March 25, 2020: Medical Officer of Health press briefing

(notes taken by Rosemary Frei)

- [2:30] Dr. Barbara Yaffe – As of this morning we have a total of 688 cases confirmed in Ont. So this is an increase of 100 from yesterday. So the numbers are going up every day.

- total of 9 deaths – including 2 more than yesterday. One of them was a woman in her 80s from Heritage Green Nursing Home [in Stoney Creek - http://hgseniorcare.ca/] who died in hospital. Other was a man in his 80s who was a resident of Ina Grafton Gage Village in St. Catharines [http://www.niggv.on.ca/]. This person had close contact with a family member who had recently travelled to Europe. He died 11 days after he had was confirmed to have the virus.

- Of the total cases, exposure info still pending for 43%.

- Of those we know – 64% had travelled outside of Canada within 14 days before symptom onset, 23% were close contact of a case. In 13% we had no history of travel or close contact, so they were acquired in the community.

Of travel – 30% to US – most common states were NY, Coloardo, Calif, Fla and Nevada. Next – 28% had travelled to Europe

- Hospitalizations – we are aware currently of 40 cases hosp’d in Ont. Of those, 17 are in ICUs and of those 15 were on ventilators.

- [4:44] lab data – Our numbers of course are going up every day. We have over 10,000 that are still pending because the lab is trying to prioritize health care workers, people in long term care, homeless shelters and First Nation reserves or rural communities. A lot of work being done to increase the testing capacity

- Dr. Williams – We’ve heard some more announcements from the federal government about enhancing their quarantine order – effective for all travellers, both symptomatic and asymptomatic, waiting for details on how they’re going to implement that at all entry points, and how they’re going to be giving that info to provincial authorities.

I was anticipating that this would happen, and now we’re looking at how we would ensure they’re able to do that isolation... We can assist them so they can maintain their isolation at their home location... So our prerogative is to help you self-isolate.

- Cases are going up in all provinces. Some more than others... All dealing with, like we are, a load of tests and some backlog, as their cases are escalating with more and more travelers coming back

- national data: how do we compare – of those age groups – 20-59 [year-olds] make up 60% of those cases, 60 and above make up only 31% of the cases at this time

- [7:44] National rate of hospitalization on overall data just under 6%, and ... ICU or venting [ventilation] is just under 2%

- there’s things unique to each setting – demographics, how their systems are set up, and unique challenges they have ... So if you’re doing comparisons, ... you need to know all the intricacies.... and challenges the individual places are facing

- .. We’re still concerned with the situation for our neighbours to the south, cases going up rapidly, not surprisingly since they’ve got 10 times our population .. [But] ... what does that mean esp. those states that are adjacent to our borders and how does that impact our returning citizens as well?

- Yesterday – the decanting of Trenton... The third cohort is through. Just a few are left – the ones who are finishing off Quarantine because they had turned positive while at Trenton Base. - Of the 200-odd ose who came back, 13 had converted in that time who were previously asymptomatic, one became symptomatic on the flight

- We have asked people not to go on cruise ships at this time because of the high risk of exposure site

- Lab testing: as Dr. Yaffe noted, yesterday we went up, and we had pending an increase of 2,000. Today we had the same number of tests come in, but we didn’t really move much, we kept the numbers, so we didn’t accrue very much more, so we’re continuing to make headway on that capacity. We hope to keep pursuing that, as the week goes ahead, trying to carry out 5,000 tests a day

- We still recording deaths, it is still in our high-risk population, and that is concerning... We’re continuing to monitor in long-term care and other settings to make sure infections are walled off and dealt with quickly and appropriately. .. We need to protect our vulnerable population.

- My message is that... at this time especially, you need to stay home. You need to do the physical distancing, the social distancing, whatever your title and term.. .You need to do it consistently, with vigilance. I haven’t seen many aspects of violating that. Ontario citizens are highly responsible- if you’re not doing that, and you choose to do the activities, I would say that’s foolish, perhaps a better word is a stupid thing to do. It’s irresponsible and inappropriate for yourself, your family and vulnerable populations. If we do that consistently over the next week we can ... plank the curve... But not without the full dedication of our citizens and all you out there are doing what you need to do over the next number of days.

