COVID-19 pandemic in Ontario: Difference between revisions
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=== Amount of testing === |
=== Amount of testing === |
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[[File:COVID-19 Ontario Testing Rates.png|thumb|upright=2.0|The COVID-19 testing rates in Ontario from March to May 2020 (updated May |
[[File:COVID-19 Ontario Testing Rates.png|thumb|upright=2.0|The COVID-19 testing rates in Ontario from March to May 2020 (updated May 12, 2020). Points are data and lines are a 4-day moving average. Source:[https://data.ontario.ca/dataset/status-of-covid-19-cases-in-ontario data.ontario.ca]]] |
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The displayed chart shows the number of tests performed per day, the daily backlog, and the percentage of positive tests in Ontario from March to May 2020. The WHO advises to test every suspected case. Positive test rates above 10% indicate that the testing is too targeted and the number of test-confirmed cases will not accurately indicate the prevalence of COVID-19 in the population. This 10% limit was exceeded on multiple days in early April. Since a relatively limited number of cases are tested, the actual number of cases will be much higher than the test-confirmed numbers.<ref name=":10" /><ref name=":11" /> |
The displayed chart shows the number of tests performed per day, the daily backlog, and the percentage of positive tests in Ontario from March to May 2020. The WHO advises to test every suspected case. Positive test rates above 10% indicate that the testing is too targeted and the number of test-confirmed cases will not accurately indicate the prevalence of COVID-19 in the population. This 10% limit was exceeded on multiple days in early April. Since a relatively limited number of cases are tested, the actual number of cases will be much higher than the test-confirmed numbers.<ref name=":10" /><ref name=":11" /> |
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In late March and April, Ontario was performing the lowest number of tests per capita of all the provinces.<ref>{{cite news |last1=Crawley |first1=Mike |title=Wait list for COVID-19 test results balloons to 11,000 in Ontario |url=https://www.cbc.ca/news/canada/toronto/covid19-test-ontario-waiting-lab-results-coronavirus-1.5510644 |website=CBC |accessdate=22 April 2020}}</ref><ref>{{cite news|url=https://www.cbc.ca/news/health/covid-19-testing-variations-1.5520812?fbclid=IwAR2TSyDyl5J8cK-N8hJ2hBLnvN36-5VU1E9CaKRPM7plfi_xC0mVrD2gTZw|title=Why COVID-19 testing varies so much across Canada|work=CBC|first=Emily |last=Chung}}</ref> As of early May 2020, among the larger provinces, Ontario is second to Alberta and ahead of British Columbia and Quebec in daily tests per capita.<ref>{{cite web|title=Ontario couldn’t ramp up its testing quickly enough during the deadly outbreak of COVID-19. Here's what went wrong|url=https://www.thestar.com/politics/provincial/2020/05/02/ontario-couldnt-ramp-up-its-testing-quickly-enough-during-the-deadly-outbreak-of-covid-19-heres-what-went-wrong.html|date=2020-05-02|website=thestar.com|language=en|access-date=2020-05-04}}</ref> |
In late March and April, Ontario was performing the lowest number of tests per capita of all the provinces.<ref>{{cite news |last1=Crawley |first1=Mike |title=Wait list for COVID-19 test results balloons to 11,000 in Ontario |url=https://www.cbc.ca/news/canada/toronto/covid19-test-ontario-waiting-lab-results-coronavirus-1.5510644 |website=CBC |accessdate=22 April 2020}}</ref><ref>{{cite news|url=https://www.cbc.ca/news/health/covid-19-testing-variations-1.5520812?fbclid=IwAR2TSyDyl5J8cK-N8hJ2hBLnvN36-5VU1E9CaKRPM7plfi_xC0mVrD2gTZw|title=Why COVID-19 testing varies so much across Canada|work=CBC|first=Emily |last=Chung}}</ref> As of early May 2020, among the larger provinces, Ontario is second to Alberta and ahead of British Columbia and Quebec in daily tests per capita.<ref>{{cite web|title=Ontario couldn’t ramp up its testing quickly enough during the deadly outbreak of COVID-19. Here's what went wrong|url=https://www.thestar.com/politics/provincial/2020/05/02/ontario-couldnt-ramp-up-its-testing-quickly-enough-during-the-deadly-outbreak-of-covid-19-heres-what-went-wrong.html|date=2020-05-02|website=thestar.com|language=en|access-date=2020-05-04}}</ref> |
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In mid-April, polling firms Forum Research and Mainstreet Research released results of a pair of surveys about COVID-19 symptom prevalence and testing. <ref name="auto2">{{cite web| url=https://www.mainstreetresearch.ca/one-fifth-of-ontario-households-have-one-or-more-symptoms-of-covid-19/ |title= COVID-19 Symptom Study - Ontario}}</ref> <ref>{{cite web| url=http://staging-poll.forumresearch.com/post/3059/covid-19-symptoms-wave-2/ |title= COVID-19 Symptom Study Wave 2 - Ontario}}</ref> Four to five thousand Ontario households were randomly selected. Of them, 2% of households contained someone who had been tested by April 12, increasing to 5% on April 19, whereas the incidence of COVID-19 symptoms in a household decreased from one in five to one in seven households. The second survey indicated that one-third of Ontarians report an underlying condition that might aggravate a COVID-19 infection. |
