The COVID-19 pandemic

[jeffster]

I was just thinking a place like Kingston, ON could go back to normal if they wanted to (as in the old normal). Just keep out people from outside the region from coming in. Their public health unit and head doctor did a phenomenal job at keeping the city safe. They're down to 1 active case. They had 61 cases in total, and no deaths. This coming from a region of just over 200,000.

Key difference in Kingston was that public health concentrated on LTC and retirement homes, making sure PPE was available, and ensuring isolation of the infected (they pull staff off of their other jobs). They also did a lot more testing and it was concentrated in those areas that were high at risk.

I really can't say that I am overly impressed with the job that we did here in this region, but it is what it is. Different region, different priorities. This time it hurt it.

[danbrotherston]

I was just thinking a place like Kingston, ON could go back to normal if they wanted to (as in the old normal). Just keep out people from outside the region from coming in. Their public health unit and head doctor did a phenomenal job at keeping the city safe. They're down to 1 active case. They had 61 cases in total, and no deaths. This coming from a region of just over 200,000.

Key difference in Kingston was that public health concentrated on LTC and retirement homes, making sure PPE was available, and ensuring isolation of the infected (they pull staff off of their other jobs). They also did a lot more testing and it was concentrated in those areas that were high at risk.

I really can't say that I am overly impressed with the job that we did here in this region, but it is what it is. Different region, different priorities. This time it hurt it.

A municipality has zero power to institute a complete shutdown on visitors, whether it could even be done at a provincial level I suspect is somewhat questionable, it would need extrodinary circumstances (which COVID clearly is, but I don't think this particular use would qualify) as it is pretty explicitly restricting a charter freedom.

That being said, a region which has a complete shutdown on interregional travel would be about as far from normal as you can get while sitting in restaurants...for that matter, what would the restaurants be serving? No region in Ontario produces it's own food, they all rely on interregional travel.

It is truely amazing how interdependent and interconnected we are, and how completely we delude ourselves into believing we are independent and self sufficient.

[jeffster]

I was just thinking a place like Kingston, ON could go back to normal if they wanted to (as in the old normal). Just keep out people from outside the region from coming in. Their public health unit and head doctor did a phenomenal job at keeping the city safe. They're down to 1 active case. They had 61 cases in total, and no deaths. This coming from a region of just over 200,000.

Key difference in Kingston was that public health concentrated on LTC and retirement homes, making sure PPE was available, and ensuring isolation of the infected (they pull staff off of their other jobs). They also did a lot more testing and it was concentrated in those areas that were high at risk.

I really can't say that I am overly impressed with the job that we did here in this region, but it is what it is. Different region, different priorities. This time it hurt it.

A municipality has zero power to institute a complete shutdown on visitors, whether it could even be done at a provincial level I suspect is somewhat questionable, it would need extrodinary circumstances (which COVID clearly is, but I don't think this particular use would qualify) as it is pretty explicitly restricting a charter freedom.

That being said, a region which has a complete shutdown on interregional travel would be about as far from normal as you can get while sitting in restaurants...for that matter, what would the restaurants be serving? No region in Ontario produces it's own food, they all rely on interregional travel.

It is truely amazing how interdependent and interconnected we are, and how completely we delude ourselves into believing we are independent and self sufficient.

That's true, it would probably next to impossible to re-open without the legal ability to do so.

Though obviously when it comes to food, they are getting it right now, and without covid-19 tagging along. Likely truckers are low risk and hence why their active cases is down to 1 now.

Would restaurants do a lot of business if opened? I'm sure they wouldn't be as busy even if everyone in Kingston decided to go back to normal. It's a tourist town.

Thunder Bay has done well also. It looks like they practiced the same thing as Kingston, concentrate on the retirement homes and LTC homes. They have 77 cases, 65 that are resolved, so 11 active and 1 death.

By comparison, Thunder Bay did over 5,200 tests, and Waterloo Region just shy of 8,100. The per capita testing in Thunder Bay is 3x higher.

I suppose it's easy to criticize the region and our public health on the job, but the excuses I hear just don't make a lot of sense when other places have done so much better.

