Covid 19 Chief Medical Officer of Health Ontario press conference March 27 2020

- Dr. Yaffe – as of this morning there are 991 lab-confirmed cases in Ont. In addition we have been notified of 2 deaths at Pinecrest Nursing Home in Bobcagyeon. Not lab-confirmed but included in our numbers because Covid was confirmed in the home. In addition we were notified of a death in York Region – woman in 80s. Total deaths that we are aware of is 18. Total cases 993 – increase of 135 from yesterday. We do expect the number of resolved cases to go up quite a bit, well over 200, over the next few days.

We are missing data on about 40% of cases. Of those we know about, 1/3 had travelled in 14 days before becoming ill. Most common source of travel exposure has been the US. At this pt the US has more cases than China did – 85,500 approx vs 81,340 in China.

- the second-most-common source is Europe.

- 10% of the cases had close contact with a confirmed case. And 16% had neither travel nor close contact. So again, again evidence of community transmission.

- We are aware of approx 60 cases who are hospitalized, and of those 43 in ICU. Of those 43, 32 are on ventilators

Dr. Williams deaths are continuing, still in the high-risk category mostly, some related to Long Term Care’s. So still dealing with the at-risk population.

- lab testing – yesterday we went from 100 new cases the day before to 170 new cases but today we only went up by 133 [note: above Dr Y said it’s 135]. So that’s a pleasant surprise to me. Also we dropped the number of cases waitng for lab analysis by 940. [5:07] So that was also improvement, starting to make headway and move on those lab tests as more and more of our satellite labs are coming on board following their quality-assurance checks with the PH Ont Lab. So that means yesterday we went to nearly 3500 tests, [4:37] we wanted to be at 3000 early mid week and we did that and we want to hit 5000 by the weekend and are optimistic that we can keep that progression going, and keep dropping the pending tests lower and lower

- So, with the increased number of tests carried out as well as the roll-back on the pending ones, I was anticipating that our [increased positive test] number would be higher than 170, so I am pleasantly surprised it’s 133. I would say that’s okay, let’s see where we go, it’s only one day. And see how we’re gonna do over the weekend. This is second weekend of the critical 2 weeks and we have continued to do well with everybody adhering to the social distancing, physical distancing. [5:26] It’s not time to get casual, do not do that. Stick to home. Sit outside in the sun for a little bit, and do other activities; keep it to smaller groups, and keep down to the distancing between non-family members. If you’re in isolation because you’re a case, you still have to do that distancing with your family members to try and prevent them from becoming cases. And that is a whole aspect that we’ve asked all along – the difference between isolation if you’re a case vs self-isolation in the house. ... Hand hygiene is critical, as well as cough etiquette etc

- I’m trying to get more details from the federal government on how implementing new quarantine order is going to happen. There are processes in place but I still need more clarification.

[6:35] – We know that whether you’re symptomatic or assymptopmatic you have to do the quarantine for the 14 days if you’ve coming back from travelling outside of the country to comply with national law -- the Quarantine order.

- As you see there, the numbers continue to rise across our neighbour to the south, and some parts of that country are worse than we are. We continue to monitor that as well as Quebec – a large number of cases and hospital challenges are already occurring there

- the main thing is this weekend and this real week of intensity that we want to continue... Keep that distance going... Respect vendors, ... cashiers... Pay attention to their physical barriers so they can do their part to help you

- Keep at it. We’re not through this yet. It’s not a sprint but a marathon.

Q and A:

- Q – Alison Jones, CP – Dr. Yaffe – [9:00] – nursing home – why didn’t you bother testing the two people who died for Covid?

- Dr. Yaffe – This is a provincial guideline for respiratory outbreaks in LTC facilities. That applies to Covid and also to other respiratory infections. So basically, it’s saying we need about 3 or 4 positive specimens showing the same organism - in this case Covid - and if all those people have similar symptoms, we determine what we call a case definition – so we say, all these people had for example, fever and cough for whatever days within a certain time period – then we use that, and anybody who meets the case definition is considered to be a case at that point without lab testing. Because basically they are at that point a case. And we don’t want to use up the limited lab resources to test everybody when we already know what the cause of the outbreak is.

- Q – are you concerned then that because of those regulations and because we’ve seen several clusters in LTC home that we’re not capturing the full scope of it?

- Dr. Yaffe – It’s important to remember we’re also doing what we call sentinel testing. And any respiratory outbreak in any LTC facility now, the lab automatically tests for C in addition to the other respiratory pathogens, like influenza which we still have. ... That’s how we picked up that outbreak, through sentinel testing. So we’re pretty confident that we’re not gonna miss an outbreak

- Q – what is the main age range of people who are in ICU -- trying to get a sense of whether there are younger folk.

- A – Dr Yaffe – I don’t have that specific information at this point

- Dr. Williams – nationally the median age is 50s. They tend to fall much like our other demographics. Are we starting to see younger people? I have not seen evidence of that.

- Q – is there a latest number on number of health care workers infected? And the grocery worker who died yesterday – who worked at Grocery Gateway ... do people need to worry about grocery delivery?

- Dr. Yaffe – our info from Durham Health Department is that the individual did not have any underlying illnesses, but that may have changed. The info I have is he was only working there for 2 days, so it’s unlikely that he acquired the infection there. Measures have been put in place to keep workers and patron safe... [13:20]

- Dr. Williams - about health care workers -- about 29 have tested positive for Covid. We’re looking for clarification how many were acquired on the job (nosocomial). But some travelled and they may have contracted Covid that way or from community contacts. Our main concern is how many did acquire covid while on the job and that is very important for us to understand

- Q – what’s the status of the ventilators hat you’ve ordered – Premier Ford mentioned that some companies have offered to make ventilators.

