are symptomatic or not. All travellers will be forbidden from isolating in a place where they can be in contact with vulnerable people (anyone over the age of 65 or any person with an underlying medical condition). Each traveller must outline a plan for self-isolation upon arrival. Any traveller that does not have an adequate plan must go to a designated isolation area, such as a hotel or other location designated by public health authorities.
This measure is enforceable under the Quarantine Act. It includes monitoring measures through public health units and RCMP officers, if required.
The U.S. and Canada are currently discussing an extension on the Canada/U.S. border closure for non-essential travel, originally put into place until April 19, 2020. Essential goods and services over the border continue.
CASES AND CONTRACTIONS – CANADA
COVID-19 infections continue to increase across the globe and in Canada. As of April 14, 2020, Canada has confirmed 26,163 cases of COVID-19 and 823 deaths.
On April 9, 2020, federal health officials released data projections of COVID-19 spread in Canada. Best case scenario projections, based on strong (current level) public health measures, estimate Canada will see between 11,000 and 22,000 deaths over the course of the pandemic.
With strong public health response measures in place, officials expect between 1% to 10% per cent of the Canadian population to become infected. A total population infection rate of 2.5% is estimated to result in 4,000 deaths, while a 10% infection rate will result in 44,000 deaths. These numbers are based on projections estimating 8% of cases will require hospitalization, 2.8% will require critical care, and 1.1% will result in death.With weaker public health controls, it is estimated that between 25% to 50% of the population would become infected; and, with no controls, the infection rate estimate rises to between 70% to 80%.
Canada has currently confirmed a hospitalization rate of 12.5%.
The pandemic is expected to come in two or three waves, with the first wave expected to peak near the end of summer. The Prime Minister has stated that there will be some type of restrictions in place across the country until a vaccine has been discovered.
Causes of Contractions
74% of COVID-19 cases in Canada are related to community transmission, while 26% are contributed to either exposed while travelling or close contact with a traveler returned to Canada. Over 50% of cases are linked to long-term care home outbreaks.
CASES AND CONTRACTIONS – ONTARIO
Ontario is still seeing hundreds of new cases each day with a cumulative total of 7,953 COVID-19 cases. Of these cases, 3,357 (44.9%) have been resolved. 334 cases (3.9%) have resulted in death. 950 people with COVID-19 (12.8% of cases) have been hospitalized. 255 of COVID-19 patients in hospital are in critical care, and 199 are on ventilators.
Causes of Contractions
• 15.1% due to travel history in the 14-day period prior to onset of symptom
• 16.4% due to close contact;
• 22.2% had community exposure; and
• 46.3% exposure information which is missing or pending.
Case Concentration – Geographical Breakdown
The highest per capita concentrations in the province are in Leeds, Grenville & Lanark Region and Lambton Country Region.
53.9% of the cases in Ontario are located in the Greater Toronto Area. The next highest concentrations in the province are the regions of Peel, York, Ottawa and Durham with high numbers in the municipalities of York, Niagara, Peterborough, and Ottawa.
First Nation Cases
According to Indigenous Services Canada, there are 35 cases confirmed on-reserve across Canada, with 11 confirmed in Ontario. First Nation communities in Ontario currently confirming cases include:
– Six Nations (6 cases and one death)
– Kettle and Stoney Point
– Akwesasne
– Fort Hope
Please note: there may be additional Ontario First Nations communities with confirmed cases. Information seeking and monitoring continues.
Health Care Workers
Health care workers still account for approximately 10% of confirmed cases (800 people). 40 health care workers have been hospitalized and now 11 are in critical care. NOTE: not all health care workers contracted the virus on the job – these specific numbers are in the process of being determined by Ministry of Health.
TESTING
Federal and Ontario
Over 450,000 tests have been completed in Canada with 6% confirmed positive. Canada is securing rapid result or point of contact test kits, which can reportedly produce results in under an hour. They are seeking these tests internationally and are also working with an Ottawa based company called Spartan Bioscience to develop them domestically. The date for the availability of these tests and shipment to the provinces is yet to be determined.
Ontario medical officials are expecting access to point of contact or rapid testing kits in the next few weeks and are developing a strategy for their implementation. The province’s current positive test rate sits close to Canada’s at 5.7%.
Ontario has confirmed capacity to complete 13,000 tests every day and have updated their testing guidelines on April 8, 2020 to prioritize the following groups:
1. Hospital inpatients and residents living in long-term care homes and retirement homes
2. Health care workers/caregivers/care providers in those settings
3. Remote/Isolated/Rural/Indigenous communities
Indigenous
Ontario’s updated guidelines expand recommend testing to any member of Indigenous, remote, and rural communities who exhibit any of the following symptoms:
• Fever of at least 37.8 degrees Celsius or 100 degrees Fahrenheit)
• Any new/worsening acute respiratory illness syndrome
• Clinical/radiological evidence of pneumonia.