[taylortbb]

I suppose it's easy to criticize the region and our public health on the job, but the excuses I hear just don't make a lot of sense when other places have done so much better.

Anecdotally, when dealing with my contact tracing saga spanning Hamilton and Waterloo Region public health, other public health agencies in Ontario don't think very highly of Waterloo Region. The sigh was quite audible when I said "Waterloo Region public health" to the person from Hamilton public health.

[danbrotherston]

I personally have absolutely no idea how WPH is perceived by others around Ontario, or if that perception is an accurate reflection of issues at WPH, or if those issues impact the spread of COVID.

What will say is that Waterloo Region is definitely different from those two you mentioned (Kingston and Thunder Bay). We are much closer to a major city, Toronto, and we have much larger amounts of both international (as a result of a large international student population) and interregional travel. And, at some level, random chance plays a part in who gets more COVID cases and who doesn't.

But again, I have no idea how our public health agency is performing in this pandemic. I do know--since it is my area of interest--that our politicians are not being particularly progressive in their policies around public space and transportation, but I doubt that has a substantial effect on transmission rates--at least at the beginning.

[tomh009]

What will say is that Waterloo Region is definitely different from those two you mentioned (Kingston and Thunder Bay). We are much closer to a major city, Toronto, and we have much larger amounts of both international (as a result of a large international student population) and interregional travel.

This.

[jeffster]

What will say is that Waterloo Region is definitely different from those two you mentioned (Kingston and Thunder Bay). We are much closer to a major city, Toronto, and we have much larger amounts of both international (as a result of a large international student population) and interregional travel.

This.

I might add though, Hamilton has a lot more traveling to and from it, and through it. And they are right beside Metro Toronto, yet they're doing better than WR is. Peel region, which is a super dense population, has similar numbers to WR.

Where the region failed was taking into account LTC homes and seniors homes. This wasn't on the radar. I've spoken to PSW's and they all claimed that region basically ignored them for the first couple weeks, with the concentration on hospitals and FR's. This is different than Kingston (old people first), Thunder Bay, Hamilton and even Peel region, which focused on places were old and/or sick people were.

I don't think anyone in WR got sick from any international student, at least according to the stats.

I think this is one area that we're going to have to take a good hard look into, and actually take ownership on how we failed. I hear what some politicians are saying, along with public health, and really pointing fingers elsewhere. They just have to admit that some other places, like Hamilton, had better focus. Hamilton is a great place to compare to, simply because they're more integrated to Toronto, they have more international travel, and very similar in population. They have 1/2 the cases and 1/4 the deaths.

Population comparison (excluding students): Hamilton: 536,000 and Waterloo Region: 535,000. This is as close as you can get to compare cities. Hamilton, I believe, has a more aging population too.

[tomh009]

I think this is one area that we're going to have to take a good hard look into, and actually take ownership on how we failed. I hear what some politicians are saying, along with public health, and really pointing fingers elsewhere. They just have to admit that some other places, like Hamilton, had better focus. Hamilton is a great place to compare to, simply because they're more integrated to Toronto, they have more international travel, and very similar in population. They have 1/2 the cases and 1/4 the deaths.

If you take out Forest Heights Revera, that reduces our cases by something like 25% (total RH/LTC case count is almost 60% of overall total) and the death count by 45%. For a single long-term-care facility! This is one of the worst LTC outbreaks in the province, and skews the numbers a lot.

Anyway, I think there is too much finger-pointing at the moment. I would like to see a proper investigation and analysis after the fact, before blaming regional health or anyone else.

[tomh009]

The Ontario new-case count was up today to 477 for a 2.9% increase, 11.7% of active cases. 421 recovered and 63 dead for a net decrease of seven active cases. There are now 4,068 active cases given 13,990 recoveries and 1,1540 deaths.

397,149 tests to date with 16,295 for the day. 2.9% of daily tests were positive. 1,028 cases currently hospitalized (-5) and 213 in the ICU (-7).