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=== Testing capacity === |
=== Testing capacity === |
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Revision as of 15:31, 12 May 2020
| COVID-19 pandemic in Ontario | |
|---|---|
| Disease | COVID-19 |
| Virus strain | SARS-CoV-2 |
| Location | Ontario, Canada |
| First outbreak | Wuhan, Hubei, China |
| Index case | Sunnybrook Hospital, Toronto |
| Arrival date | January 25, 2020 (4 years, 9 months, 3 weeks and 2 days) |
| Confirmed cases | 20,238[1] |
| Recovered | 14,772[1] |
Deaths | 1,634,[1] 1733,[2] or 1729 (PHU) |
| Government website | |
| Ontario Government | |
The COVID-19 pandemic in Ontario is an ongoing viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first identified case of COVID-19 in Canada during the 2019–20 worldwide pandemic occurred in the Canadian province of Ontario after it arrived on January 22, 2020, when a man returned to Toronto from travel in China, including Wuhan; the case was announced on January 25. The government announced on March 17 that Ontario had "some evidence of community transmission" of COVID-19.[3]
On March 17, the Government of Ontario declared a state of emergency,[4] ordering the closure of indoor recreational programs, public libraries, theatres, cinemas, private schools (all Ontario public schools were closed since March 14), daycares and the prohibition of all public gatherings of more than 50 people (later reduced to 5 people on March 28). Bars and restaurants however were allowed to remain open, but only for those that offer takeout (Note that some bars and restaurants have both walk-in and drive-thru (if available) take out and some bars and restaurants (such as McDonald's and Wendy's) are only drive-thru takeout) and delivery services.[5][6] By order of the province, starting March 24, non-essential businesses were closed and on March 30, a province-wide closure of all outdoor recreational amenities began.[7][8]
On April 3, the Government of Ontario released projections indicating that over the full course of the pandemic with no mitigation measures 100,000 deaths would occur, and with the then-current measures 3,000 to 15,000 deaths would occur.[9] Projections for test-confirmed cases by April 30 were 12,500 (best case scenario), 80,000 (expected case scenario), and 300,000 (worst-case scenario).[9] On April 20, their modelling showed that widespread physical distancing had reduced this expected case scenario to "likely less than 20,000."[10]
Since early April, the majority of the deaths occurring each day have been of residents of long-term care homes.[9] In late April, one out of five of all long-term care homes in Ontario had an outbreak [9] and 70% to 80% of all COVID-19 deaths had been in retirement and long-term care homes.[11]
Timeline
January–February
On January 23, the first presumptive case in Canada was admitted to Sunnybrook Health Sciences Centre in Toronto and placed into a negative pressure chamber.[12][13] The patient, a male in his 50s who travelled between Wuhan and Guangzhou before returning to Toronto on January 22, contacted emergency services following rapid onset symptoms.[14] The presumption of infection in the patient was made after a rapid test was done at Public Health Ontario's Toronto laboratory. Final testing conducted at the National Microbiology Laboratory in Winnipeg, Manitoba confirmed the presumptive case on January 25.[12][13] Authorities said that the patient was experiencing respiratory problems but was in stable condition.[12] His condition later improved and he was released from hospital on January 31.[15]
On January 27, the Chief Medical Officer of Health of Ontario announced the man's wife as the second presumptive case.[16] Officials reported that she was in good condition and that she was asymptomatic.[16]
On January 31, the third case in Ontario (and the fourth case in Canada) was reported in the city of London.[17] Officials said that the individual, a woman in her 20s and a student at University of Western Ontario, returned from Wuhan on January 23.[18] She was asymptomatic and had tested negative at first, but additional advanced testing confirmed that the woman had low levels of the virus in her system.[18] Officials said that the individual wore a mask during her voyage and she voluntarily entered self-isolation upon her return, making a full recovery after two or three days.[18] On the same day, the Government of Ontario reported that 17 cases were under investigation within its provincial jurisdiction.[19] Officials said that most of the individuals under investigation were awaiting results while in self-isolation at home.[20] As of January 30, the associate medical officer of Ontario said that the province had conducted a total of 67 tests with 38 negative results.[20] Officials said that all possible cases—including previous negative results—were being retested as additional assessments become available.[18]
