By Staff

June 18th, 2020

BURLINGTON, ON

We are not where we want to be yet – the objective is going to be to ensure that it doesn’t get any worse.

People will be out mixing with other people.  Be careful – pay attention and realize what we are up against.

If there is a spike in infections at the end of the month the province will have to take away the play time we’ve been given.  Beating this virus is a job that we all share – don’t blow it.

This is the first Public Health Unit report where Burlington has not had the lowest number of infections in the Region.  Halton Hills is the lowest – just by one.

Cases over time

789
COVID-19 cases among Halton residents to date (710 confirmed + 79 probable)

83
COVID-19 cases currently active among Halton residents (74 confirmed + 9 probable)

 

Figures 1 and 2 show the 789 COVID-19 cases among Halton residents reported by end of the day on June 17. All cases have been graphed according to their episode date, which is used to estimate the date that symptoms began. Figure 1 shows the number of new cases per day, while Figure 2 shows how cases have accumulated over time. Counts for the past 14 days should be interpreted with caution (indicated using the grey shaded area on the graph), since there is a delay between when a person becomes infected and when they develop symptoms, get tested and are reported as a case. Please note the large increase on April 11 is due to expanded testing and identification of COVID-19 among asymptomatic individuals at Mountainview Residence.

Individuals who are lab-confirmed cases are shown in green. Individuals who are probable cases are shown in orange. Probable cases are individuals presumed to have COVID-19 because they have symptoms of COVID-19 and are travelers returning from an affected area, have had close contact with a confirmed case and/or lived/worked in a facility experiencing a COVID-19 outbreak, or have indeterminate test results.

For each day, Figure 3 shows the average number of new confirmed COVID-19 cases over the past seven days, including only those cases that are not staff or residents/patients associated with an outbreak in an institutional or congregate care setting. Cases have been graphed according to their collection date, which is the date that a sample was taken from them to be tested for COVID-19. The graph suggests that the average number of new cases per day was highest in late March/early April, with another increase in mid-May. Counts for recent days should be interpreted with caution (indicated using the grey shaded area on the graph), since there is a delay between when a person is tested and when their test results are reported to Public Health and entered into the system.

Case demographics

78
cases were residents or patients of an institution experiencing an outbreak (10% of all cases)

111
cases work in health care (14% of all cases)

Figure 4 shows that by end of the day on June 17, the most COVID-19 cases were among Halton residents aged 40-59 (with 284 cases, or 36%). 441 cases (56%) were female.

 

Figure 5 shows that by end of the day on June 17, the greatest number of COVID-19 cases were among residents of Oakville (with 265 cases, or 34%). Please note this figure shows counts, and therefore does not take into account the different population sizes or age structures of the four municipalities. Counts in municipalities can also be inflated by outbreaks that have occurred within institutions in their boundaries.

Case exposure source

Figure 6 shows the percentage of COVID-19 cases by primary exposure category for Halton’s four municipalities and for Halton overall. For Halton overall, by end of day on June 17, 285 cases (36%) had contact with a confirmed case that was believed to be the source of their infection. 266 COVID-19 cases (34%) had no known travel or contact history, and therefore were believed to have acquired the virus within Ontario, making them community cases. 132 (17%) were residents/patients or staff associated with an outbreak in an institutional or congregate care setting. 99 cases (13%) had a history of travel that was believed to have been the source of their infection. Information on exposure source was pending for the remaining 7 cases (1%). These proportions vary by municipality. It is important to note that cases can have multiple exposures, and these data reflect only their primary exposure category based on information gathered during case investigation.

Case and contact follow-up

Figure 7 shows that 100% of Halton cases reported over the past seven days (June 11-17) were reached by Halton Public Health within one day of being reported, which exceeds the provincial goal of 90%. Similarly, Figure 8 shows that Halton Public Health reached 100% of contacts identified over the past seven days (June 11-17) within one day, compared to the provincial goal of 90%.

Case outcomes

97
cases who have ever been hospitalized to date (14 listed as currently in hospital)

682

cases who are recovered/resolved

24
cases who have died to date (11 of the deceased were residents or patients of an institution experiencing an outbreak).