That's now five days at roughly 4,100 active cases. The ICU count continues to inch down but the total number in hospitals is still over 1,000; I believe this is partly due to the hospitals' inability to release recovered patients back to LTC facilities.

Quebec added 912 cases today (just one more than yesterday) for a 2.6% increase. 270,919 tests done to date, about 6,500 in the last 24h. Quebec is particularly trying to do massive testing in Montreal, but at this point the data indicates that they are struggling to get the volume up. 207 cases currently in ICU (-17).

April
2020-04-01 4611 (+11%) 2020-04-02 5518 (+20%) 2020-04-03 6101 (+8%) 2020-04-04 6997 (+15%) 2020-04-05 7944 (+14%)
2020-04-06 8580 (+8%) 2020-04-07 9340 (+9%) 2020-04-08 10031 (+7%) 2020-04-09 10912 (+9%) 2020-04-10 11677 (+7%)
2020-04-11 12292 (+5%) 2020-04-12 12846 (+5%) 2020-04-13 13557 (+6%) 2020-04-14 14248 (+5%) 2020-04-15 14860 (+5%)
2020-04-16 15857 (+7%) 2020-04-17 16798 (+6%) 2020-04-18 17521 (+4%) 2020-04-19 18357 (+5%) 2020-04-20 19319 (+5%)
2020-04-21 20126 (+4%) 2020-04-22 20965 (+4%) 2020-04-23 21838 (+4%) 2020-04-24 22616 (+4%) 2020-04-25 23267  (+3%)
2020-04-26 24107 (+4%) 2020-04-27 24982 (+4%) 2020-04-28 25757 (+3%) 2020-04-29 26594 (+3%) 2020-04-30 27538 (+4%)
May
2020-05-01 28648 (+4%) 2020-05-02 29656 (+4%) 2020-05-03 31865 (+2%) 2020-05-04 32623 (+2%) 2020-05-05 33417 (+2%)
2020-05-06 34327 (+3%) 2020-05-07 35238 (+3%) 2020-05-08 36150 (+3%)

[KevinL]

Would the difference in out public health unit and those around us, be our lack of teaching hospital? There are such institutions in Toronto, Hamilton, and London, but not here...

[clasher]

To me, masks can do no harm, so I'm all in.  It certainly raises my comfort level, as something additional I can do on top of self-isolation/social distancing.  It doesn't seem to be much disputed that wearing a mask might reduce the chance of infecting others, so that's reason enough for me.

Masks can reduce the chance of infecting others, they do little to protect oneself, but because they make most people feel better, that can change their behaviour, which means masks could do harm...

But at the end of the day, there is little to no evidence that as a public health policy (read: this is absolutely different from whether they might help a particular person or not because it depends on the effects on an entire population) they are effective or not.  Of course, data on COVID is slim, and culture matters a lot, but there is strong evidence about the efficacy of social distancing and isolation for COVID.

Here's a site that you might wanna dive into if you want some science and stuff... please don't argue with me about it; I didn't write it, just suggesting a place you might want to look if you want some stuff.

https://masks4all.co/#the-science

[tomh009]

Another positive day in Ontario: the new-case count was up by only 346 -- in spite of increased testing -- for a 1.8% increase, 8.7% of active cases. 393 recovered and 59 dead for a net decrease of 106 active cases. There are now 3,962 active cases, a level similar to that from four weeks ago, given 14,383 recoveries and 1,599 deaths.

416,376 tests to date with 19,227 for the day, another new record and very close to the 20K mark. Only 1.8% of the daily tests were positive. 1,016 cases currently hospitalized (-12) and 203 in the ICU (-10). The ICU count is down to the level from five weeks ago.

Quebec added 836 cases today, the first drop in some time, for a 2.3% increase. 281,370 tests done to date, about 10,500 in the last 24h and the first time they have managed 10K in one report. 205 cases currently in ICU (-2).

