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REPORT: Tracking the Spread of COVID-19: Sharp escalation in large COVID-19 outbreaks in health care settings – Data updated to January 8
Posted: January 11, 2021
(January 11, 2021)
The second wave of COVID-19 in Ontario’s long-term care homes has now almost reached the peak numbers that were experienced in the first wave. By the late July, the cumulative number of residents and staff that had been infected with COVID-19 reached 8,373 according to Ontario Public Health’s data tracking. At the beginning of September there were only 25 active cases of COVID-19 in Ontario’s long-term care homes. Since then the number of people infected in long-term care has steadily gained pace, escalating ever more rapidly since the end of October. By mid-December we began to see an escalation by about a thousand cases every week, which is where we are at now. Ontario is now, in the second wave, at the cumulative number of people infected by COVID-19 in long-term care, that we saw in the first wave.
Clearly the measures that have been taken are not adequate. Virtually every day we hear from staff and families about inadequate PPE, inadequate cohorting and infection control practices, lack of accountability for the home operators who are not ensuring adequate safety measures, and crisis-level staffing shortages.
The following report tracks and analyses at the large outbreaks in long-term care, retirement homes and hospitals across Ontario currently.
Analysis: Status of Current Large Health Care Outbreaks
By every measure, the large outbreaks in health care settings (hospitals, long-term care, retirement homes) in which the spread of COVID-19 has not been limited to less than 10 people, the rate of spread of the virus is frightening:
- The number of large outbreaks has increased drastically.
- The size of the large outbreaks has also increased significantly.
- The geographic area in which there are large outbreaks continues to increase.
Total currently active health care outbreaks (long-term care, retirement homes and hospitals) is 451[1] including all large outbreaks and outbreaks that are currently small.
- Total current long-term care outbreaks: 231, of which 81 are large outbreaks (>10 residents and/or staff infected).[2]
- Total current hospital outbreaks: 72[3], of which 20 from 10 hospitals are large outbreaks.
- Total current retirement home outbreaks: 148, of which 32 are large outbreaks. [4]
This report shows the growth of the 133 current large outbreaks in health care settings. The number of large outbreaks has more than doubled since our report before the holidays (on December 1) where we found 64 large outbreaks, an increase of 215%. Of the 119 large currently active outbreaks (including more that 10 residents/patients/staff) in health care settings in this period (December 1 – January 8):
- 81 are in long-term care homes
- 20 are in 10 hospitals
- 32 are in retirement homes.
The Minister of Long-Term Care has repeatedly tried to downplay the situation but looking at the numbers we are finding, just in the large outbreaks, we can see that there is no question that the outbreaks which have not been controlled at very small numbers have grown alarmingly and the number of people — both residents and staff affected — has also increased in a devastating way. As of January 8, the cumulative number of residents and patients infected just in the currently active large outbreaks in health care settings is 4,256. This is a huge increase (80% increase) from our last report, December 1, when the cumulative number of residents/patients infected in active large outbreaks was 2,369. The cumulative number of staff members infected in active large outbreaks is 2,918, which is an 132% increase from 1,257 four weeks ago on December 1. The number of other cases (including unspecified cases and visitors) is 211, for a total of 7,385 cases cumulative in the currently active large outbreaks. A month ago, the total number of cases in currently active large outbreaks was 3,626, thus, a 104% increase in cases overall.
With great sadness we report that 772 of those residents and patients have died in just the large outbreaks. These are huge numbers and they capture only the currently active large outbreaks in health care. These numbers represent human beings and they underline the fact that the measures being taken to improve infection control and care in those facilities are not adequate to stop the spread of the virus.
Long-term care:
Through the summer months following the first wave of the pandemic, though long-term care outbreaks still began, there was only one that had more than five cases. After September 1 and particularly after schools reopened, case numbers in long-term care began to rise. The beginning of September now clearly delineates the start of the second wave. On August 30, the second wave began with the outbreak at Extendicare’s West End Villa in Ottawa. Within a few weeks 11 Ottawa long-term care homes were in outbreak followed by the beginning of large outbreaks in Halton, Niagara and Toronto. In the last 5 weeks over the winter holidays, the case numbers in long-term care have sky-rocketed. Over the last four months both the number of the outbreaks and the severity of the outbreaks has increased dramatically. The death toll is increasing tragically, as those who caught the virus early on in the second wave are dying. Long-term care outbreaks have spread now across the entire breadth of southern Ontario and into northern Ontario.
Growth in the number of people infected in long-term care 2nd wave:
The numbers of people infected in long-term care are continuing to increase at an alarming rate. At the end of August there were there were 3 currently active cases among long-term care residents and 18 currently active cases among long-term care staff.[5] Using Public Health Ontario’s daily epidemiologic reports we have tracked the number of people infected by COVID-19 in long-term care homes in the second wave of COVID-19 (since September 1). From September 1 to November 17 the cumulative number had increased by 2,424 (1,920 residents and 504 staff). From November 17 to December 1 the cumulative number has increased to 3,462 (2,737 residents and 725 staff). From December 1 to January 8 the cumulative number has increased to 7,971 (5,978 residents and 1,993 staff). This is an increase of 4,509 cases in five weeks, or 130%.
