Monday, March 30, 2020 Ontario Public Health Media conference

- Dr Williams – this is the second week of need for a lot of precautions... Looking to increase PH measures as you saw over the weekend.... Hopefully we’ll be able to see a little bit better by the end of this week... Will we be able to bend the curve? We’ll see

- [1:] Dr Yaffe – as those of you who’ve checked MOH website we’ve updated it to how we report cases. Using daily epidemic summary produced by PHO. Gives you more regional and .. data on cases, trends of cases, geography , exposure and severity info

- as of this morning we have 1,706 cases in Ont, through a system called integrated Public Health Information System [iPHIS] – used by local PH units to input data on case and contact investigation. So that’s where the info is coming from

- increase of 351 more cases than reported yesterday

- at the time of this morning’s posting there were a total of 23 cases who unfortunately had passed away. We know this is a very fluid situation and the data we are presenting is a snapshot of time. However we are aware of an additional 10 deaths since this morning. And that brings total to 33 deaths that we’re aware of, sadly

- I’m pleased to note that of 1706 cases, 431 are now considered resolved

- hospital info – from the Critical Care info system we are aware of 100 case of confirmed Covid patients in ICU. Of those, 61 on ventilators.

- lab testing – [4:15]- labs have now done 4,000 tests over last 24 hours. The backlog is going down rapidly. As of this morning was about a 5650 backlog and expect to go down even further over next couple of days

- Dr Williams – while the number of positives is up, as we said before that would not be surprising knowing the backlog, and percent positivity hasn’t changed substantially, but we still have a backlog ... Still some activity, a lot of people coming through positive. That reflects back 5-6 days ago. So one can’t be complacent... And that’s one reason I did send letter out emphasizing that to the public. Trying to encourage you, that we are in this together. I know it’s long for some people ... but we have to keep at it. So we have these 14-day periods, we are into the 2nd week of this 14-day period, which by the end of this weekend will be our fifth... So we have to stay the course -we’re into the 3rd and 4th quarter... keep working and beat Covid. At least bend the curve and go down even further. Some evidence of that from our modeling colleagues ... but they’re also delayed

- this gives us some measure of how well you’re doing with public health measures. Overall you’re doing quite well. There are some individuals who are not

- as well – We now have an order saying than 5 people at public gatherings. That was felt necessary. [7:20]. We had a number of comments in from the public saying that didn’t make sense. We’re trying to be sensitive to maybe some events, such as funerals, and we did alter that and they can be convened as an event, not as a public event

- and besides that, we want to look at the over-70, and we want you to stay inside ... and want others to help them out

- Dr. Yaffe – re Long Term Care homes. We always knew that the population in LTCs is a particularly vulnerable, high-risk population for serious illness, complications and even death. Unfortunately we are seeing that play out in places like Pinecrest in Haliburton/Pine Ridge. The Ministry of Health has been working very closely with the facility to try and increase the resources etc. But it is challenging. And we’re looking at strengthening communication and advice for staff.

- Dr Williams – over 70 – at high risk. Want to encourage them. We have to do [shopping etc] for them, so they don’t feel forced or pressured to go out of the house. And connecting w social media... Trying to maximize social-media visits

Q: John McGrath, TVO – I’m watching the debate on social media- people generally understand they shouldn’t be buying dozens of surgical masks or masks from the hardware store, but any thought to changing public health guidance to guide people to get some sort of face coverings?

- Dr Williams – I’d prefer that people keep to the 2 meters – because some of masks are loose-fitting. So that doesn’t give the benefit of the 2 meters... Some who feel that they have to be in close contact could consider using the surgical mask... I see some people driving with a mask and I don’t know who they’re protecting.

- Dr Yaffe – working with PHO and looking at latest scientific evidence... [15:35]. I agree fully with Dr. Williams. The only exception is if someone is symptomatic and being sent to assessment or emergency, they should wear a mask.

- Travis Danhraj, Global News – the premier was asked today re possible mandatory stay-at-home order considering we’re seeing seniors, police, etc. come down with Covid and this death toll continues to get worse. Every time he is asked about putting more measures in place he says he is deferring to you. So when do you decide more measures need to be put in place to prevent more deaths in Ont?

- Dr Williams – that’s always on our minds ... We’re not ignoring the issues, we’re monitoring whether they can maintain those jobs and keep social distance.