CFB Trenton in Trenton, Ontario has been used as a quarantine facility for repatriated Canadians since February 7.[21] By March 24, 13 positive cases for the virus of the repatriated citizens at CFB Trenton were reported.[22]
On February 24, a fourth presumptive case in Ontario was announced of a woman in her 20s who presented to a hospital on February 21 with symptoms after travelling to Wuhan. The woman was tested locally with a positive test result and the sample was sent to the National Microbiology Laboratory in Winnipeg.[23] On February 24, health officials in Ontario stated that all three previous cases in Ontario were "resolved", which means patients had two consecutive negative test results 24 hours apart and that the "system was working".[23]
March
On March 5, Ontario reported three more cases of the virus, for a total of 23 in the province, with cases in Toronto, Kitchener, and Mississauga being reported. The three cases came from Iran, Italy, and the Grand Princess cruise ship, respectively. It was also announced that another case in Ontario was resolved.[24]
Five cases, two imported from each of Iran and the Grand Princess, and one from Las Vegas, were reported on March 6.[25] Four more cases were reported to have been imported from Colorado, Washington, D.C., France, and Germany on March 8, bringing the total to 32.[26][27][28]
On March 9, Ontario confirmed two new cases of coronavirus, bringing the total number of cases in the province to 34. They are an octogenarian and a septuagenarian from Toronto having travelled to Iran, where cases of COVID-19 had multiplied in recent weeks.[29]
On March 10, a close contact of a previous case and a man who travelled to Switzerland were confirmed as Ontario's 35th and 36th case, respectively. Later the same day, a Sudbury man who attended the Prospectors & Developers Association of Canada (PDAC) conference in Toronto on March 2–3 was confirmed as the 37th positive case, and the first in northern Ontario.[30]
On March 11, a 40-year-old man who recently travelled to Austria was confirmed as the first coronavirus case in Ottawa.[31] The overall coronavirus case number in Ontario rose to 42 on the same day. On March 12, 17 new cases were confirmed including a baby boy who had recently visited the North York General Hospital in Toronto. That day, the total number of cases in Ontario increased to 59.[32] On March 13, health officials reported 19 additional cases, bringing the number of cases to 79, and on the 14th, 24 more, making the total 103.[33][34] On March 17, it was announced that a man in his 70s, who had died in Barrie, was the first death in Ontario as a result of COVID-19.[5] On March 18, an undisclosed player for the Ottawa Senators hockey team was tested positive.[35] That day, 23 new cases were confirmed in Ontario that day, bringing the total number of cases to 212.[36]
From the initial case on January 23 to March 18, over half of the reported cases are reported in Toronto (220 cases),[37] of which 11 are under investigation for community transmission.[38] Hamilton reported 23 cases,[39] Ottawa reported 19 cases,[40] Durham reported 18 cases[41] and Waterloo Region reporting 14 cases.[42]
April
On April 2, Lakeridge Health declared an outbreak of COVID-19 at Lakeridge Health Oshawa in Oshawa, and announced that one of its in-patient units would be temporarily closed after a hospital-acquired case of COVID-19 was transmitted to a health care worker treating the patient.[43]
On April 9, Ontario reported its first death of a healthcare worker, a man in his fifties in Brampton.[44]
May
Government response
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Ontario has announced they have a dedicated web page updated twice daily with the total and new cases.[1] In addition, they have been making new releases as cases are confirmed, with their source whether they are due to travel history or close contact.[45] Ontario Minister of Health Christine Elliott and Minister of Long-Term Care Merrilee Fullerton is overseeing the emergency plan for the virus.[46]
On March 12, the Government of Ontario announced publicly funded schools would be closed for an additional two weeks after March Break until April 5.[47]
On March 15, The Ontario Superior Court of Justice announced a suspension of most criminal matters, including trials until the end of May.[48]
On March 17, Ontario Premier Doug Ford declared a province-wide state of emergency.[4] This included prohibition of all public events of over 50 people (later reduced to 5 people on March 28), the closure of libraries, theatres, cinemas, private schools (in addition to publicly-funded schools which were already been ordered closed from March 14 until further notice) and daycares. While most bars and restaurants were allowed remain open, however they can only offer takeout and delivery services (some restaurants have both walk-in and drive-thru takeout (if available) and delivery services, and some restaurants such as McDonald's Canada [49] and Wendy's [50] [51] are drive-thru takeout and delivery services only).[5][6] The following day, a state of emergency was also declared in Peel Region[52] and Simcoe County by Warden George Cornell.[53]
