March 26, 2020 Chief medical officer of health news briefing

- Dr. Williams: this week is an important one to understand how we’re being impacted with all the people ... who have come back to Canada and also some of the early things like school closures

- Dr. Yaffe: as of this morning: 858 lab-confirmed cases in Ontario. Increase of 170 cases since yesterday. Now have a total of 15 deaths. This is an additional 6 since we last spoke – 1 in Ottawa, 2 in Toronto and 3 in Durham Region.

- in the cases where the PH investigation is complete, exposure info is missing for about 38%.
60% had travelled, 15% had close contact, 25% had neither. So they were likely acquired through community transmission. And of those who travelled outside of Canada, the US and Europe remained the most popular destinations

Since Jan. 15 we have had a total of 80 people hospitalized. As of today 29 are in ICU with covid, which is an increase of 12 since yesterday. 20 are intubated.

- Dr. Williams – US numbers – over 68,000, with over 1000 deaths already unfortunately. Our numbers in Canada are going up quickly. In Quebec they are experiencing considerable growth in numbers. And so are we, with 170 more positive tests reported today...
What does this mean: with the travel, the social distancing, our physical separation, remember we started those about 2 weeks ago today... and with people making decisions then to not go on the March break.

But the weekend following that announcement people started to return, which escalated especially on March 16. This week and last - 5th 14-day section and we wanted to see what that means. Up to 100 more tested positive yesterday, 170 today. Some say that’s due to backlog. But with those numbers we didn’t reduce our backlog considerably, because of getting new labs qualified up... And I’m pleased to say some of those have gone from 900 to 1100 outside of PH labs, so getting towards 3000 up to the 5000 tests we’d like to achieve at least by the end of this week.
- of the numbers rising today, knowing they came in last night, and the average time of production is about 2-3 days, that takes you back from the 25th to the 21 or 22, and knowing that people don’t come in the instant they get sick. And that means you go back another 4-6 days, which takes you to late in weekend and the 16 and 17th. We’re starting to see the numbers ramp up. So that makes it a crucial time for social distancing ... The quarantine law means that not only symptomatic people have to quarantine for 14 days. How to monitor that, work in partnership at provincial level – we’re working that out.

- We’re still requesting Canadians, if you’re out, try to get back, and the government is trying to help them do that
- that means of course our border crossings, rail and water, are all going to be under the same order
- so it’s not surprising that we’re starting to see that rise, because of people who came back after the orders and were cancelling March break plans. And more and more coming back 16-17 days and later. So it would not be surprising to me to see our numbers go up again – could see numbers go up over 200. So we need to continue social distancing this week and weekend and coming week, because we’re still in this very critical time
- [9:24] about 6% have to be hospitalized. The number of people on ventilators, as Dr. Yaffe said, is going up. So we’re sadly seeing more deaths. And while most are over 70, we have 2 under 70. So are on upswing time, and it’s a critical time. ...
- my main message is to stay at home. Stay focused on what your distance is. Stay healthy. And stay the course... and together I still feel confident we can stay the track of COVID in Ontario, because I know Ontarians are taking this very seriously and doing it diligently.

Q&A

'- Antonella Rutusso, TO Sun: an inmate went to TO South correctional facility, he was a presumptive case. Local officials said they were able to keep him in isolation. Can you give update? And do you have concerns re an outbreak in jails?
- A - DR Yaffe – we are familiar with that situation. TPH had identified this individual as a presumptive case. So when he was transferred to the correctional facility he was transferred appropriately and put in isolation. There is no risk of spread.

- Q – grocery store in Oshawa – in media – lots of people ... gloves being thrown in the parking lot. Are you still satisfied.. ,.grocery stores are safe?
- A - Dr. Williams – maintaining essential services is a critical part. I think stores are doing everything they can to protect first their tellers and their staff. Some people need to learn not to touch their face, I’m still trying to learn that.
- gloves – throwing them out on ground does concern me. If you’re doing that you need to find the proper receptacles. ... first do what stores want you to do ... And practicing the two-step – put your things on the counter, back up, then when they’re ready you step forward, etc. Make the payment – usually electronic is better... This is a new way of doing life for the next while. People are adapting.

