Has the Covid-19 infection curve flattened? Not yet. Long term care nursing taking the brunt of it all

News 100 blueBy Staff

April 20, 2020



The Halton Public Health Unit releases data on a regular basis. This is the data up to end of day on April 19, 2020

Cases over time

37  COVID-19 cases reported to Halton Region Public Health since the last update (27 confirmed + 10 probable)

439  COVID-19 cases reported to Halton Region Public Health to date (383 confirmed + 56 probable)

Fig 1

Fig 1 cumulative

Figures above show the 439 COVID-19 cases that had been reported to Halton Region Public Health by end of the day on April 19. All cases have been graphed according to the date they were reported, which is often several days after the onset of symptoms. Top shows the number of new cases per day, while bottom shows the cumulative cases over time. Among the cases in these figures, 37 were reported since the last update (meaning they were reported between April 16 and April 19, 2020).

Individuals who are lab-confirmed cases are shown in green. Individuals who are probable cases are shown in orange. Probable cases are epi-linked cases, which means they are presumed to have COVID-19 because they are symptomatic close contacts of cases or returning travelers who have COVID-19 symptoms.

Case demographics

70  cases were residents or patients of an institution experiencing an outbreak (16% of all cases)

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


Age gender splits

Figure shows that by end of the day on April 19, the most COVID-19 cases were among Halton residents aged 40-59 (with 160 cases, or 36%). 256 of the 439 cases (58%) were female.



By municipality

Covid cases by municipality

Figure shows that by end of the day on April 19, the greatest number of COVID-19 cases were among residents of Oakville (with 144 cases, or 33%). 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 shows that by end of the day on April 19, 188 of Halton Region’s COVID-19 cases (43%) had no known travel or contact history, and therefore were believed to have acquired the virus within Ontario, making them community cases. 146 cases (33%) had contact with a confirmed case that was believed to be the source of their infection. 90 cases (21%) 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 15 cases (3%).

Case outcomes

57 cases who have ever been hospitalized to date (29 listed as currently in hospital)

188 cases who have recovered to date

16 cases who have died to date (9 of the deceased were residents or patients of an institution experiencing an outbreak)

Institutional outbreaks

9 confirmed institutional outbreaks of COVID-19 are currently ongoing in Halton

10 confirmed institutional outbreaks of COVID-19 reported to Halton Region Public Health to date

Among the ten confirmed institutional outbreaks reported to date, five (50%) have been in retirement homes, three (30%) have been in long-term care homes, and one each have been in a hospital and a group home. Nine of the outbreaks remain ongoing. Please note these counts do not include any suspected outbreaks that remain under investigation.

Lab testing

>6,000 Halton residents are known to have been tested for COVID-19 to date

Comparison to Ontario

11,184 total confirmed COVID-19 cases reported in Ontario to date

Region - province comparison

Figure 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 similar to the provincial rates for all age groups (for example, while Halton has 29.8 cases per 10,000 residents aged 80+, this is not statistically significantly different from the 34.0 cases per 10,000 residents aged 80+ in Ontario). 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.


There are people who are concerned about the validity of some of the Regional data.  One resident wrote the Public Health Unit and got the following response:

Confirmed cases are posted frequently to Halton.ca. Confirmed institutional outbreaks including facility names and date outbreaks declared can be found listed below the “Current Cases in Halton” section of our webpage. Having said that the confirmed cases there are a reflection of the residents/patients within each facility. It does not reflect the staff affected in those numbers at this time. Confirmed cases are reported by municipality of their residence. Of which, there is no reporting structure that reports this without breaching privacy and confidentially mandates in protecting an individuals identity.  The reporting structure now used on the Halton.ca webpages reflects changes to reporting made at the Provincial level.

Rest assured, our case numbers in Halton Region are updated daily as we conduct a risk assessment for every COVID-19 case. Based on the risk assessment, high-risk exposures are followed up on according to Ministry and Public Health Ontario guidance. Any individuals deemed close contacts of COVID-19 positive cases will be notified directly. If an outbreak is declared at the long-term care home, there are specific measures must be taken. Positive clients and their close contacts are being case managed and monitored closely by Public Health.

Your concerns are valid and I would direct you to share your ideas at the Provincial level. The government of Ontario is welcoming ideas from businesses, organizations, and individuals to help address the spread and impact of the 2019 Novel Coronavirus (COVID-19) on our communities. Click this link to submit a proposal for ideas, other products or services to help Ontarians:https://www.ontario.ca/form/submit-your-ideas-to-help-fight-coronavirus

The demands on staff at the Public Health Unit are extreme.  They are doing the best they can with what they have.  A little more transparency on what is really happening at the long term care facilities would help people feel more assured.

Data limitations & data sources
Halton case data: integrated Public Health Information System (iPHIS), extracted at 7:00 AM on April 20, 2020, to reflect data entered by the end of the day on April 19, 2020

Halton lab data: COVID Data Information System, extracted on April 20, 2020.

Ontario case data: Public Health Ontario, Epidemiologic Summary, COVID-19 in Ontario: January 15, 2020 to April 19, 2020, posted on April 20, 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.

Figure 1 distinguishes between lab-confirmed and probable cases. Since April 7, probable cases are defined as epi-linked cases, meaning they are symptomatic close contacts of cases or returning travelers who have COVID-19 symptoms and therefore are presumed to have COVID-19. All other figures and numbers include both confirmed and probable cases combined.

In subsequent reports, counts in Figure 1 may increase as cases are added from past dates due to delayed data entry or new arrival of lab results. To minimize such retrospective changes, cases have been graphed according to case reported date, which does not reflect onset of illness.

Cases are considered to live in an institution if the name of a facility (e.g. a long-term care home, retirement home, prison) has been entered for their address in iPHIS.

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.

Exposure type is determined by examining the  MISSING

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