On March 20 further measures were announced including waiving the three months waiting period for health care coverage,[54] the launch of an e-learning portal[55] and extended privileges for hospitals to re-deploy staff.[56]
On March 23, Ford announced that all "non-essential" businesses be ordered closed starting 11:59 p.m. on March 24. Ford also stated that schools would remain closed past the original April 6 opening date and until further notice.[57][7] A list of 74 "essential" businesses was published later in the day on March 23.[58][59][60] The same day, a state of emergency was declared in Toronto by Mayor John Tory,[61][62] in York Region by Chair Wayne Emmerson,[63] and in Halton Region by Chair Gary Carr.[64] The following day, a state of emergency was also declared in Durham Region by Chair John Henry[65] and in Kawartha Lakes by Mayor Andy Letham.[66]
On March 25, Ford and Finance Minister Rod Phillips introduced a $17-billion response package that includes an influx of cash for the health sector, direct payments to parents and tax breaks for businesses.[67]
On March 26, a municipal state of emergency was declared in Kingston by Mayor Bryan Paterson due to two new cases of the virus announced by KFL&A Public Health. Three recent cases in the region had reported no prior close contact with known infected persons, causing health officials to conclude that community transmission is present in the region, and closures of several medical clinics.[68] In addition, following California and British Columbia, takeout and delivery orders from restaurants can include alcoholic beverages as long as the order contains food items and is ordered between 9 a.m. and 11 p.m.[69]
On March 27 at 2:00 p.m. ET, Alert Ready was activated on all radio stations, television channels and providers, and LTE wireless networks in Ontario, to distribute a warning informing travellers returning to Ontario of the mandatory self-isolation requirements under federal law.[70]
In response to the anticipated increase in patients requiring critical care, the Ontario government announced on March 27 that over 3,000 ventilators are ready to be deployed in Ontario (compared to the current capacity of approximately 1,300 critical care beds with ventilators and 43 patients requiring critical care as of March 27).[71]
On March 30, the Ontario government extended the state of emergency through April 13, and also ordered the province-wide closure of all outdoor recreational amenities, including beaches, playgrounds and sports facilities (several Ontario municipalities including Toronto, had already ordered similar closures of their recreational amenities several days prior to the province-wide order).[8] On March 31, it was announced that the schools would remain closed until at least May 4.[72] The same day, Mayor of Toronto John Tory announced that the city would cancel all city-led major events, festivals (including Toronto's Pride Parade, which was scheduled to take place on June 28), conferences, permits and cultural programs until June 30. Tory clarified that this does not necessarily restrict professional sporting events, but they are still covered under provincial restrictions on public gatherings.[73][74]
On April 3, it was announced the number of "essential" businesses would be reduced to 44 beginning 11:59 p.m. on April 4; this included the halting of most non-essential construction, including industrial construction, and residential construction that did not begin before April 4, but excluding "critical" infrastructure projects, as well as the closure of all cannabis stores.[75][76][77]
The same day (April 3), the government released extensive data modelling that claimed that public health measures in the province prevented an estimated 220,000 cases and 4,400 deaths up to that point. Between 3,000 and 15,000 deaths related to COVID-19 were predicted with the current public health measures over the course of the pandemic, compared to a total projected 100,000 deaths if no action were taken, and if further measures are taken, models showed projections as low as 12,500 additional cases and 200 additional deaths by the end of April.[78] The models projected that by April 30 there would be 80,000 cases and 1600 deaths under the current interventions.[79] In addition, the government projected a peak use of ICU beds of 1200 beds by April 18 under their best-case scenario (with over 3000 ICU beds required under the worst-case scenario by April 30).[78]
On April 14 during an emergency session, the Legislative Assembly voted to extend the provincial state of emergency through May 12.[80] Premier Ford also announced that public schools would not open on May 4 as previously planned,[81] which was extended to May 31 on April 26.[82]