- Q – Alison Martell of Reuters – Dr. Williams – there’s a school of thought that advocates testing very widely... Not possible in Ontario right now, but are we working towards that?
- A - Dr. Williams – we’ve had a lot of discussions about that.
Because usually if people are symptomatic, the virus has replicated enough that it’s spread in their blood, so if they cough they are spreading the virus. If they are asymptomatic they still have dead particles on the swab. So the asymptomatic part is challenging. If we had thought it was only close contact as we started out, we wouldn’t have been so eager to carry out the distancing measures. Because if everybody is distant then the chance of spread is zero. ... The wide testing ... if I have some small viruses in the back of my nose.. then in 6-8 hrs it starts replicating again.. .So I think you have to be careful when you’re doing population screening of asymptomatic people, that can give a false impression – if people want to go back to work, if a test is negative that doesn’t tell you that you can’t become positive. So we really recommend the 14 days.
- Q – with asymptomatic people we can still see pretty high viral titres.
- A - Dr. Williams – we don’t have high viral titres in our testing methodology. So I’d have to see that study. But sometimes you can have a high load, especially in the upper respiratory tract,... so if there’s a cough... droplets more likely to be laden w the virus. ... I haven’t seen positives in asymptomatic people. Can’t tell whether alive or dead. What I’ve seen is presence or absence but not quantitative

- Dr. Yaffe – generally speaking the more symptomatic, the more infectious that individual is. Not to say asymptomatic people are not infections, they may be. To look for higher titres refers to serological tests which we don’t do -- that’s more to see if somebody has been infected and recovered. We talk more about viral load, which refers to how symptomatic people are.
- re testing – we are recommending that people who are symptomatic be recommended for testing. The decision whether to test or not is decision of clinician who sees them. We do have priority groups, but they are not the only ones who can get testing

- Q – Rob Ferguson TO Star – some organizations are extending their closures for a few more weeks – eg CN Tower up until May 30. What can you tell people about how long they will have to do social distancing? At least 2 more months?
- A – Dr. Wiliams that’s the question everybody’s asking and we’ll have to see what happens this week. If we’re going down – that wd be surprising and we’re not seeing that. We have to wait until the peak then can reduce distancing.
Some who were going to open by April 1 are deferring. We need to keep social distancing and flatten the curve and ideally make it even lower than that. We’ve gone from lower to 100, to 170, let’s see what Friday and the weekend brings. Would not surprise me to see numbers climb to over 200 a day

- Q – the number of people in hospital today?
- A - Dr. Yaffe – I’ll have to get back to you – I only have the number who have been hospitalized to date, which is a cumulative number

- Q – Alison Jones from CP – can you clarify – 15 or 16 deaths – and on the website update this morning it said 13. What are the ages and regions of those new cases since this morning?
- A- Dr. Yaffe – I’m aware on this day of 15 deaths. That is 6 more than yesterday – 1 in Ottawa who was a man in his 90s living in the commumity. 3 in Toronto, 2 in Seven Oaks; 2 in Durgham region, 1 man in 80s who had recently travelled outside of Canada and one man in his 40s who at this point has no history of travel

- Q – Since we’re expecting more cases – especially in places like Toronto with so many active cases. Are PH officials able to keep up tracing?
- Dr. Williams – that’s we’re asking them to do. We’re trying to address that with the number of resolved – we know it’ll be 150-170, a lot from Toronto. So we don’t have full load still on table. Looking at malls to make sure they can do all the contact tracing, phone calls, and all other aspects that the public with a history of contact uses the self-assessment tool, Telehealth, etc. People need quality help. So they would do that in such a way that the people involved in social isolation would feel supported, would be able to get their questions answered, and if false positive, if they need something and it’s urgent they could ask for assistance so they don’t feel pressured to go out. With the new federal quarantine orders, there are more challenges and how we’re going to implement that. The orders are not meant to be punitive, meant to be preventive and caring. We need PH to ensure that kind of continuity, communication that is empathetic, sympathetic and functional enough to get all the data... Constant dynamic discussion... Good question and we want that answered quickly