Ontario is also recommending that testing be considered for Elders and children, even if they have atypical symptoms, as well as community testing for contacts if there is a confirmed case in a community.
Full guidelines are available here: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_covid_testing_guidance.pdf
SECURING SUPPLIES
Federal and Provincial
On April 14, 2020, the federal government confirmed procurement of 1.1 million N95 masks that are now ready to be distributed to provinces and territories.
In Ontario, more than 13 million surgical and procedural masks, 200,000 N95 respirator masks, and 38 ventilators have been delivered to pandemic stockpile warehouses over the past five days.
Ontario has established a donation effort through which thousands of masks have been donated. Donations can be made by visiting the following: https://www.ontario.ca/form/supply-emergency-products-help-fight-coronavirus
First Nations
Due to global increase in demand for testing supplies, different methods of securing and distributing supplies for community nursing stations are being developed. These methods are being coordinated by Regional Health Tables in coordination with local public health units.
First Nation Inuit Health Branch of Indigenous Services Canada – Ontario Region has indicated they have a dedicated staff person who will be processing supply orders and responding to requests. The email for First Nations Chiefs and Health Directors across Ontario to submit questions, concerns, and requests is sac.covid19fnihbontario.isc@canada.ca
If First Nations are having issues securing PPE or other supplies, Chiefs can also contact Indigenous Services Canada ADM Dr. Valerie Gideon directly. She has provided her contact information to Chiefs. Valerie.gideon@canada.ca. Alternative contacts are Dr Tom Wong, MD at Tom.wong@canada.ca. or Julien Castonguay at julien.castonguay@canada.ca.
MEDICAL CAPACITY
Ontario Health officials are indicating that hospitals in Ontario are operating about 70% capacity, meaning there are still ICU beds and ventilators available. Ontario is working to rapidly increase hospital capacity both in terms of supplies and staff. The premier indicated during a press conference on April 14, 2020 that the focus of concern is shifting away from hospital capacity in the province and towards capacity for long-term care and retirement homes.
Additional Health Care Workers
Ontario has launched an official call for health care workers, asking individuals with a health background and not currently working to help increase the province’s frontline capacity in hospitals, clinics or assessment centres. The call is seeking health care providers who are:
o retired or non-active health care professionals;
o internationally educated health care professionals;
o students; or
o volunteers.
An online portal has been set up to help match available health care workers with employers. Both employers and interested health care professionals can register for this program here: https://healthcloudtrialmaster-15a4d-17117fe91a8.force.com/matchingportal/s/
VIRUS TRANSMISSION
Recent studies show that transmission of COVID-19 can happen before an infected person has any symptoms (pre-symptomatic transmission). Transmission can also happen if an infected person never develops symptoms (asymptomatic transmission).
It is currently not known how large of a role pre-symptomatic and asymptomatic transmission play in spreading COVID-19, but it is occurring through physical contact or/and close physical settings. This is the reason that physical or social distancing measures are followed by everyone very strictly, even if they are not a vulnerable population or exhibiting any symptoms.
More information on distancing, preventing spread, and reducing risk: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html
CONFIRMED CASES – GLOBAL
The number of cases globally continues to increase with 1.9 million cases confirmed worldwide. Over half of the case count is located in Europe, with the highest case counts in Italy, Spain, Germany, and France. The U.S. has over 605,000 cases with over 200,000 cases in New York.
FURTHER INFORMATION AND RESOURCES
Public Health Unit Contact: http://www.health.gov.on.ca/en/common/system/services/phu/locations.aspx
Telehealth Ontario: 1-866-797-0000
Online COVID-19 self-assessment tool: https://covid-19.ontario.ca/self-assessment/#q0)
Support for Health Care Workers:
Frontline workers and health care workers may contact the Ontario’s Health Care Provider Hotline at 1-866-212-2272. Health care workers can also access additional information via email at: emergencymanagement.moh@ontario.ca
Ontario COVID-19 website: https://www.ontario.ca/page/2019-novel-coronavirus
Canada COVID-19 website: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
World Health Organization COVID-19 site: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Tips for reducing spread and risk: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html?topic=tilelink
Chiefs of Ontario COVID-19 webpage: https://chiefsofontario.wordpress.com/
Interactive COVID-19 MAP Canada: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html?&utm_campaign=gc-hc-sc-coronaviruspublicedu2021-2021-0001-9762248618&utm_medium=search&utm_source=google-ads-99837326356&utm_content=text-en-428935858540&utm_term=covid#a1
