Ontario MOH media briefing March 31, 2020

- Dr Yaffe – at this point as of 4 pm yesterday the data in the iPHIS ... had a total of 1,966 confirmed C. This is an increase of 260 cases from previous report. At time of posting this morning there were 33 cases that had passed away, which again is based on numbers in database. Numbers are fluid and we know that our local health units are continuing to work on new cases and deaths. .. we will provide more detail when the numbers are available

- 534 cases resolved. At this point there are 291 patients in hospital in Ontario, of those 125 are currently in ICU. Of those 82 are on ventilators. - lab numbers – we’ve tested 51,629 people. Many have multiple specimens tested on them, especially those in hospitals.

- 4,280 currently under investigation. And in last 24 hrs we’ve had results on 3076

- Dr Williams – we’re making headway on the backlog.... the numbers were down a bit from yesterday, because of carrying out a number of backlog cases, so that’s not surprising. The percent positivity stays about the same.

- Global situation, esp US as of today 143,000 cases, which is larger than China, and nearly 2600 deaths, and that seems to be unfortunately escalating at a very rapid pace. We’re monitoring esp NY state

- people are asking what does it mean that the numbers yesterday and today were higher than last week. As I said before that’s not surprising – these numbers indicate what happened almost 2 weeks ago. If someone had tested positive yesterday or today, that means it was in the lab 2-3 days, and they were at assessment centre 2 days before that, and incubated 5-7 days before that... so 11, 12 days before was when they were exposed. The week we were most concerned about – March 13 – and during March Break, then starting March 16, the maximum number of people coming back to Canada was up to 130,000/day. That number continued - March 28 total coming in: 25,000 for all of Canada and 13,000 from Ontario [6:51]

- so if people came back positive from travel -- and not everybody coming back is positive – yet we still require those people to isolate, and ask them to do their 14 days.

- so the fact that we have a surge of cases now reflects that – people coming back March 16-19

- as a result we have started to see an increase in hospitalization and ventilation

- so –expect those numbers to increase in the days to come

- keep at tasks, keep physical distance, keep at home because all you need is a few children who are incubating and they go back to school and the whole school is infected

- in my letter I didn’t say not to go outside and walk – but not going to public places heavily attended. And maintain your physical separation. Some people have difficulty doing that.

- -There are people who have gone up to northern areas, cottages - ... but that puts an unprecedented load on those communities.... Should just stay overnight for checking to see if your cottage is okay (for insurance). But if you stay longer remember those communities are seasonal.. .Therefore if you go up there you compromise the communities for the local residents.. And health services are set up seasonally as well. Those areas have not surged up with locums etc for the summer doubling, tripling of population. You don’t have the access to local physicians and to health you have in GTHA. So by going up there you might be putting yourself at risk and local population, esp over next 4-6 weeks.

Q&A

Avrey Haines, CTV News – for weeks the messaging has been to the public that everyone should treat everyone else as C-positive, especially if asymptomatic. So why are personal support workers not being supplied with PPEs in LTCs? We’re being told it’s locked up and will be brought out if there’s an outbreak. Unions are calling for all workers to have PPE.

- Dr Williams – if all visitors have been screened very carefully and all workers have been screened, that should be a relatively safe zone, compared to out in public... Versus if you think you have a case then you have to move on PPE asap. We have put out those directives carefully to not put staff or residents at risk

- and no short visits in and out, because then you can’t control what gets introduced into the nursing home

- Q – given that so many people are asymptomatic and PSWs are terrified to go into work – they’re only given gloves....and potentially transferring C from pt to pt. Are you requiring that these facilities give them adequate PPE

- Dr Williams – we have to make sure we have an ongoing supply, so you need proper PPE for the right procedure at the right time.. If we had lots of supply to give out at any time .. .we could give it out. But we have to be judicious about that. And hopefully you won’t have an outbreak... Unless you come into contact on your off time, because you can’t tell where all your friends have been and what they’ve done

- Alison Jones, CP – Dr Yaffe – any updated figures on number LTCs dealing w C, and how many of 33 deaths have been in LTC residences

- Dr Yaffe – according to data I have in iPHIS - ... we recognize it is not up to date – 10 LTC with outbreaks of C, and 11 deaths. So 11 out of the 33, which is probably the right proportion. The majority of deaths are probably out in the community

- Artonella Artusso, TO Sun – I was speaking to doctor in Bobcaygeon who said he was surprised at the rate at which C spread thru local nursing home. Does C spread far faster through nursing homes than influenza?

- Dr Williams – in our experience of this we have only Bobcaygeon – and the BC situation. There are a lot of ... parts to the puzzle. And..... each place is unique in its own way, but that means we have to deal quickly with any gaps. This is a big stressor to the organizations, residents are at risk, there’s the intensity of comunicating with the public and your staff can no longer be on the job, you need backups so you can maintain functioning.