Institutional outbreaks

19
confirmed institutional outbreaks of COVID-19 reported to Halton Region Public Health to date (1 is ongoing)

Figure 9 shows the 19 confirmed outbreaks of COVID-19 in Halton institutions reported by end of the day on June 17. Institutions are defined as long-term care homes, retirement homes and hospitals. 18 of the outbreaks have resolved, and one is ongoing. Among the 19 confirmed institutional outbreaks reported to date, 11 (58%) have been in long-term care homes, seven (37%) have been in retirement homes and one has been in a hospital (5%).

Lab testing

>3,100
Halton residents were tested for COVID-19 within the past seven days of available data (June 7-13).

>24,400
Halton residents are known to have been tested for COVID-19 to date.

The green bars in Figure 10 show the number of Halton residents who were tested for COVID-19 each week, beginning the week of March 1-7. Data for the most recent week (June 7-13) is incomplete due to reporting lags. The number of people tested decreased the week of May 17 compared to past weeks as mass testing of institutional residents was completed. The number of people tested then began to increase again, as the provincial government permitted more widespread testing.

The orange line in Figure 10 indicates the percentage of tested Halton residents who were positive for COVID-19. The percent positivity was highest the week of March 29-April 4, when 8.2% of Halton residents who were tested for COVID-19 had positive results. In the most recent week (June 7-13), 0.8% of people tested for COVID-19 tested positive, although this number is subject to reporting delays.

Comparison to Ontario

32,917
total confirmed COVID-19 cases reported in Ontario to date

Figure 11 shows age-specific rates of COVID-19 for Halton and Ontario. Rates take into account the population size of each age group to make it possible to compare between different areas. Halton’s age-specific rates are currently significantly different from the provincial rates for all age groups except youth aged 0-19. For example, Halton has 36.4 cases per 10,000 residents aged 80+, which is statistically significantly lower than the 84.3 cases per 10,000 residents aged 80+ in Ontario overall. It is important to note that these rates will fluctuate as numbers increase throughout the pandemic and that differences between age groups may reflect differences in the likelihood of developing symptoms and being tested.

Data limitations and data sources

Halton case data: integrated Public Health Information System (iPHIS), extracted at 7:00 AM on June 18, 2020, to reflect data entered by the end of the day on June 17, 2020

Halton lab data: Institute for Clinical Evaluative Sciences, Number of individuals who were confirmed positive for COVID-19, COVID-19 Testing Period: 15 Jan 2020 to 13 June 2020. Received on June 15, 2020.

Ontario case count overall: Public Health Ontario, Epidemiologic Summary, COVID-19 in Ontario: January 15, 2020 to June 17, 2020, posted on June 18, 2020 to https://www.ontario.ca/page/2019-novel-coronavirus.

Denominators for Halton and Ontario age-specific rates: Population projections [2020], IntelliHEALTH Ontario, extracted on April 8, 2020.

Data notes
All cases of diseases of public health significance diagnosed in Ontario are entered into iPHIS by local public health units. iPHIS is the Integrated Public Health Information System. It is a dynamic disease reporting system which allows ongoing updates to data previously entered. As a result, data extracted from iPHIS represent a snapshot at the time of extraction and may differ from previous or subsequent reports as data are updated.

The data only represent cases reported to public health and recorded in iPHIS. As a result, all counts will be subject to varying degrees of underreporting due to a variety of factors, such as disease awareness and medical care seeking behaviours, which may depend on severity of illness, clinical practice, changes in laboratory testing, and reporting behaviours.

Cases are included if their “diagnosing health unit” in iPHIS is Halton Region, which means counts include only individuals whose primary residence is in Halton Region. The case may not necessarily have been managed by Halton Region, if they were temporarily residing elsewhere during their case management period. Cases managed by Halton Region who normally live elsewhere but who were managed by Halton Region staff because they were temporarily residing in Halton during their case management period have not been included.

Cases for which the Disposition Status in iPHIS was reported as ENTERED IN ERROR, DOES NOT MEET DEFINITION, DUPLICATE-DO NOT USE, or any variation on these values have been excluded.

Cases are considered “currently active” if they are open in iPHIS.

Figures 1 and 2 distinguish between lab-confirmed and probable cases. Probable cases are defined as epi-linked cases, which means they are presumed to have COVID-19 because they have symptoms compatible with COVID-19 and have travelled to an affected area; have had close contact with a confirmed case; and/or lived in or worked in a facility known to be experiencing an outbreak of COVID-19; or have indeterminate test results. All other figures and numbers include both confirmed and probable cases combined.

