Select Committee on Emergency Management Oversight
fifth interim report
1st Session, 42nd Parliament
70 Elizabeth II
The Honourable Ted Arnott, MPP
Speaker of the Legislative Assembly
Your Select Committee on Emergency Management Oversight has the honour to present its Report and commends it to the House.
Daryl Kramp, MPP
Chair of the Committee
Select Committee on Emergency Management Oversight
1st Session, 42nd Parliament
John Fraser sara singh
Lorne Coe regularly served as a substitute member of the Committee.
Clerk of the Committee
Statement and Discussion
Deputy Premier’s Statement
Presentation of COVID-19 Modelling
· Overall mortality continues to increase, exceeding 25 deaths per day within a month. This makes COVID-19 “among the most common causes of death.” While not as significant as cancer or heart disease, “it is more common than virtually every other category” reported by Statistics Canada on a regular basis. Based on forecasting, Ontario’s overall daily mortality will continue to increase.
· COVID-19 intensive care unit (ICU) bed occupancy (a key indicator) is now over 200 and is likely to be over 200 for the rest of December.
· The data demonstrates a consistent pattern: access to suitable housing and employment outside of essential, front-line services are predictors of lower COVID-19 infection growth. If people cannot obtain suitable housing, or have to be in an in-person job, the result is “much faster growth of the pandemic.”
· The current set of restrictions that started in the middle of September has not reduced mobility (and resulting contacts) as much as the spring lockdown. While this is understandable (because the spring lockdown included a more stringent set of restrictions), this is important to keep in mind, because it means that the current restrictions are “not reducing contacts down as fast.” However, it does look like the current restrictions “are having an impact.”
· The data shows “a huge degree of variation” across public health units in terms of the spread of the disease through the second wave. For example, Peel has 197 weekly new cases per 100,000 residents, “down to about 30 in Ottawa.” The very different “picture of spread” across the province reinforces the importance of a region-by-region approach.
· There is also a significant variation in the percentage of new cases that have no known epidemiological link across public health units, ranging from about 70% in Toronto, down to about 6% in London. This is a critical measure of public health capacity. When Ontario “hopefully” enters the declining phase of this second wave, it will be important to identify the source of every case in order to work toward suppression of the disease.
· There is considerable variation across the province regarding the wait time for COVID-19 test results. This is an important measure of public health capacity.
· Overall, it appears that COVID-19 test positivity (i.e., the percent of tests that come back with a positive result) is “flattening.” This demonstrates Ontario’s “very precarious mixed picture.” Because percent positivity is starting to flatten and testing volumes are “reasonably strong,” the province is at the point that “we’re either going to lose control or gain control” of the pandemic.
· Percent positivity by age group is very different for the first and second waves of the COVID-19 pandemic. In the first wave, the most significant spike is seen in long-term care, with relatively lower spikes in other age groups. This reflects the “very significant” restrictions in the first wave which reduced contacts among people who would otherwise be mobile. For the second wave, the data shows a very different picture of community spread “with distribution that’s much more consistent across a series of different age groups.” The importance of understanding community-based spread also comes back to long-term care, because the single most important predictor of an outbreak in congregate care settings is an outbreak with a high degree of spread in the community (that then finds its way into a long-term care home or other congregate setting).
· COVID-19 cases in long-term care homes appear to be flattening, while deaths remain high. Numbers presented demonstrate the consequence of COVID-19 cases among a very vulnerable population. There has been “an accelerating rate of death” since the summer, with 493 deaths since September 1, 2020 (102 of which have been in the past 7 days). The challenge in thinking about how to bring these numbers down is that death is “a lagging indicator of the pandemic,” meaning that even if disease transmission is broken, “you can expect deaths to continue on their trajectory” as a function of existing positive cases in long-term care homes.
· COVID-19 related hospitalizations and ICU admissions continue to rise, with about a 92% increase in hospitalizations since mid-November and about 166% growth in ICU admissions.
· Modelling of ICU occupancy projects that Ontario will remain above 200 ICU beds occupied by COVID-19 patients for the next month, if we are able to control further spread of the pandemic. If Ontario is unable to control spread and we see a 1% increase in growth, then the projection brings the province closer to 300 ICU beds occupied. If Ontario sees growth of 5%, the modelling estimates ICU rates of around 500 to 550 beds occupied by COVID-19 patients by the end of the first week of January. The current ICU bed occupancy is heavily clustered in the regions with the highest case growth, meaning that there is a high concentration of ICU beds being used within a small number of communities. For example, in places like Peel there are now significant challenges in staffing ICUs, which require highly specialized staff.
· Because of the intense nature of care, ICUs operate below 100% occupancy. As admissions rise and patients stay in ICU longer, Ontario may see even more crowding in our ICUs.
· The pandemic has caused a huge reduction in access to health care for people who do not have COVID-19. While there was some readjustment as the pandemic lessened over the summer, access to health care in Ontario continues well below 2019 volumes. This is critical because, instead of making up the deficit from the first wave, “we’re actually slowly adding to that deficit.” The result will be delay of things like cancer care and cardiac care and loss of ICU capacity needed for motor vehicle accidents or other emergencies. With shutdowns in primary care and a reduction in things like screening and diagnostic imaging, this deficit goes beyond hospital care and it will have long-term consequences.
· As shown in a series of graphs, long-standing structural factors result in certain people being at greater risk of exposure to COVID-19. In order to control the pandemic, it is important to “test, trace, isolate and also support, because these are factors that drive exposure that are beyond people’s control.” Growth in cases is highest in communities with the least access to suitable housing (i.e., housing that would allow individuals to isolate). Unless support is provided within these communities “you will see this continue to propagate forward.” The same pattern is seen in communities with more multi-generational housing. As well, higher growth is found in communities with a high number of people working in non-health care essential jobs (e.g., people working in grocery stores or various jobs in manufacturing and trades): “These are the people who cannot isolate at home; they need to actually work, and often face a very difficult decision whether to go to work or not, or whether to get tested or not.” The structural factors that drive high rates of COVID-19 in these communities make it hard for public health restrictions to take effect “unless it is a complete lockdown.”
· Under the current public health restrictions, Ontario is seeing “some impact” on mobility during this second wave, “but not as much as we’d like to see.”
· According to a simple mathematical model, if R (the reproductive rate) stays at 1.1, the result is a huge increase in infections over a short period of time and “you very quickly lose control.” If R stays at 0.9, the result is a huge reduction in infections in a short period of time. Ontario is in “this precarious place” where we are balancing either just above or just below 1.0: “If we can keep it … on the good side, you’ll actually see very significant control quickly.”
Questions from the Committee
Terms of Reference*