Statistics
 | Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org. |
| Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org. |
| Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org. |
| Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org. |
Geographical distribution
| Public Health Unit | Cases | Cases per m | Resolved | Deaths | Ref |
|---|---|---|---|---|---|
| Algoma | 16 | 142 | 13 | 0 | [83] |
| Brant County (including Brantford) | 100 | 742 | 85 | 3 | [84] |
| Chatham-Kent | 90 | 873 | 83 | 1 | [85] |
| Durham Region | 1,162 | 1,799 | 746 | 148 | [86] |
| Eastern Ontario (Stormont, Dundas and Glengarry-Prescott and Russell) | 130 | 640 | 65 | 7 | [87] |
| Grey-Bruce | 89 | 549 | 70 | 0 | [88][89] |
| Haldimand-Norfolk | 199 | 1,813 | 72 | 30 | [90] |
| Haliburton, Kawartha, Pine Ridge District | 157 | 877 | 126 | 32 | [91] |
| Halton Region | 573 | 1,045 | 426 | 23 | [92] |
| Hamilton | 488 | 904 | 328 | 23 | [93] |
| Hastings Prince Edward | 43 | 267 | 20 | 5 | [94] |
| Huron-Perth | 49 | 360 | 35 | 5 | [95] |
| Kingston, Frontenac and Lennox & Addington | 61 | 321 | 61 | 0 | [96] |
| Lambton County | 200 | 1,579 | 142 | 17 | [97] |
| Leeds, Grenville & Lanark District | 314 | 1,855 | 249 | 43 | [98][99] |
| Middlesex-London | 438 | 952 | 287 | 43 | [100] |
| Niagara Region | 546 | 1,219 | 379 | 53 | [101] |
| North Bay-Parry Sound (including most of Nipissing District) | 18 | 146 | 16 | 0 | [102] |
| Northwestern (Most of Kenora District, Rainy River District and part of Thunder Bay District) | 16 | 211 | 16 | 0 | [103][104] |
| Ottawa | 1,653 | 1,769 | 1,049 | 161 | [105][106] |
| Peel | 3,064 | 2,217 | 2,150 | 196 | [107] |
| Peterborough (City and County) | 72 | 522 | 57 | 2 | [108][109] |
| Porcupine (Cochrane District, Hornepayne, James Bay communities) | 64 | 762 | 49 | 5 | [110] |
| Renfrew County & District | 18 | 163 | 12 | 1 | [111] |
| Simcoe-Muskoka | 360 | 667 | 184 | 25 | [112] |
| Southwestern (Oxford, Elgin, St. Thomas) | 62 | 312 | 45 | 4 | [113] |
| Sudbury & Districts (including Greater Sudbury) | 60 | 306 | 50 | 2 | [114] |
| Thunder Bay District (including First Nations communities in the far north) | 77 | 507 | 68 | 1 | [115] |
| Timiskaming (including Temagami) | 18 | 545 | 12 | 0 | [116] |
| Toronto | 7,413 | 2,714 | 5,192 | 578 | [117] |
| Waterloo Region | 932 | 1,742 | 479 | 102 | [118] |
| Wellington-Dufferin-Guelph | 321 | 1,128 | 151 | 30 | [119] |
| Windsor-Essex County | 694 | 1,740 | 263 | 59 | [120] |
| York Region | 1,853 | 1,670 | 910 | 132 | [121] |
Updated as of May 9, 2020.
Demographic distribution
| Age range | Cases | Cases per m | Resolved | Male | Female | Transgender, other | Unknown sex | Deaths | Deaths per m | Male deaths | Female deaths | Male Deaths per m | Female Deaths per m |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 19 and under | 418 | 133 | 299 | 203 | 213 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 |
| 20-29 | 1957 | 941 | 1,485 | 826 | 1,124 | 1 | 5 | 2 | 1 | 1 | 1 | 1 | 1 |
| 30-39 | 2,084 | 1,055 | 1,579 | 910 | 1,167 | 0 | 7 | 5 | 3 | 5 | 0 | 5 | 0 |
| 40-49 | 2,391 | 1,292 | 1,837 | 1,002 | 1,379 | 1 | 9 | 14 | 8 | 10 | 4 | 11 | 4 |
| 50-59 | 2,899 | 1,407 | 2,171 | 1,201 | 1,692 | 0 | 6 | 41 | 20 | 23 | 18 | 23 | 17 |
| 60-69 | 2,263 | 1,331 | 1,614 | 1,103 | 1,150 | 0 | 10 | 91 | 54 | 58 | 33 | 70 | 37 |
| 70-79 | 1,602 | 1,470 | 957 | 803 | 779 | 1 | 19 | 218 | 200 | 133 | 84 | 261 | 145 |
| 80-89 | 2,270 | 4,451 | 1,227 | 839 | 1,384 | 0 | 46 | 441 | 865 | 206 | 233 | 954 | 787 |
| 90 and over | 1,662 | 12,785 | 829 | 395 | 1,219 | 0 | 47 | 404 | 3,108 | 125 | 274 | 3,125 | 3,044 |
| Unknown | 7 | 7 | 2 | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Totals | 17,553 | 1,205 | 12,005 | 7,284 | 10,112 | 4 | 150 | 1,216 | 83 | 561 | 647 | 78 | 88 |
Updated as of May 3, 2020.[122][123]
COVID-19 testing
COVID-19 testing can be used to track the prevalence and spread, to diagnose individuals for treatment, to identify infections for isolation and contact tracing, to screen at-risk populations, to clear exposed healthcare workers to return to work, and to identify individuals with potential immunity. The World Health Organization says that jurisdictions should aim to test every suspected case of COVID-19.[124] Estimates and projections for testing rates needed each day in order to safely reopen economies have ranged from 150 in April, 1,500 in early June, to 6,100 in midsummer 2020, all per 100,000 people.[125][126] On April 23, Trudeau identified broader testing as key to reopening the country, mentioning the target of 60,000 tests per day set by Dr. Theresa Tam, but warned that up to 120,000 per day may be required.[127] In early May, Ontario was testing just over 16,000 people per day, equal to a testing rate of about 110 tests per 100,000 people each day.[128] As of early May, a total of over 920,000 tests have been performed in Canada of which, 350,000 were in Ontario.