Figures 1 and 2 use episode date, which is a field that is intended to approximate the symptom onset date for each case. It is calculated hierarchically, using symptom onset date if available; when it is not available, specimen collection date is used; if neither symptom onset nor specimen collection date are available, the lab test date is used; and finally, if none of these other dates are available, the date the case was reported to Public Health is used.

In subsequent reports, counts in Figures 1-3 may increase as cases are added from past dates as individuals become symptomatic, get tested, and their results are reported to Halton Region Public Health, as well as any past results are added due to delayed data entry or new arrival of lab results.

Cases are considered to be patients or residents of an institution experiencing an outbreak if they are linked to a confirmed Halton institutional outbreak in iPHIS, and they are not known to be a staff person at the institution.

Cases are considered to work in health care if they are known to have an occupation that involves caring for patients, e.g. physician, nurse, occupational therapist, recreational therapist, chiropractor, paramedic, midwife, orderly, etc. Individuals who work in health care settings but do not provide direct care to patients (e.g. managers, cleaning staff) have not been included.

Exposure type is determined by examining the exposure and risk factor fields from iPHIS to determine whether a case travelled, was a resident/patient or staff member in an institution or congregate care setting experiencing an outbreak, was a contact of a case or neither. A hierarchy has been applied as follows: Travel-related > Associated with institutional or congregate care setting outbreak > Close contact of a confirmed case > Neither (indicating community acquisition) > Information pending. It is important to note that cases can have multiple exposures, and these data reflect only their primary exposure category. Numbers are relatively low, and differences between municipalities have not been assessed for statistical significance. Known cases reflect only individuals who were prioritized for testing, which means that differences between municipalities are currently difficult to ascribe to other factors.

Case outcomes (hospitalizations, recovered/resolved, deaths) reflect the latest available information reported to Halton Region Public Health and recorded in iPHIS by the extraction time.

Cases are considered to have been reached within 24 hours if their investigation start date and case reported dates in iPHIS are no more than one day apart.

Contacts are manually tracked to determine if they were reached within one day. Any contacts referred to Public Health Ontario for follow up have not been included.

Institutional outbreaks include outbreaks of COVID-19 in settings such as long-term care homes, retirement homes, hospitals and prisons.

Lab testing data reflects only lab tests that have been assigned to Halton Region based on the methodology used by the Institute for Clinical Evaluative Sciences. There are several known limitations associated with this data which result in the numbers being underestimates:
• The unit of analysis is the tested individual. Once an individual is confirmed positive, subsequent tests for that individual are excluded from the daily totals;
• The COVID-19 test results were captured in the Ontario Laboratories Information System (OLIS). The testing date represents the date of specimen collection: “observation date” in OLIS. Due to the time required for transportation and processing of specimens, it takes six days for approximately 95% of results to be finalized and reported for a given testing date. Some laboratories did not report all or part of their COVID-19 test results to OLIS. Unconsented test results were excluded;
• Daily counts less than six suppressed;
• The location of tested individuals was based upon the test recipient’s postal code (and corresponding PHU) recorded in the OHIP Registered Persons Database (RPDB) for those residing outside a long-term care (LTC) facility, and the LTC address on the OLIS test requisition for specimens collected from LTC facilities. These address assignments lead to misclassification of PHU in approximately 14% of individuals.

By Pepper Parr

June 17th, 2020

BURLINGTON, ON

 

In the eyes of the Mayor the provincial reopening strategy, will allow “our beloved restaurants” to welcome customers again to dine on-site – just in time for summer!

In her most recent Better Burlington Newsletter the Mayor explains that: “While indoor dining is not yet permitted, outdoor patios will be permitted to open for businesses as of this Friday, June 19th for those who are ready to reopen.

“I know our restaurant owners have been deeply engaged in the health and safety guidelines that will help them reopen in ways that keep our community health, such as the Dinesafe reopening guide and checklist from the Ontario Restaurant Hotel & Motel Association and the comprehensive guidelines set out by the Province.

“To help our local restaurants manage provincial guidelines on physical distancing and serve as many customers as possible, the City of Burlington is working hard to enable patio expansions and pop-ups.