- Alison Jones, CP – Dr Yaffe you said there were 10 more deaths for total of 33. Is there more info about those 10 deaths?

- [20:08] Dr Yaffe – I have bits and pieces of info, to be honest. ... What I can tell you, not complete yet - we have info coming in through the day... Another death in Haliburton. We’re not sure if it’s related to the outbreak. 2 additional deaths in Lambton, who are in their 70s or 80s, one in Haldiman-Norfolk and one in Huron-Perth in their 60s [20:50]

- Q CP24 – Dr Williams –are you moving closer to full lock-down so we can help flatten this curve?

- Dr Williams – Going out to exercise - we have seen some people this weekend go to large areas – if you’re going to busy areas then you shouldn’t go there. I’m not discouraging people from going to an early-morning jog. [22:20] But it’s better to stay home...But again if can do it in a way that’s off-hours, not go to busy places...

- Alison Martell, Reuters – [25:12] is whatever work-arounds to get more testing done permanent or temporary to slow down the backlog?

- Dr Williams – with lab testing - it’s permanent. We did a little over the weekend, did 4,000 last night and hoped to move that up from 5000 to 10,000 if we can, and get rid of the backlog totally

- Q – do you anticipate expanding who you test? - [26:02] Dr Williams - if we get done all our priority testing, ... then we could contemplate doing some wider type of testing. Plus we may be changing some definitions, to get a wider part of the population involved and that. But we want to get first our priority done, people who are symptomatic, HC workers, first responders [26:40] And others like LTCs, and any remote communities like our First Nation communities

- Miranda Enthistle Global News – we’ve heard from some LTC workers who are being prohibited from wearing masks on shift

- Dr Yaffe – that protocol is under review. But if they’re in a facility with an outbreak they definitely should be wearing a surgical mask and when working full protective equipment with patients who may be infected with Covid.... If not working in an outbreak facility that’s where the recommendations may be changing at this point.... We need very strong screening of people coming in. No visitors except under really exceptional circumstances. Really scrupulous cleaning. So PPE is just one thing that needs to be done.

- Maheem from Vista Radio – as reported first in the TO Star... There were 920,000 visits to the self-assessment website by midnight March 27 – 120,000 were directed to needing immediate assistance. Correct or glitch?

- Dr Williams – you’re talking about the self-assessment tool? - Reporter – yes - Dr Williams – we’re very pleased with the number of people accessing that site... we have people who are not that ill and are self-assessed to self-isolate, others unrelated to Covid, others instructed to call a nurse, others felt it necessary to go to emergency or call 911. The ones moved to self-isolate were just under 25%

- Cathryn Berlatt w Radio Canada – the new way the numbers are reported on provincial website - talks about male vs female cases. How relevant is that to the way the pandemic is evolving? And why change the reporting?

- Dr Yaffe – up until today, we’d been reporting based on lab numbers. Those are important numbers but they don’t give you the whole picture of how did people get it – through travel, through contact? Who were the people who got it? When we look at what’s going on with the trend in a disease we always look at person, place and time – so how many people in each age group are affected? Is it affecting males more than females, as it seems to be the pattern. [31:08] What are the characteristics as much as we can determine of who is more seriously affected? And the geography. Those data help us prevent further cases and direct further care and plan treatments. We get that info through PH units and put in iPHIS database... [32:38]

- Laura Stone, Globe – Dr Yaffe – additional measures in LTC?

- Dr Yaffe- we’ve been looking at the challenge – this is not just us, it’s across Canada – of how best to protect this vulnerable population, to try and address the fact that a lot of them don’t have symptoms early on, and to detect that as quickly you can. So in the past we had a protocol related to influenza, where we would stop testing as soon as we found 4 and we would call it a group outbreak and link them epidemiologically. Now, we’re going to go much quicker on that – as soon as you have a case, someone symptomatic, we’re going to assume [33:52] that it probably is an outbreak and it probably is Covid, to start doing your action right away. Not waiting ‘til you get your lab testing done. And there’s a number of steps we’re asking the LTC facilities to do in bringing in more training -- we have webinars planned for the staff, we’re looking at our regional resources, much like in the past we had Regional Infection Control Network and we still have some of the staff for that at our hospitals, and we can link over to our LTC facilities. Looking at how we can do an all hands on deck approach - [eg] if you have a facility that’s a possible outbreak, look at their staffing, look at their structure, their case management, how the cleaning’s done. ... And circumvent a larger outbreak as we have seen in some of the facilities already. So we’re really trying to ramp up a lot of the things in the LTC facilities-- around screening, staff, if you have a large facility can all the people be on same floor or same place eating ... can we stop that so we can put up a wall? And limited staff movement between different facilities... .. Hope to have some new directions out on that very soon with the Minister [of Health] and the Minister of LTC.

