By Chad Ingram
On Jan. 13, at the first of a planned series of weekly media teleconferences launched by the health unit last week, Dr. Ian Gemmill, acting medical officer of health for the Haliburton, Kawartha, Pine Ridge district health unit spoke to questions around Ontario’s stay-at-home order, and the need to stop gathering and travelling to protect the healthcare system and vulnerable Ontarians.
Gemmill said the virtual media scrum would enable more efficient sharing of information between the health unit and local media, describing the pandemic situation as being “quite fluid, not only from the point of view of the virus, but from the policy decisions that change from week to week.” The event took place the day before Ontario’s 28-day stay-at-home order began on Jan. 14, an order Gemmill said was necessary to disrupt the second wave of the pandemic that was predictably proving to be more severe than the first.
“The second wave is affecting not just [our local region], not just Ontario or Canada, it’s affecting the entire world, some places more than others,” said Gemmill. “In a way, even though we’ve had more cases over the last several weeks, we’re a bit in a more privileged position than some parts of Ontario. I talk to my colleagues in the GTA and so on, they are really, really stretched and really pulling out all the stops to do all the work that needs to be done for each case and high-risk contacts that’s identified.”
The health unit region, which includes Haliburton County, City of Kawartha Lakes and Northumberland County, has seen 724 confirmed cases of COVID-19 to date, with 29 deaths among confirmed cases and 13 deaths among probable cases. To date, 43 cases of COVID-19 have been reported in Haliburton County, with five cases currently not resolved and 14 current high-risk contacts.
“People in no areas should think, we don’t have to worry about this,” said Gemmill, noting because of the risk of the virus being spread throughout communities, people shouldn’t relax until a minimum of 70 per cent of the population is vaccinated for reasonable community-wide protection. “The risk may be lower from place to place but I’ve also seen it moving around.”
Gemmill said the health unit has been seeing more cases in younger populations over the last little while, with the highest-risk group being those aged 30 to 39 age, followed very closely by the 50 to 59 age group, then 20 to 29 years group and finally those aged 60 to 69.
“That’s not surprising, in the first go around we didn’t have testing for everybody, there may have been cases that were missed, and we saw the cases mostly in the elderly populations, especially in long-term care homes,” he said. “Now with widespread testing, I think we can get a better picture of what is going on across the population.”
Strong support for stay-at-home orders from healthcare workers
While noting strong support for the measures of a Boxing Day lockdown and stay-at-home orders issued on Jan. 14 by the provincial government, Gemmill said he was dismayed to hear that a curfew would not also be put in place, as it was in Quebec, given that many of the preventable transmissions are occurring because of gatherings. Instead of an evening curfew, he said the province was under a 24/7 curfew instead.
“People have to stay home unless there’s a really logical and necessary and approved reason for leaving the home,” said Gemmill.
Without the stay-at-home order, Gemmill said he thought the situation in the province would be out-of-control in terms of the health care system accommodating people with COVID-19 and also with other illness and medical emergencies and in reducing the number of people being infected prior to vaccinations.
“To me the stay-at-home order – the most important thing – is sending the right message to the public,” he said. “This is serious. You can’t pretend this is 2019, it’s not. We’re in the middle of a second wave of an illness that’s clogging up the health system and is killing some of the population that otherwise would be OK.”
Everyone responsible for protecting themselves to protect vulnerable
“Now some people say that a person might say to themselves, well, ‘I don’t care if I get sick.’ But I think what is not recognized enough, and I want to emphasize this as well, is that every person is only two or three degrees of separation from possibly a vulnerable person,” said Gemmill.
Gemmill said almost 40 per cent of long-term care homes have had active coronavirus outbreaks, with 198 residents and two staff at long-term care homes dying of COVID-19 since the beginning of the year.
“Since Jan. 1, 198 residents of long-term care and, even more shocking to me, two long-term care staff – that’s people who are otherwise healthy who were just going in to do their very level-best to look after people who have trouble looking after themselves, they have died of coronavirus and this is just unacceptable.”
Forecasts suggest, said Gemmill, that more deaths will occur in long-term care homes during the second wave than died in the first wave, which is why he has said people living and working in long-term care facilities will be the first to be vaccinated.