- Dr Yaffe – we’ve had experience over the years with flu. This is new – no vaccine, no antiviral that’s been proven effective.... [23:40]

- Q – how do you decide which LTC patients should go to hospital? Some residents should die in LTC - .. how are those decisions reached?

- Dr Wiliams – it’s a complicated one, because they’re all there with different situations and conditions. Some have living wills – more of a palliative-type approach. I think LTC usually makes an assessment, and if the physician presiding thinks the patient needs full resuscitation and intensive care he would transfer the patient to the local hospital and that’s normal routine.

Hayely Cooper, Newstalk 1010 – province said schools closed to May 4, daycares closed to at least April 13 (cuz province can only extend closures at 2-week intervals). Will they be closed longer past April 13?

- Dr Williams – I haven’t seen all the details of that. There has to be some attention to the needs of health care workers if there is much more intense impact on the health care system. We have gotten through a large part of the 14-day Quarantine period for health workers.

- Q – The province said in large part it’s taking its direction from you Dr. Williams. So will you be directing daycares to stay closed past April 13 deadline for another 2 weeks under the provincial emergency declaration?

- Dr Williams- my advice was we had to extend past original date... [28:12] It;s within the Ministry of Education purview. And of course my concern would be that children who have travelled can contaminate or infect other children in school, and they could do the same in daycare system. It could defeat some of the long-term work we’ve done. Parents have worked so hard. That would be a step back.

Rob Ferguson, TO Star – now that we have 125 people in ICU – on Sat you were saying we were already at 68% capacity in ICUs

- Dr Williams – if there’s say 125 in ICU, at the moment there are 2,959 ICU beds available

Q ... given what’s happening in nursing homes – do you foresee a point where you might have to start conscripting doctors out of family practice into LTCs and hospitals? And foreign doctors?

- Dr Williams - we have a command team that’s looking at all that. Our family practice has been trying to expand their virtual care. We’re looking at bringing back retired people. So right now we’re trying to work within [parameters we have]. But in an emergency we have to do things differently

- Kenyon Wallace, TO Star – latest numbers re daily tests completed – according to what’s posted now, there were 3,168 tests done yesterday, approx 1370 of those came off the backlog. Last week we heard about this being the time we may be able to hit 5,000 or more...

- Dr Williams – I looked at that, and our Public health lab which has our samples in backlog – did around 2100. Our external labs – by my data here – received about 970 samples, and they did them all. So it’s a flow issue. They did whatever came in. Was there a delay, or drop in demand? I don’t have that information.

- Brian Platt, Nat Post – we’re entering the critical phase.. where we’re going to see whether we’re flattening the curve because of measures we brought in 2 weeks ago. How confident are we we’re doing that if we keep the testing criteria so tight?

Dr Williams everyone who’s symptomatic and goes to an assessment centre and thinks they have C, they will do the test. And we have 86 testing/assessment sites. That’s a lot of opportunity. I can’t see that that’s limiting. We may do some milder cases. We still have our symptomatic assessment. And that hasn’t been going down. [38:16] .. But I would hope that wioth our lab capacity ramping up, we may have an opportunity to do wider testing to make sure we’re not missing anything

- Q: have you been widening the criteria? Being symptomatic was not enough, people had to travel or have a close contact

- Dr Yaffe – the criteria are for people who are prioritized – health care workers, someone in a facility, a patient in hospital who’s very ill, or remote communities. But those are not the only people who should be tested. It’s a clinical decision. And if they feel the patient should be tested they are tested

Q – are NY numbers going to affect precautionary measures in Ont?

Dr W We have federal travel orders for symptomatic or asymptomatic to be quarantined. And we haven’t seen a change in that direction. So I feel symptomatic people will not be coming over or flying in. And people are quarantined in their home situation. If that’s done diligently we’re not that concerned. But as neighbours we’re sad to see those sad events

- Tabia Morrow, Hamilton Spec – there are directives that apply to LTCs and retirement communities. Another sector that is pretty vulnerable is residential care facilities. And in many respects – the staffing issue and close quarters also apply to these homes. Should these directives also apply to those facilities?

- Dr Williams - This directive has some cross-overs, but they are differnt. So we’re trying to put out some guidance documents to help them prepare. Talking to MCCS and seniors ministry around retirement homes. So as we deal with all these different components – including homeless, mental health, remote and indigenous communities – are all important and have unique challenges.

- Q – when will you issue a directive? They’re really struggling...

- Dr Williams – that’s what we’ve heard. We hope to have our guidelines out shortly. We haven’t put out directives... The demographics of what they have vary from institution to institution. Some more at risk than others.

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