Types of tests
Virus-RNA tests
Diagnostic testing for COVID-19 in Ontario is conducted using a method called RT-PCR. A carefully produced and validated swab is used to collect a sample from a person's throat, back of the nose, or front of the nose. The swab is put inside a sealed container containing a medium that preserves the virus, which is sent to test-processing centres in the corresponding province or territory. At the centres, highly skilled technicians use large commercial machines from a variety of manufactures to process batches of tens to hundreds of samples at a time. The test chemically strips the RNA from the sample then mixes it with a test kit containing chemical reagents designed to detect RNA signatures of SARS-CoV-2. The sample is cycled between a set of temperatures to amplify the chemical RNA signature. This leads to processing times that range from 4 to 24 hours.[129]
In early April, Ontario has contracted Spartan Bioscience Inc. from Ottawa to supply it with virus-RNA testing systems that process a single swab sample in 30 to 60 minutes.[130] The contract was for 900,000 swab test kits, whereas the number of machines has not been disclosed. While these machines cannot process many samples in total, they have the advantage of being small and easy to use. Thus, they can be used to provide rapid results at the point-of-care. They are expected to be useful at border crossings, isolated communities, prisons, and care homes.[130] On April 13, Health Canada approved this test but on May 3 the test was recalled due to unreliable results.[131]
Serology tests
Ontario is performing experiments testing the performance of blood tests that look for antibodies to the SARS-CoV-2 virus.[132] Antibodies do not form immediately upon infection, so these tests are not well-suited for detecting a current infection. However, they can potentially identify those who have been infected in the past.[132]
Testing facilities
Public Health Ontario has six testing laboratories to which samples can be sent. The main laboratory is the top four floors of the MaRS Centre in downtown Toronto.[133] As of early April, accounting firm KPMG has been contracted to organize all the labs in the province that are capable of microbial testing.[134] In addition to the six public health labs, this includes 10 hospital networks and three private lab networks, including Dynacare and LifeLabs.[135][136]
Testing access
Access to testing is set by Public Health Ontario who publishes a guidance document that defines the conditions for an individual to be tested.[137] Conditions have included close contact with a test-confirmed case, recent travel, admission to hospital for serious symptoms, healthcare worker, longterm care home resident, etc. The set of conditions has been updated repeatedly from January to April 2020, at times reducing access and at other times increasing access to testing.[138] Starting in March, the public health units across the province have opened over 70 assessment centres, which members of the public can visit if directed by a health professional (List of Ontario COVID-19 Assessment Centres & Their Individual Criteria). These range from mobile units, to walk-up locations, to drive-through locations. This diverts potentially infected people from hospitals and doctors' offices. If warranted, the centre will collect a swab from a visitor for testing. Swabs are also collected at hospitals and by public health officials, for example, at longterm care homes.[139]
Since many cases are not tested, the number of test-confirmed cases, which are the infection numbers reported by the Ontario government, should not be misconstrued as the actual number of infections, which have been estimated to be a factor of 20 to 100 higher. [140] Unlike some countries, the number of suspected or probable infections is not reported by the Ontario government.[141][142]
Amount of testing
The displayed chart shows the number of tests performed per day, the daily backlog, and the percentage of positive tests in Ontario from March to May 2020. The WHO advises to test every suspected case. Positive test rates above 10% indicate that the testing is too targeted and the number of test-confirmed cases will not accurately indicate the prevalence of COVID-19 in the population. This 10% limit was exceeded on multiple days in early April. Since a relatively limited number of cases are tested, the actual number of cases will be much higher than the test-confirmed numbers.[140][141]
In late March and April, Ontario was performing the lowest number of tests per capita of all the provinces.[143][144] As of early May 2020, among the larger provinces, Ontario is second to Alberta and ahead of British Columbia and Quebec in daily tests per capita.[145]
In mid-April, polling firms Forum Research and Mainstreet Research released results of a pair of surveys about COVID-19 symptom prevalence and testing. [146] [147] Four to five thousand Ontario households were randomly selected. Of them, 2% of households contained someone who had been tested by April 12, increasing to 5% on April 19, whereas the incidence of COVID-19 symptoms in a household decreased from one in five to one in seven households. The second survey indicated that one-third of Ontarians report an underlying condition that might aggravate a COVID-19 infection.