“Our teams have been working with the Burlington Restaurant Association over the past month to better understand their interest and needs so we could be ready to quickly work together on this initiative with a one-time detailed application form and an accelerated approval process.

“Restaurants can apply for patio permits that leverage city space downtown such as sidewalks or streets, and permits that expand into private property such as parking lots (in partnership with landlords) anywhere in the city.

“I know we are all looking forward to spending time outside together in a new and safely distanced way, and supporting our restaurants and small business owners who are very excited to see us again.

The Province’s framework for reopening includes additional details on this stage:

Restaurants, bars, food trucks and other food and drink establishments (e.g., wineries, breweries and distilleries) can open for dining in outdoor areas only, such as patios, curbside, parking lots and adjacent premises.

Establishments must take appropriate measures to ensure physical distancing of at least two metres between patrons from different households, including:

using reservations

limiting number of patrons allowed in the outdoor space at one time

ensuring enough space between tables, including to allow for movement

access to indoor facilities is limited to patio/outdoor dining area access, food pickup, payment, washrooms or other health and safety purposes

The big question is: Are you going to be able to get a table? Many people are about to find out just how much that restaurateur loves them.

By Pepper Parr

June 15th, 2020

BURLINGTON, ON

 

In a report to Council Sheila M. Jones, Executive Director, Strategy, Accountability, explained that “the need to re-design and to be agile to respond to the time-sensitive nature of some decisions, this report serves as a template for bringing decisions and information to the Corporate Services, Strategy, Risk and Accountability (CSSRA) Committee. As such, it is beneficial to provide an overview of how and what is expected in this report format.”

Jones was talking about the Service Redesign that gets upgraded almost every day. By service she means the services the city delivers to the citizens of the city – something that went through a radical change when the province declared a State of Emergency and used the power behind that legislation to order that municipalities limit severely the opportunities the members of the public have to congregate the city found itself having to lay off most of the part time staff and move most of the full time staff out of city hall and have them work from hone using ZOOM and their cell phones as their method of communicating.

In the early stages, mid March to near the end of April it was hectic and a close to 24/7 operation.

There wasn’t much news coming out of city hall, some city Councillors felt very much out of the loop.

City Manager Tim Commisso was living a constant round of meetings with the email volume almost unmanageable. The Gazette was able to get through to Commisso on a few occasions.

As the calendar rolled into May we began to see some stability and staff were a little more comfortable with the way they now had to do business.

The public wasn’t really aware with what senior city staff had to deal with – the change was relentless – they rarely knew was was coming at them next.

There were serious financial pressures building up – huge drops in revenue and expenses piling up at the same time.

Parks were closed; schools were closed. The streets were open and the public was asked to yes get out for some exercise but don’t congregate while out for a walk and stay at least six feet away from other people.

Pharmaceuticals were not rationed but all you could get was a one month supply. You had to keep your dog on a leash – which turned out to be very difficult to enforce.

The number of new Covid19 infections in Burlington are the lowest in the Region and the deaths at Long Term Care facilities were low – relative to the rest of the province.

Commisso had to not only manage his own time and energy but he had to keep a very close eye on his senior team to ensure that they are at least coping.

In an interview with the Gazette Commisso said “I have a conversation with each of them frequently on how they are doing personally and listen very closely for signs that the stress might be getting to them.”

Commisso doesn’t talk about how he is coping. At times he does sound a little tired and he surely must wonder if taking on the task of serving as city Mayor was the smartest career move he ever made.

Burlington is now waiting hopefully for the province to announce that the GTAH – Greater Toronto Area including Hamilton can move into phase 2 which will allow, hopefully, some restaurants to open, and for more in the way of city services to be opened.

The Summer Camp program for kids was cancelled and Parks and Recreation is working through some ideas for what they will be able to offer once the province moves the city into Phase 2.

Thus the reporting template that Jones introduced on how the Emergency Coordination Group is going to get updates to Council.

It has been a hectic three months for this group of people; many have been pushed to the limit and worked well beyond an 8 hour day.

Vacations are coming up – Commisso knows that his people need that time off – but vacations are dependent on when the need to constantly adjust the programs being offered slows down a little.

Getting into Phase 2 is essential – limiting the number of Covid19 infections is vital.

And at this time in this world vital trumps essential.