Northeastern Ontario has emerged as a COVID-19 hotspot in recent weeks: of the health units with the four highest case rates in the province, three are in the region. Algoma, Timiskaming, and the Sudbury and Manitoulin Districts are sitting at 282.26, 149.9, and 136.67 per 100,000 people — the provincial average is 46.63.
The sudden spread of the virus in the northeast is in contrast to previous waves, when urban centres such as Toronto, Ottawa, and Peel and York regions often saw the highest rates. TVO.org speaks with experts about the challenges facing these areas and what we do and don’t know about what’s driving the spread.
Throughout most of October, Sudbury’s active case count stayed well below 100, rising from 47 cases on October 7 to 69 cases on October 18. But by October 28, the number had climbed to 125. That day, Public Health Sudbury and Districts released a statement warning of a surge: “While the province of Ontario is seeing improvements in COVID-19 case counts, trends in Greater Sudbury are going in the opposite direction.” Public Health Sudbury & Districts had 189 active cases then, or a rate of 96.2 per 100,000. By November 8, there were 231 active cases.
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Since then, schools have been sites of new outbreaks in the region. Fifteen separate outbreaks were declared in school-related environments, including three bus lines — accounting for more than half of the total outbreaks declared in November. On November 26, the Sudbury Star reported that 99 of the 261 active cases in the region, or about 37.9 per cent of the cases within the health unit, were associated with schools. “We’re continuing to see cases throughout all settings and sectors (for example, social gatherings, workplaces and schools), and not one sector or setting is responsible for the recent surge in cases,” PHSD told TVO.org via email. As of December 2, there are 324 active cases within the unit.
For most of October, Algoma Public Health didn’t exceed 10 active cases in a given day. But from October 23 to 24, active cases went from 10 to 19. Case numbers rose significantly the next month: on November 12, the health unit issued warning of a surge after hitting 98 active cases. Six days later, active cases more than doubled, reaching 201. On November 30, there were 323 active cases — a rate of 285.6 per 100,000 people (the provincewide average was 46.9).
Public-health officials in the region have struggled to piece together how the spread occurred. “When we see cases rise and surge in any region, especially our own, everyone really wants to know: Why now? It will take a long time before we truly understand the dynamics of the transmission patterns that we're seeing,” says Medical Officer of Health Jennifer Loo. Case rates in nearby northern Michigan have been high relative to those in Ontario: the week of November 16 to 22 saw seven-day case rates of 186.7 per 100,000 people in the state’s Upper Peninsula. Prior to the lifting of cross-border travel restrictions on November 8, Loo says, there were around 200 essential workers travelling to and from the United States daily: “Though we do always have a proportion of cases that are linked to international travel. That is not the majority of current cases at this present time.”
Throughout much of the pandemic, the Timiskaming district has gone untouched by COVID-19. In October, the daily case count never exceeded 10. The rise began November 15, when there were 15 cases, up from nine the previous day. On November 20, Timiskaming hit 29 active cases; the next day, the number soared to 46. On November 26, the number of cases peaked at 80 — a rate of 239.7 cases per 100,000 for the health unit. (That same day, the provincewide average was 39.07.)
Glenn Corneil, Timiskaming’s medical officer of health, says the health unit’s small population — 33,365 — is part of why case rates quickly swelled to some of the highest in the province. “For our case rates [per 100,000], with our population, you multiply [active cases] by three,” he says. Still, the health unit announced increased measures on November 23.
Corneil attributes the surge of cases to community spread: “Basically, we don't know where the person acquires the infection. And the concern with that is it means there's more [spread] going on the community than we're aware of.” While there are four active outbreaks in the district, including two in schools, Corneil says they’re all “in the small size — of less than five to 10 cases right now.” But rising cases have also driven spread within households. “That's where we tend to see vaccine breakthrough: when somebody has had prolonged close contact with a positive case. Most of the time with our families, the index case [who brought COVID-19 into the household] in that situation has been unvaccinated or ineligible to be vaccinated,” he says, noting that around 75 per cent of reported cases have come from unvaccinated or partially vaccinated people.
What’s being done?
All three health units have announced enhanced restrictions to try to control spread. Sudbury was the first to act: on October 28, the unit issued a class order mandating self-isolation for those who test positive, have symptoms, are awaiting testing, or are a close contact of a positive case. On November 8, it instituted a return to indoor-capacity limits, the enforcement of mask-wearing, and proof of vaccination for kids aged 12 and up in organized sports. Algoma followed suit on November 15 with a class order mandating self-isolation, a return to capacity limits, and proof of vaccination; Timiskaming did the same eight days later.
Amid the rise of cases in schools, the Sudbury unit issued a set of “strong recommendations” to organizations and businesses, including schools, on November 26. They include “symptom screening, increased hand hygiene, masking requirements, cohorting, enhanced ventilation and staff PPE requirements.” (Algoma has made similar recommendations.) The health unit has assigned a team of public-health nurses to schools and issued rapid-antigen tests for students and staff.
Although case rates in such health units as Algoma have been much higher than the provincial average was during the height of the third wave — when provincewide lockdowns were implemented — Loo says the key difference in the fourth wave has been the efficacy of the vaccines. “When Ontario was at 130 cases per 100,000, the province was in lockdown because there was a high risk of our hospitals getting overrun,” she says. “We are putting additional measures in place so that it doesn't skyrocket higher and jeopardize our hospital capacity. But we continue to have schools and businesses open in the midst of these protective measures, because of, in large part, the protection of vaccines.”
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