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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 December 1

Posted: December 3, 2020

(December 3, 2020)

Click here for full version of the health care outbreaks report, of which a summary can be found below.


As measured by the number of large outbreaks in which the spread of COVID-19 has not been limited to less than 10 people, the numbers are escalating by every measure:

  • The number of large outbreaks has increased significantly.
  • The size of the large outbreaks has also increased significantly.
  • The geographic dispersion of the large outbreaks has also spread significantly: large outbreaks have spread from border to border across southern Ontario, into Simcoe Muskoka, and the first large outbreak is now happening in Thunder Bay.

Total currently active health care outbreaks (long-term care, retirement homes and hospitals) is 213[1] including all large outbreaks and outbreaks that are currently small.

  • Total current long-term care outbreaks: 117 of which 45 are large outbreaks (>10 residents and/or staff infected).[2]
  • Total current hospital outbreaks: 42 [3] of which 2 are large outbreaks.
  • Total current retirement home outbreaks: 54 of which 17 are large outbreaks [4]

This report shows the growth of the 64 current large outbreaks in health care settings. Two weeks ago, on November 18, we found 49 large outbreaks. Of the 64 large currently active outbreaks (including more that 10 residents/patients/staff) in health care settings in this period (November 17 – December 1):

  • 45 are in long-term care homes
  • 2 are in hospitals with 8 outbreaks
  • 17 are in retirement homes.

As of December 2, the total number of residents and patients infected in just the currently active large outbreaks in health care settings is 2,369, and the number of staff is 1,257 for a total of 3,626. With great sadness we report that 381 of those residents and patients have died. These are huge numbers and they capture only the currently active large outbreaks in health care. Most of these currently large outbreaks started in late October or the beginning of November. These numbers 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 are long-term care homes were in outbreak followed by the beginning of large outbreaks in Halton, Niagara and Toronto. Over the last three months both the number of the outbreaks and the severity of the outbreaks has increased dramatically. 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). This is an increase of 1,038 cases in two weeks, or 30.0%.

 

Growth in the number of active long-term care outbreaks:

  • As of December 1 there are 118 active outbreaks in Ontario’s long-term care homes. [6]
  • As of November 17 there were 100 active long-term care outbreaks.[7]
  • As of October 31 there were 76 active long-term care outbreaks.[8]
  • As of September 30 there were 42 active long-term care outbreaks. [9]
  • As of September 1 there were 18 active long-term care outbreaks [10]

 

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 (December 1)

  • 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;
  • 1 outbreak includes more than 200 residents and staff infected.

By comparison, the large outbreaks as at November 17 were as follows: [11]

  • 34 outbreaks included more than 10 residents and staff infected;
  • 13 outbreaks included more than 50 residents and staff infected;
  • 12 outbreaks included more than 99 residents and staff infected
  • 4 outbreaks included more than 150 residents and staff infected.

 

Geographic spread of the outbreaks:

Long-term care outbreaks which were concentrated in Ottawa at the beginning of the second wave (in September) have now spread across the province. The first large outbreak of the second wave started in Ottawa on August 30 at West End Villa and more large outbreaks started in September across the city. Toronto, Halton, Simcoe Muskoka and Niagara started seeing large outbreaks later in September. At the beginning of October, the large outbreaks spread to Eastern Ontario followed by York in mid-October. At the end of October, Hamilton and Peel saw large outbreaks develop along with regions west of the GTA, in Windsor, Brant County and Huron Perth. Large outbreaks in London started at the beginning of November, however it is difficult to determine how many of the outbreaks in London Middlesex are large as the Public Health Unit does not publish the case numbers for each COVID-19 outbreak. Northern regions such as the district of Thunder Bay were nearly untouched by COVID-19 in the first wave, but have recently started seeing large outbreaks at the end of November, along with Durham which is once again growing into a “hotspot”. Notably, Halton and Eastern Ontario have already seen more large outbreaks in the second wave than they did in the first wave.

 

Hospitals:

A number of large COVID-19 outbreaks in the second wave have occurred in hospitals. On November 18, we had found 5 hospitals that had 10 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).[12] As of December 1 a number of these outbreaks were resolved. Although both CAMH in Toronto[13] and The Ottawa Hospital[14] still have outbreaks, they each add up to less than 10 cases and are therefore not counted in this report’s tracking of large outbreaks.

As of December 2, there are two hospitals with large outbreaks as defined as ten or more patients and staff infected. London Health Sciences Centre’s University Hospital had its second outbreak (the only active one at the time) start on November 10, and had its third outbreak start on November 11. Since then, LHSC has announced that these two outbreaks have extended to other areas of the hospital at least five times. The cumulative cases are now reported as 48 patients including 7 deaths and 35 staff members.[15] The Scarborough Health Network in Toronto had its fifth COVID-19 outbreak start October 27, and since then has had 8 more outbreaks, with 6 of them active as of December 1.

 

[1] 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

[2] 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

[3] 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

[4] 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

[5] Ibid accessed August 24, 2020.

[6] 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

[7] 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

[8] 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

[9] 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

[10] 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

[11] 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/

[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] Outbreaks in Toronto Healthcare Institutions. City of Toronto. November 27  2020. https://open.toronto.ca/dataset/outbreaks-in-toronto-healthcare-institutions/

[14] Daily COVID-19 Dashboard. Ottawa Public Health. December 1 2020. https://www.ottawapublichealth.ca/en/reports-research-and-statistics/daily-covid19-dashboard.aspx

[15]  Stacey, Megan and Jonathan Juha ‘Abundance of transmission within staff’ driving deadly hospital outbreak London Free Press December 2 2020.    https://lfpress.com/news/local-news/covid-19-university-hospital-lowers-flags-as-outbreak-death-toll-rises

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