Q and A with the press

- first Q – Brian Lilley, TO Sun: how much equipment have we got?-
A Right now we have a lot of ventilators available in our stockpiles as well as in our hospitals. With the cancellation of elective surgery, we’ve freed up room in some of the ICUs, as well as other parts of the hospitals. So we have some flexibility there now. It doesn’t mean we’re satisfied. We’re going out trying to purchase others, [16:10] and we’re looking at – as the premier has announced, some of our people and our creative industries, we’re going to make some adjustments and continue to manufacture equipment

- Q 2 from Lilley – about Quebec – they’ve got way more cases than we do. The Montreal Jewish Hospital, I’m told, is now well above capacity for ICU, for critical care, and the Royal Vic is not far behind. In Ontario... We’re about a week behind Quebec from March Break... Do you expect we may be a crunch period in the next week or so, ... will we have enough in a week’s time?
- A – Dr. Yaffe – To reiterate, at this point we have 17 patients with COVID in ICUs, and of those 15 are intubated or on ventilators. We are working extremely hard, basically day and night now, to get more supplies. We have recently secured an additional more 300 more ventilators, in addition to 310 that the province already has in an unallocated surplus [18:44]. There’s lots of other supplies as well.

'''about Quebec - Dr. Arruda – the very fast surge is also because some of their lab results had been pent up because of they were waiting for confirmation from the National Microbiology Lab. Now they’ve agreed that they don’t need that confirmation. So all of a sudden they had big jump in their numbers -- some of that was due to a backlog.

- I can say that our Command Table, working with Ontario Health – at the assessment centres our emergency numbers have continued to drop down. Our admissions from our emergency departments to hospital have dropped down. Our occupancy of our hospitals including our ICUs – as one hospital said, this is an all-time 10-year low as far as occupancy is concerned. So we have created that space if we need to do it and when we need it. So – will it be necessary tomorrow, next week, another day, we’ll have to wait and see..... So we are preparing? Are we satisfied, no, we are doing more preparations

- Q – Rob Ferguson, Toronto Star – Dr. Yaffe – the number of patients in hospitals is about double since Fri, and number of patients on ventilators has tripled or quadrupled since then [21:03], with half the pts almost in ICU. ... It’s ramping up fast.

- A – Dr. Yaffe It’s telling us that there are more cases happening every day. And there are more cases that are severely ill. [21:27] This partly reflects who’s being tested. People who are mildly ill are generally not being tested, they’re told to go home and self-isolate. So it’s not saying that the disease is getting worse, it’s saying that we are identifying more severe cases.

- Q – Rob Ferguson – I heard on CNN talk about home test kits for this

- A - Dr. Williams – Point of Care testing kits, or rapid test kits.... they’re being promoted. There are 2 types – a blood test – serological test – that tells you if you had any immune reaction that’s perhaps indicative of a COVID infection. But those home test kits are about 50% sensitive. So if it’s positive it tells you something, if it’s negative it doesn’t tell you too much. If you’re positive it doesn’t tell you if you are infectious, just that you were exposed to it sometime in the past.

- Point of care test is not on the market yet... Part of the revolving tech that back in Dec. did not exist. ... This is where industry is applauded, for coming up with ideas on very short notice... But what is the specificity [and accuracy], so we’re not coming up with false results?

- Q - how much is this costing?
- A - Dr. Williams: that’s a good question. The main thing is there’s very much support from the premier.. and cabinet... a large amounts of funds available. Trying to account for those costs... I don’t have the numbers on hand. It’s very early yet... a lot hasn’t been purchased yet... We’re not holding back, ‘what you need to do, we do... we’re covering it.’

- Q – specific costs? - Dr. Williams – at least hundreds of millions of dollars on Ontario. And the federal government even larger numbers w their new [legislative] bill

- Q from Hayley Cooper, Newstalk 1010 – clarification on transmission – droplets from sneezing and coughing. But can virus be contracted thru the air, say if somebody breathes on you?

- A - Dr. Yaffe – if somebody breathes right on you there probably are microscopic droplets if they’re close to you, that you wouldn’t necessarily see - for example if they’re talking or shouting or singing or whatever. But that is not the same as airborne. [27:21] That is still a droplet or contact. And of course we have to remember also that people can touch things, and then the viruses can survive on the surface for hours or sometimes for a day or two. So cleaning surfaces is very important

- Q- –Is the federal government too late in implementing 14-day quarantine?

- Dr. Williams - we already did the quarantine for cohorts in Ont on behalf of the federal government – at Trenton, for cruise ships. Whether people were symptomatic or asymptomatic, we asked them to quarantine for 14-days and self-isolate anyways. This federal law just strengthens that – this makes it a pan-Canadian approach at all borders

- Q - - cleaners, grocery store workers, without personal protective equipment .. Could the province provide more PPE for them?