- Q – Mike Crawley, CBC News – Dr. Williams – do you have in your mind a date when if you don’t start to see the number of new cases drop by then you start to get worried?
- A – Dr. Williams: if you extrapolate we’re now seeing the end of the first weekend after the school closure. That week had about a million people come back ... so we would have to ask the question– when has that come to a halt. And I know it’s ramping down, we’re trying to get some border land security data – if the border is walled off and everybody maintains the distance for the period of 14-plus days, one would expect to see -- depending on how successful the PH measure -- and that’s quite critical – then the virus doesn’t go anywhere. It can’t spread. It will be like a report card – how well did we do? Most travel will have ended entirely by the end of this week, but even by this week it’s dropping off. And more and more people are restricted in their social activities. So this week is going to tell me how the impact of travelling public is going to hit Ontario, and it seems to be significant already. Next week will give us numbers ... are social distancing etc. going to start to ‘flatten the curve’?

- Q – I didn’t hear date – thinking – if not reduction by end of week 2 of April, then we should start to worry
- Q - re lab testing – why so relatively few lab tests being done? Staffing? Lack of reagents? Not enough facilities on line?
- A – Dr. Williams –we’re opening up 8-9 new labs. PH lab does about 1900/day, and labs outside of Ottawa are doing 800-900, so 2700. We’re hoping to get to 3000 this week. For any new lab, the first 50 have to be retested at PH Ontario. But that’s an investment – because once a new lab is up and running, it can go up to 200 a day... The other aspect is that you’re getting more and more patient in hospital, being in ICU – often they need 2 and sometimes 3 samples, and those have to be done on a priority level... So we’re being crushed on different sides.

- Q – if someone sees someone not respecting quarantine they should call PH – but PH is overwhelmed (Dr. Tam’s announcement)
- A – Dr. Williams – I didn’t see Dr. Tam’s announcement. We’re figuring out how to enforce quarantine – police officers, border guards, and the RCMP. That discussion is yet to happen. How we might to that – people have reported already large gatherings that they think are inappropriate in parks etc. So that’s useful. But people coming back are going to want to do it the Canadian way, which is civil and being responsible. I’m not sure we want to spy on anybody.. .I haven’t put out any edict yet. Hoping to ramp up case meetings considerably in the next week.

- Q – So you’re saying re cases already reported to police – is that your preference- if someone’s not really respecting the law, they should call the cops? ... Cordon off those areas (parks) – that was decision of TO. In other parts of Ontario they have municipal police and OPP. We haven’t decided how ...
- Q – Phil Perkins, CHCH TV – 25% of our new cases are from community spread – is that discouraging? Does that mean people aren’t abiding by the rules?
- A – Dr. Yaffe - to be clear, it was 25% of the cases that have been investigated by PH. It’s 25% of 60% - which is 15%. So this is of concern. Within the capabilities of PH investigations, they haven’t been able to determine where they got it. To me this is evidence of community transmission. ... so people should know it’s very important to keep up the social distance. So stay home obviously, and if you can’t stay home keep social distance... People who are asymptomatic may be infectious

- Q – is it possible to find out where they’ve been, so we can make that public info, so [others] can figure out what situation they might be in?
- A - Dr. Yaffe – that’s up to local PH officials so can do local contact follow up. And then notifying those people. And then telling those people they should be self-isolating for 14 days.... We’re all walking – unless you’re at home – I take the TTC still. Everybody’s pretty good about keeping that distance.

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