- Q – will you be publicly posting online about cases where there are outbreaks in LTC homes for families and others concerned about their loved ones in these homes?

- Dr Williams - Right now, the PH units in that area if there is an outbreak they put out a notice. And if there is an outbreak it should be a joint release with the facility and their local PH unit. If have Qs you have to go to the manager of facility and LTC ... Better if handled at the local level

- Kate Allen, TO Star – how may probable cases from iFIS?

- Dr Yaffe – at this point we’re not reporting probable cases. Some local PH units are reporting them and others are not... As we move along we have to decide whether it makes sense... There should not be too many probable cases.

- Rob Ferguson, TO Star – given your directive today for people over 70 and those with more vulnerability, how much higher is the risk all of a sudden, and can people in those conditions go out for a walk or do they really need to stay home?

- Dr Williams – you asked last time re cases and segmentation by ages – we have that now in our report – 19 and under, small percentage. Bulk is 77%, and 65 and older is 20%. Yet with older people they have a higher rate of hospitalization and mortality. ... Mortality goes up continually up there. ... And if they have other co-morbidities... People between 40 and 60 don’t have [many?] co-morbidities, but we're concerned about people who are immunocompromised. They have to take extra precautions

- Kenyon Wallace, TO Star – how many tests being done every day as of now?

- Dr Yaffe – in the last 24 hrs labs did approx 4000 tests. And by mid-April almost 19,000 every day

- Dr Williams – over weekend we did 5,000. ... When more people are in hospital and ICUs each has multiple tests (each have 2-3 samples). ... We did bump over a little bit, just over 4,000, and external ones we added are ramping up

- Mike Crawley, CBC – ICU suspected pts. Dr Yaffe said there ought not be so many probable cases. Why so many pts in ICUs who are showing all symptoms but don’t have their test results back yet?

- Dr Williams – we’ve been asking that and have been asking facilities – what is your case definition in the hospital and in the ICU of a suspected case, is it the same as ours out in the field, yes or no? It seems now anyone with respiratory distress is C-suspected. It does puzzle me a bit because we are prioritizing those ones, so if we have a suspected one we are assuming they’re going to take the samples as quickly as possible, transport them as quickly as possible to one of our now many regional labs around. And we would like to turn that result around in 24 hours. So, I am not sure why they are not moving those through to confirm or rule out as quickly as they can. Because we are certainly making testing a priority.

And for us, a confirm has to have a positive test. If you have someone that you can’t get any positive tests on and they continue to be negative, and they’re in respiratory distress you need them in ICU or a ventilator, there are other causes that we have all the time. And we ask the PHUs to tighten up their case [43:37]

- Lisa Zing, CBC – LTCs and testing – I spoke with some experts who said we should be testing everyone in LTCs as soon as one person tests positive, and not just adhering to full protocol

- Dr Williams – we moved quickly to testing anyone with any symptoms or concern to the LTC staff, especially to those that might be right around that person in the same area, and staff – there’s been a staff member [infected so] who that staff member might have been in contact with. The challenge of course with LTC residents is that because of their age or their conditions, they don’t manifest some of the more overt or more obvious symptoms signs of C or influenza-like illness: they may not mount as much of a fever or cough - they always have a cough sometimes - so we’re looking at more and more finer measures, to say, ‘can we detect it earlier and earlier?’ If we just went around and tested, and say you had a negative test today, and then tomorrow if there was another person, would we ignore that person? [44:54] No, we’d have to go back and test them again. A negative yesterday doesn’t mean they can’t be having it today. So it may give us a sense of false security.

So we’re going to have to be very and careful with the method of looking at those early signs. We’re having discussions with experts, geriatricians, how can we do that better, what are those even softer signs that are may be not so obvious that this person should be tested regardless [if] they don’t have evidence all the signs and symptoms of Covid. So it’s something we’re driving at, and it’s one of the challenges that Covid presents to us.

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