Testing capacity
Since January 2020, Ontario has been increasing its capacity to perform testing based on RT-PCR. Various factors have impeded this increase, including shortages of reagent chemicals for the RT-PCR machines and shortages of validated swabs. To tackle these challenges, labs have adapted. In particular, RT-PCR machines from multiple manufactures have been obtained, each of which takes different sets of chemicals. New suppliers of swabs have been found but each must be tested and validated to perform properly. Returning tests results to individuals is automated with an online portal.[148]
Testing capacity projections
| Date of Projection | Stated Current Capacity/day | Projection of Testing Capacity/day |
|---|---|---|
| March 13, 2020 | 2,500 | 5,000 by unspecified date[149] |
| March 26, 2020 | 2,500 | Each week, an increase by 3 to 4,000 tests per day and 19,000 by April 17[150] |
| April 9, 2020 | 13,000 | 19,000 by April 29, 2020 [151][152] |
| April 10, 2020 | 14,000 | 8,000 by April 15, 2020, 14,000 by April 29, and 16,000 by May 6, 2020 [153][154] |
Backlogs
On March 18, The Toronto Star reported that test results announced by the provincial government were several days old, with turnaround times increasing from 24 hours to 4 days, leading the government to "making decisions based on old information".[155] The province was only able to process around 2,000 tests per day by March 19, which caused the backlog.[156] The backlog increased to over 8,000 unprocessed samples on March 24 with patients waiting at least four days for results, partially due to fact that private and university laboratories are not allowed to process samples.[157][158]
Management of testing in Ontario
Dr. Vanessa Allen, chief of medical microbiology with Public Health Ontario[133]
Dr. Peter Donnelly, president and CEO of Public Health Ontario (on leave as of April 9, 2020)[159][160]
Colleen Geiger, interim president and CEO of Public Health Ontario (as of April 9, 2020)[159][160]
Dr. David Williams, Ontario's chief medical officer[161]
Dr. Barbara Yaffe, Ontario's associate chief medical officer of health[161]
In early April, the Ministry of Health brought in a multinational accounting firm KPMG to assist in the organization and optimization of testing capacity in Ontario.[134] Premier Doug Ford said on April 8 he was losing his patience with Ontario's inadequate testing numbers, showing testing capacity was not being fully utilized.[162] Later that day, the province appointed a former Toronto public health head, Dr. David McKeown to troubleshoot and rethink the province's response to the pandemic. The following day on April 9, amid mounting criticism of the province's testing, the president and CEO of Public Health Ontario Dr. Peter Donnelly temporarily stepped down for medical reasons and was replaced in the interim by Colleen Geiger, Public Health Ontario's chief of strategy, stakeholder relations, information and knowledge.[159][160][124]
Long-term care homes
Background
On April 15, 2020, the Ontario Nurses' Association released a statement saying that long-term care (LTC) homes pre-COVID-19 were already understaffed, but now they are in “crisis” mode. Prior to the pandemic, long-term care home staff who were part-time or casual staff were allowed to work at multiple locations, increasing the risk of transmission and spread between LTC homes.[163] The province issued a new Emergency Order on March 28 that introduced temporary additional staff members to help in the facilities and allowed homes more flexibility in staff deployment.[164] Many LTC homes in Ontario are considered old and small and feature shared bedrooms, increasing the difficulty in isolating sick residents from those who are well.[165]
Inspections
On April 15, CBC reported that the Ontario Ministry of Long-Term Care had conducted resident quality inspections (RQI) at only nine out of 626 long-term care homes in the province in 2019,[166] down from a bare majority in 2018 and larger proportions from 2015 to 2017.[166] RQIs are proactive, unannounced and more comprehensive than the other main category of care home inspections in the province, complaint and critical incident inspections, where facilities know of the impending scrutiny in advance;[166] the 2018 Long Term Care Homes Public Inquiry noted that "focusing only on specific complaints or critical incidents could lead to missing systemic issues."[166] As of 15 April 2020[update], 114 care facilities in Ontario had experienced COVID-19 outbreaks, and those that had multiple COVID-19 deaths last had their RQI in 2018 or earlier.[166]
Outbreaks
As of April 7, Ontario reported that there are 51 long-term care homes in the province that are experiencing COVID-19 outbreaks, and by April 10, it had surged to 69 LTC homes in Ontario.[165][164] Some LTC workers pointed to a lack of personal protective equipment as a cause of the outbreaks.[164] By April 21, 121 outbreaks have been reported in long-term care homes.[167]