- A – Dr. Williams – I know we’ve had reports of companies that have stepped fwd... Ontario already has 300 plus 200 that we’d ordered anyways. But it is encouraging that these companies can more of them produce quickly. .. .Of course have to have clinical tests before it’s used for clinical/public care

- Q – what’s the timeline for their use?

- A - Dr. Williams – I don’t have a timeline yet. The premier and the minister of health have encouraged these companies to come forward... The would be manufactured in Ontario – that gives us much more availability in the near future

- Q – Phil Perkins, CHCH News – about the new government text alerts [at 2 pm] – why are we just starting to text message this now?

- A – Dr. Williams we’ve reviewed all our public health measures. After a number of days some people may say ‘I guess this is not as big an issue as before’ so we wanted to remind the public about proper hygiene and doing distancing.

- Q – Will people get the government texts daily or how are they going to be spread out?

- A -- Dr Williams – I haven’t seen the timelines on that. We can get back to you when we get details on that

Q – is it still safe to use cash?

- A -- Dr Yaffe – I have to say I haven’t used cash in a long time. I would say that if you’re using cash, and sometimes there is no other option, wash your hands or use hand sanitizer after and don’t touch your face. But it is preferable to use other sources of [money]

- Dr. Wiliams – and we recommend cashiers use gloves. Some clients insist on using cash, and some of those may be vulnerable patrons. It would be preferable if someone in the neighbourhood could shop for them. We want to look out for our vulnerable populations among us...

- Q – what about lottery tickets?

A - Now people can do it all electronically – you will get rewards etc sent to you... better if you did it electronically. They have tried to accommodate that and make it as friendly as possible. So people can avoid using cash. In some demographics that’s not what people are used to, but that’s part of adaptation at this time. Safer to do it electronically. Assistance over the phone is available.

- Q – this afternoon Premier Ford said there will be mass testing and the province has placed some very large orders for new [testing] [21:53]

- Dr. – Yaffe – there were issues around swabs and reagents – using different kinds of reagents so they’re not depending on one supplier. Also expanding how many labs are doing the test... And creating a provincial coordination of the testing... There are a lot of different mechanisms in place that are going to increase the capacity to test quite a bit

- Q – are new technologies that are using different types of reagents or something else being considered to increase the capacity for mass testing?

- Dr Yaffe – labs are looking at different types of tests used in other countries – eg serology that’s being used in UK... If we find they’re valid, sensitive and specific enough to be useful we will implement them. But for now we’re sticking with PCR test... That’s a very sensitive and specific test that’s done right now. And as I said more and more labs are growing their capacity to do the test.

- Q –– with Ontario labs dropping pending cases down to 940 and the drop in number of new cases today, will you say to anybody that this is coming off the peak?

- A -- Dr. Williams – as I said, yesterday we had nearly 11,000 tests pending, and now ... 940. [25:27] I want 24-26-hours turnaround and quicker for urgent cases. While I’m a bit surprised that the increase has dropped down from 170 to 133, it’s just one day. I’ve seen this before, where it’s down one day then the next is 180, 190... So I would say the fact that it didn’t go up by a big number is reassuring, the fact that it was less than the day before doesn’t mean anything

- Q – with PCR testing – A, it requires equipment and B it takes time. Universities across Ontario usually have pretty high-level labs... Why are we not using those?

- A -- Dr Yaffe – there’s a whole group looking at the lab-capacity issues... I know they’re working with the University of Guelph and a lot of other universities. [27:30]

- Q – How many cancer operations are being cancelled?

- A – Dr Williams – I have received some emails from concerned people about that – we have quickly gone to regional hospitals and asked whether this is the type of procedure that can be cancelled. It’s my assumption that the individual hospital didn’t understand it. I don’t want to step into an ongoing patient-care protocol. Those persons deserve to have their questions addressed by their health care provider. In order to choose what’s elective, the physician has weighed all the considerations.

- Q – I’m sure you have anxiety if your operation is cancelled... Is it not vital that they should get that operation?

- A -- Dr Williams – as we go through the measures to prepare for large surges in Covid cases, because it can come on very quickly --as you’re sitting in your bed waiting for surgery and it’s cancelled because they’ve brought in 2-3 more people on ventilators. But other cases go on... strokes, heart attacks, cancers, etc. And we don’t want to cause more harm. We need a very careful balance on how to make that happen. Social measures like social distancing and using self-assessment forms mean you don’t overload the hospital system... save the space not only for Covid but for people who need other medical care now. Weighing is necessary: can this one that be deferred? We don’t want to compromise the situation, so that those who need the care get the care

- Q – Hayley Cooper, Newstalk 1010 - 16% community spread – is that higher or lower than predicted?

- A – Dr Yaffe – in 40% of cases we don’t have any information about their exposure. One reason is because people can’t remember where they’ve been and who they’ve been with for the previous 14 days. Also the health unit may not have the capacity to do the interviews and re-interviews to try to get that info. Re the 16% - they obviously got it from somebody else, and they got it from somebody else in the community they’re in.. It’s something of concern and we’re working with health units to try to do more contact people [33:05]

- Q – so the goal is to be completing 5,000 tests by the end of the weekend?

- A -- Dr. Williams – yes... today we’re up to about 3,500 and the other 9, almost 11, satellite labs are finishing their quality checks with Public Health Ontario. I’m fully anticipating by the weekend we go up to 5000. We might even go beyond that, and that would be a pleasure.

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