Growth in the number of active long-term care outbreaks:
- As of January 8 there are 231 active outbreaks in Ontario’s long-term care homes.[6]
- As of December 1 there were 118 active outbreaks in Ontario’s long-term care homes. [7]
- As of November 17 there were 100 active long-term care outbreaks.[8]
- As of October 31 there were 76 active long-term care outbreaks.[9]
- As of September 30 there were 42 active long-term care outbreaks. [10]
- As of September 1 there were 18 active long-term care outbreaks [11]
Growth in the size of the active long-term care outbreaks:
There continue to be more large outbreaks each period of several weeks that we measure, and the severity of those outbreaks is continuing to increase as shown in the numbers below.
Of the current Ontario long-term care home outbreaks (January 8)
- 81 outbreaks include 10 or more residents and staff infected;
- 41 outbreaks include 50 or more residents and staff infected;
- 19 outbreaks include 100 or more residents and staff infected;
- 11 outbreaks include 150 or more residents and staff infected, and;
- 7 outbreaks include 200 or more residents and staff infected, and;
- 3 outbreaks include 250 or more residents and staff infected.
By comparison, the large long-term care outbreaks as at December 1 were as follows: [12]
- 45 outbreaks include more than 10 residents and staff infected;
- 20 outbreaks include more than 50 residents and staff infected;
- 10 outbreaks include more than 99 residents and staff infected;
- 5 outbreaks include more than 150 residents and staff infected, and;
- 1 outbreak includes more than 200 residents and staff infected.
Geographic spread of the outbreaks:
Many long-term care outbreaks in Ottawa, where the second wave began, are now resolved. London is now seeing large long-term care outbreaks, as are the regions of Guelph (listed under Wellington/Dufferin/Guelph in this report) and Waterloo. Toronto, Halton, Hamilton, Niagara, Peel, Windsor, York are hotspots. Northern regions such as the district of Thunder Bay were nearly untouched by COVID-19 in the first wave, but started seeing large outbreaks at the end of November, along with Durham which is once again growing into a “hotspot”.
Hospitals:
A number of large COVID-19 outbreaks in the second wave have occurred in hospitals. On January 8 we had found 10 hospitals that had 20 active outbreaks among them (if the number of cumulative cases from all outbreaks occurring at the same hospital equal ten or more, then we count that hospital in the large outbreaks tracking).[13] Notably, The Scarborough Health Network in Toronto had its fifth COVID-19 outbreak start October 27, and since then has had 16 more outbreaks, with 4 of them active as of January 6.
[1] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to January 5, 2020. Public Health Ontario. January 6 2020. https://files.ontario.ca/moh-covid-19-report-en-2021-01-06.pdf
[2] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to January 5, 2020. Public Health Ontario. January 6 2020. https://files.ontario.ca/moh-covid-19-report-en-2021-01-06.pdf
[3] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to January 5, 2020. Public Health Ontario. January 6 2020. https://files.ontario.ca/moh-covid-19-report-en-2021-01-06.pdf
[4] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to January 5, 2020. Public Health Ontario. January 6 2020. https://files.ontario.ca/moh-covid-19-report-en-2021-01-06.pdf
[5] Ibid accessed August 24, 2020.
[6] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to January 7, 2020. Public Health Ontario. January 8 2020. https://files.ontario.ca/moh-covid-19-report-en-2021-01-08.pdf
[7] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to December 1, 2020. Public Health Ontario. December 2 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-12-02.pdf
[8] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to November 17, 2020. Public Health Ontario. November 17 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-12-02.pdf
[9] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to October 31, 2020. Public Health Ontario. October 31 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-12-02.pdf
[10] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to September 30, 2020. Public Health Ontario. September 30 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-12-02.pdf
[11] Daily Epidemiologic Summary- COVID-19 in Ontario: January 15, 2020 to September 1, 2020. Public Health Ontario. September 2 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-12-02.pdf
[12] REPORT: Tracking the Spread of COVID-19: COVID Numbers in Health Care Outbreaks Escalating Dramatically – Data Updated to November 17. Ontario Health Coalition. November 19 2020. https://www.ontariohealthcoalition.ca/index.php/report-tracking-the-spread-of-covid-19-covid-numbers-in-health-care-outbreaks-escalating-dramatically-data-updated-to-november-17/
[13] REPORT: Tracking the Spread of COVID-19: COVID Numbers in Health Care Outbreaks Escalating Dramatically – Data Updated to November 17. Ontario Health Coalition. November 19 2020. https://www.ontariohealthcoalition.ca/index.php/report-tracking-the-spread-of-covid-19-covid-numbers-in-health-care-outbreaks-escalating-dramatically-data-updated-to-november-17/