On April 8, the Ontario Ministry of Health released directives to ramp up coronavirus testing and infection control. Also, new residents entering a home must be isolated for 14 days and tested within that period. The directives also require that all long-term care home staff and essential visitors for gravely ill residents wear surgical masks, "whether the home is in outbreak or not." LTC homes are expected to take "all reasonable steps" to follow the new long-term care rules. Prior to this directive, LTC staff were not required to wear masks or other PPE, and testing levels were considered low for at-risk seniors and LTC staff.[165][168]
On April 28, Chief Public Health Officer Theresa Tam stated that as many of 79 percent of Canada's COVID-19 fatalities occurred in long-term care homes, with Ontario and Quebec accounting for most of the cases.[169]
As of 8 May 2020[update], the following LTC homes in Ontario have 10 or more confirmed COVID-19 related deaths:[170][171][172][173]
- Orchard Villa (Pickering) - 67[173]
- Camilla Care Community LTC (Mississauga) - 48[173]
- Altamont Care Community (Scarborough, Toronto) - 46[173]
- Forest Heights Revera (Kitchener) - 45[173]
- Isabel and Arthur Meighen Manor (Toronto) - 42[173]
- Eatonville Care Centre (Etobicoke, Toronto) - 40[173]
- Seven Oaks (Scarborough, Toronto) - 40[173]
- Mon Sheong Home for the Aged (Toronto)- 32[173]
- Madonna Care Community (Orleans, Ottawa) - 30[174][173]
- Pinecrest Nursing Home (Bobcaygeon) - 29[170][173]
- Carlingview Manor (Ottawa) - 28 [174][173]
- Chartwell Ballycliffe Lodge LTC (Ajax) - 28 [173][175]
- Montfort Long-Term Care Centre (Ottawa) - 27[174]
- Almonte Country Haven (Almonte) - 26[173]
- Anson Place Care Centre (Hagersville) - 23[173]
- Ina Grafton Gage Home (Toronto) - 23[173]
- Downsview Long Term Care Centre (Toronto) - 23[173]
- Laurier Manor - 21 (Gloucester, Ottawa)[174][173]
- Hawthorne Place Care Centre – (Toronto) - 21 [173][171]
- The Westbury (Toronto) - 20 [173]
- West Park Long Term Care Centre (Toronto) - 20[173]
- Country Village Homes (Woodslee) - 19[173]
- Heron Terrace (Windsor) - 18[173]
- Lundy Manor (Niagara Falls) - 18[176]
- The Rekai Centre at Sherbourne Place (Toronto) - 18[173]
- Elm Grove Living Centre (Toronto) - 17[173]
- Erin Mills Lodge Nursing Home LTC (Mississauga) - 17 [177]
- Markhaven Home for Seniors (Markham) - 18[121]
- Royal Rose Place (Welland) - 17[173]
- The Rekai Centre at Wellesley (Toronto) - 16 [173][171]
- Villa Colombo Vaughan Di Poce Centre (Kleinburg, Vaughan) - 17 [121]
- Shelburne Long Term Care Home (Shelburne) - 15[173]
- Trinity Village LTC (Kitchener) - 14 [173]
- Harold and Grace Baker Centre (Toronto) - 13 [173]
- Village of Erin Meadows LTC (Mississauga) - 13 [177]
- Village of Humber Heights, Schlegel Villages (Etobicoke, Toronto) - 13[178]
- Hillsdale Terraces (Oshawa) - 13[173]
- Kipling Acres (Toronto) - 13[173]
- Weston Terrace (Toronto) - 13[173]
- Chartwell White Eagle Long Term Residence (Toronto) - 11 [173][171]
- Lakeshore Lodge (Toronto) - 11[173]
- Mackenzie Place Long-Term Care Home (Newmarket) - 11[173][121]
- Villa Leonardo Gambin (Woodbridge) - 11[173]
- Mountainview Residence Retirement Home (Georgetown, Halton Hills) - 10[171]
- Bradford Valley (Bradford) - 10[173]
- Grace Manor (Brampton) - 10[173]
- Chartwell Aurora (Aurora) - 10[173]
- Villa Forum (Mississauga) - 10[173]
Criticism
Initial response
Regional public health experts suggested that Ontario's initial incremental response — adding new voluntary measures piece by piece — had been ineffective. Businesses of all sizes remained open, and unnecessary social contacts continued. Describing Ontario's efforts to battle COVID-19 as piecemeal and ineffective, Dr. Shanker Nesathurai, who was one of Ontario's 34 regional medical officers of health, urged his colleagues to band together and use more powerful measures to contain the pandemic than provincial leaders had endorsed by the third week of March. In an email, Dr. Nesathurai, who worked for Haldimand Norfolk Health Unit, wrote on March 19 that Ontario's response had undermined the province's attempt to contain the outbreak, as businesses remain open and travellers ignore advice to self-isolate.[179]
Protests
On April 25, there were small protests totalling 200 protesters in front of the Ontario Legislative Building in Queen's Park, Toronto, demanding that Doug Ford end all emergency measures. Some of the protesters consider the coronavirus a hoax. Ford called them "a bunch of yahoos."[180]
On May 2, there was another protest with 100 protesters in front of Queen's Park.[181]
See also
- Toronto Transit Commission incidents § COVID-19 pandemic: about the effect of the pandemic on TTC operations
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