New data released by Public Health Ontario suggests a COVID-19 paradox — the vast majority of deaths have occurred because of outbreaks in institutions in long-term care homes, but the spread of the virus is less controlled outside of those walls today.
The information comes from the integrated Public Health Information System (iPHIS), the database the province is using to centrally track the spread of COVID-19 across the province's 34 public health units. In recent days, it has included a flag for each of the province's 26,191 confirmed cases that has stemmed from an outbreak in an institution — such as a long-term care home, retirement home, hospital, group home, shelter, or correctional facility. It does not include workplace outbreaks, such as those at meatpacking plants.
It provides the clearest picture available to date of how the pandemic has evolved differently inside and outside of institutions. It shows COVID-19 cases in the broader community spiked in mid-March and then plateaued. That curve has flattened, but has yet to begin to fall. Provincial officials have identified "hotspots" in areas of Toronto, Peel and Windsor where the infection continues to spread. A plan to enhance the province's testing regime, to be announced later this week, is expected to target those areas.
Meanwhile, institutional cases — predominately in long-term care — spiked a month later, but have also shown a significant decline. When it comes to fatalities, however, the institutional cases have dwarfed those in the community at large.
(Click on the image above to open an interactive version of the chart in a new window. The yellow line is cases flagged as outbreak-related by iPHIS, the blue line represents those that are not flagged. The cases are organized by their episode date, the approximate date the person's symptoms appeared. The shaded area represents the timeframe reporting delays impact the total number of cases, which is particularly relevant when considering the timeline of fatal cases, as deaths occur weeks after initial infection. Current as of May 26, 2020.)
According to the data released May 26, 42 per cent of the province's cases — 11,052 cases —are related to an institutional outbreak. Of them, at least 6,595 are long-term care home residents or staff. Of the 287 cases added to the system in the previous 24 hours, 74 were flagged as outbreak-related. Of the province's 2,123 fatalities, 1,690 are outbreak-related, and of those, 1,339 are in long-term care.
The province has struggled to release accurate data on how the pandemic has affected residential institutions, versus the community at large. It has released data on LTC cases from both from the iPHIS system and from the ministry of long-term care, but both sets of data appear to have been incomplete and plagued by reporting delays that have made comparisons with the overall provincial case total impossible. Chief Medical Officer of Health Dr. David Williams said as recently as last week he did not have a clear picture on where the recent uptick in cases was coming from.
Seven weeks ago, Iacovos Michael, a scientist with a background in cancer research, set out to provide accurate information on the number of COVID-19 deaths in institutions, including long-term care homes, retirement homes and group homes — not by relying on any provincial dataset, but by painstakingly combing through local news reports and information released by the province's local health authorities. He has been tweeting out weekly reports and is now receiving help with the labour-intensive work from a group of researchers called COVID-19 Resources Canada.
His most recent report identified 1,787 cases on May 25, nearly 100 more than flagged in the latest provincial data.
1/9 ⚠️ Almost 1800 #COVID19 related deaths were residents of #LTC, #retirement and Gp homes in #Ontario (~83% of total deaths.)
⚠️ On average, the past 3 weeks, 3️⃣0️⃣ 𝐫𝐞𝐬𝐢𝐝𝐞𝐧𝐭𝐬 are dying 𝐩𝐞𝐫 𝐃𝐀𝐘.
We must #ActNow to #ProtectTheVulnerable
Thread👇🏻 pic.twitter.com/wYyZccd8lW
— Iacovos Michael (@IacovosMichael) May 25, 2020
When he first began tracking Ontario deaths in early April, about 50 per cent were in institutions and the full extent of the crisis wasn't yet clear. Today, that figure has increased to 80 per cent.
"Even myself, I didn't expect this to happen," he said, adding that there has been public attention on the issue, but it seems to have shifted to the reopening of the economy lately.
Michael said the public needs to have accurate information about what is happening in these homes in order to push the government to take action on the problems, particularly in long-term care. He cited issues including the aging facilities with multi-bed wards and the failure to quickly and effectively limit staff movement between homes.
"At the end of the day, these are our seniors. I know one day all of us might be in those long-term care homes, and obviously a lot of things were not done correctly," he said, adding that the province's inspection regime has shown problems that predated the pandemic.
While the provincial data suggests the number of new institutional infections has been dropping recently, the residents who have been infected continue to die at an alarming rate — 30 a day, according to Michael's data. He said he's not convinced the situation is under control, and he fears the impact of a second wave.
"I hope we find a way to stop this," he said, adding that he hopes that by providing data to the public, his message will be amplified, and something will be done.
CORRECTION: This story has been updated to correct the definition of "episode date."
Photo Credit: Andrew Francis Wallace/Toronto Star
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