April
2020-04-01 4611 (+11%) 2020-04-02 5518 (+20%) 2020-04-03 6101 (+8%) 2020-04-04 6997 (+15%) 2020-04-05 7944 (+14%)
2020-04-06 8580 (+8%) 2020-04-07 9340 (+9%) 2020-04-08 10031 (+7%) 2020-04-09 10912 (+9%) 2020-04-10 11677 (+7%)
2020-04-11 12292 (+5%) 2020-04-12 12846 (+5%) 2020-04-13 13557 (+6%) 2020-04-14 14248 (+5%) 2020-04-15 14860 (+5%)
2020-04-16 15857 (+7%) 2020-04-17 16798 (+6%) 2020-04-18 17521 (+4%) 2020-04-19 18357 (+5%) 2020-04-20 19319 (+5%)
2020-04-21 20126 (+4%) 2020-04-22 20965 (+4%) 2020-04-23 21838 (+4%) 2020-04-24 22616 (+4%) 2020-04-25 23267  (+3%)
2020-04-26 24107 (+4%) 2020-04-27 24982 (+4%) 2020-04-28 25757 (+3%) 2020-04-29 26594 (+3%) 2020-04-30 27538 (+4%)
May
2020-05-01 28648 (+4%) 2020-05-02 29656 (+4%) 2020-05-03 31865 (+2%) 2020-05-04 32623 (+2%) 2020-05-05 33417 (+2%)
2020-05-06 34327 (+3%) 2020-05-07 35238 (+3%) 2020-05-08 36150 (+3%) 2020-05-09 36986 (+2%)

[jeffster]

Would the difference in out public health unit and those around us, be our lack of teaching hospital? There are such institutions in Toronto, Hamilton, and London, but not here...

The difference I see, and what I heard from people in the field: WR didn't set priority on LTC homes and retirement homes. This would be in reference to testing and PPE. Lots of cities outside WR did, in particular, places like London, Kingston, Thunder Bay (no teaching hospitals in either place) and Hamilton, but we prioritized FR's and hospitals first. 2nd thing, our testing is lagging large. Our regional Chair doesn't like the comparisons, nor does our doctor, but it is where we failed. Our numbers are comparable only to Toronto, but Toronto isn't expected to have the best numbers due to its sheer size. Even Ottawa massively outperformed us.

I think some people are going to look for reasons why we did poorly and why it isn't a bad thing, but the reality is that we didn't do good. Things like tests being super low is a local issue, not provincial, no matter what public health or Karen Redman says. I get that she's trying to support the local health unit, but she too needs to look at their performance here and be honest in her assessment.

As I had mentioned before, though, it seems that another key difference aside from testing was making sure staff was properly trained in fit with PPE - in particular, masks. While some believe (as do I) that it give offers a layer of protection to the wearer, the main focus is that it offers protection to the none-wearer -- in this case, patients and seniors in LTC homes and retirement homes.

A good example of what happens without the use of masks if you have a group of infected people (perhaps asymptotic) is Tyson Meats in Waterloo, Iowa. I think it was something around 1,000 employees infected by the time the plant was shut-down.

We really need to look closely how we handled the 1918 Spanish Flu. I believe they were heavy into social distancing and masks for long enough for the R0 level to go well below 1.0 and eradicate the disease. Wearing masks should become standard until we have a vaccine or unit the R0 remain below 1.0 for the disease to disappear.

[jgsz]

Would the difference in out public health unit and those around us, be our lack of teaching hospital? There are such institutions in Toronto, Hamilton, and London, but not here...

...The difference I see, and what I heard from people in the field: WR didn't set priority on LTC homes and retirement homes. This would be in reference to testing and PPE. Lots of cities outside WR did, in particular, places like London, Kingston, Thunder Bay (no teaching hospitals in either place) and Hamilton, but we prioritized FR's and hospitals first....

My understanding is that all the mitigation, be it lock-down, self-isolating, social distancing or wearing masks, etc. was not to protect us, per se, but to protect the hospitals.  Without mitigation, the hospitals would have been swamped by covid-19 patients.   I'm not sure anyone would have fared better if that happened.

[embe]

The statistics are helpfull, but is there a better resolution (overall) to how the age demographic plays a part in all the confirmed cases?  It's a dire situation for people in LTC facilities.