- Dr. Williams - I’ve gone and looked to see. And I’ve been very impressed to see what people have set up. They are very attentive to the 2-step, back and forth with the customers. Trying to use much more tap methods, if they’re using cash, to use gloves, ... spacing people as they wait, taking people with vulnerabilities ahead of time.

- Q- do cleaners need more PPE?
- Dr. Williams -if they’re wearing gloves and proper equipment... they should not come into contact, as long as don’t put hands on gloves and then on hands and face.... So they‘re going to have to pay attention... So it means on really focusing on hand hygiene, lots of handwashing [32:13], .. Like staff who do that -- just like someone doing a very dangerous job, with occupational health and safety, they have to adhere to strict standards, this is the time they have to adhere to those strict standards while they’re focusing on the job

- Q - Phil Perkins, CHCH News - why does the ‘recovered’ stat still in the single digits?

- Dr. Yaffe – [32:55] – Until recently, we have said that in order to consider a case resolved, we need to have 2 lab tests that are negative that are at least 24 hours apart. And that is the criteria for those small number of cases that are listed as resolved. Of course as you know... lots of the testing going on now has to be prioritized, so those negative tests tend not to be prioritized... Working with evidence and PHO, we have just informed the PH units they can use different criteria for resolving a case – and that has to do with if the case it not hospitalized, they’re not Health Care workers, they’re recovered, they feel fine, and it’s been 14 days since ill, we’re saying they can be considered resolved.... So our number resolved is expected to go up

- Q – people who had travelled and have symptoms are being turned away from testing
- Dr. Williams – people can take self-administered questionnaire tests – we’d consider that any traveller a case and they have to self-isolate. At assessment sites people are told to go home. If they get more severe they can be assessed and go to a Health Care centre for assessment and the hospital if necessary. We don’t want people going to hospital if they have symptoms that can be managed at home... If symptoms get worse, people can call Telehealth, or call an assessment centre...

- Q - Miranda Entwhistle, Global News – re the Toronto Nursing Home outbreak

- Dr. Yaffe – when there’s an outbreak in a nursing home – not sure about specifics of individual Nursing homes, although that info could be made available. First – standard infection control is really important. Put some restrictions on admissions and visitors – screening of staff and if they are sick they must go home. But if a case is identified, they need to get adequate care and also have to be isolated. Identify close contacts, make sure of their clinical status and that they’re isolated for 14 days. There has to be increased cleaning of the place, more active case-finding to make sure we’re not missing cases... And making sure staff are cohorted within the nursing home, so that the same staff are working with the people who are ill so we’re not potentially exposing different staff.

- Q – if staff are critical... and they have traveled abroad but don’t have symptoms... could they be still taking care of these individuals?

- Dr. Williams - directors within the health care sector have all been sent the memo – asking that staff who have returned from travel do not work, ... At the current time, the load in the facilities is not high, we’ve created that buffer... We asked health care staff not to travel starting March 12. That 14-day period is coming to an end... If we keep those people out for the moment, in a short period of time they will have completed their 14-day period so the problem will be moot...

- Q – Christina Tanaglia, CP24 – MOH potential to use hospital beds for those who are sick or recovering or those most vulnerable. How will that help, how necessary is it, how many hosp beds would be required?

- A – Dr. Williams - a hospital bed is required for a patient who requires supportive services during their assessment... such as oxygen, so-called BPAP up to Ventilator and IV therapy, as they get more complicated. So people just taking up a bed as they are recovering, as we’ve had in the past, were sent home if they didn’t need that supportive therapy and care, ... they were some of our resolved cases.

- Last Q – based on your medical opinion, construction workers – not being able to social distance. And Premier Ford has said if you don’t feel safe go home. Still an essential service. Should it be?

- Dr Williams - as you heard from the Premier, housing is still an urgent need. There is some hospital construction... so each is separate... the main thing I would look at is re occupational health and safety can they maintain the social distancing?... As far as hand hygiene, you’re [not] dealing with contaminated surfaces... instead chemicals... There’s things you could provide like hand wipes. ... It’s the breaks – I think if they can just make sure they stand apart a little bit.. that would help in that situation. But in that situation... we feel that some are very essential... But each situation is different and needs to be understood -- can you maintain social distancing while on the job?

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