“When we get the vaccine in our area, we will leave no stone unturned to get [vaccinations] in long-term care first and then others as fast as we possible can.”
The other issue, Gemmill said, is the impact of the virus on the healthcare system – both people working in it, and people needing access to care.
“You’ve heard about this from the premier, the ICU capacity is over 400 beds, surgeries are being cancelled, and the access to care will continue to decrease with real consequences to other people’s health,” he said. “So it’s not just people who are getting coronavirus, it’s people with other conditions who will not have access to care because of the huge pressure that’s on the healthcare system. So it’s not just about one person who thinks it’s OK if I get sick, but everyone that that person, and the person they all come into contact with, that is the issue here.”
Gathering and travelling allowing virus to spread
“Most of the cases for which we have a documentation for where they got the infection, one area is the household contact, and that is hard to avoid, if you live in the same household with somebody. But also by close contact which is defined as the gatherings,” he said. “People know the advice about wash your hands and don’t touch your face and stay two metres apart all that kind of thing, but what has had less emphasis is the whole issues of traveling and gathering. And that’s the cause of much of the spread that I have seen, and I work with colleagues in different parts of Ontario, before I started here with [this health unit]. “
He noted quotations from the province’s modelling group that had presented projections for potential COVID-19 spread in Ontario, which stated that mobility and contacts between people had not decreased with the provincial lockdowns and restrictions that had been in place prior to the stay-at-home order, and that while “survey data shows that the majority of Ontarians are helping to limit the spread by foll owing the guidelines, however, case numbers will not decline until more of the population follows their example.”
“With current restrictions, two-thirds of the population are acting in a way that will decrease the spread of coronavirus, but it’s not enough,” he said. “We need everybody to do this, and that’s why we had a lockdown a couple of weeks ago, and in addition, the stay-at-home order which means that we are expecting every person to be staying at home except for essential work, medical or health related appointments, and issues like medications, groceries, exercise is allowed, and I’m going to put family emergencies in here, that’s not in the list but I think that everybody can understand that. And there are no other reasons.”
Gemmill said travelling has been an issue, “and this is how the virus is taken from place to place.”
“That’s why I for one am fully supportive of the stay-at-home order and I hope it will have the desired effect of getting a better handle, better control, of this virus,” he said. “We’re in a race against the virus. We have a variant now that is more transmissible … We need to get it controlled so that we can get vaccines into arms and protect people before they are exposed to this. So travel outside one’s own local community should not be undertaken because it can transfer the virus from a place where there perhaps isn’t too much activity, to a place where there is.”
Contact tracing effective
When a positive test is confirmed, there are two things the local public health unit puts into place. First, said Gemmill, the health unit contacts that person and relays that they must isolate for 10 days, which is the current national recommendation. After that 10-day isolation period, Gemmill said at that point the person is no longer in a position to spread the infection to others and can be released from isolation. Additionally, the health unit asks the person where they might have been during the period in which they have been infectious to others.
“We take that range of time and we say, tell us everything you’ve done and the contact you’ve had with other people, who are they, what are their phone numbers and email addresses, so we can get in touch with them,” said Gemmill. “These are called the high-risk contacts.”
Quarantine for those who might be sick is 14 days, when the potential for them to show symptoms might become more clear.
He said there are some situations where someone would not be considered a high-risk contact – if, for example, a delivery person dropped a box off and stayed two metres apart – but he said he has seen contacts through household members or those at gatherings, including weddings, hockey games, and holiday gatherings.
“We have to depend, clearly, on the honesty and the memory of the case, of where they’ve been each day, who they saw, how much time they’ve spent with them, under what circumstances and so on and that’s how we follow this up. I can tell you, we scour, and I’m very impressed with how the people who are doing case and contact follow-up at [the health unit] really leave no stone unturned to find people, to get them into isolation.”
Gemmill said sometimes it’s still hard to find some contacts, or the person with the confirmed case of COVID-19 doesn’t recall their prior days accurately.
“It doesn’t always work perfectly, I mentioned before, sometimes people’s memories don’t work too well, sometimes their assessment of the situation is perhaps a little different than actually happened, but we have to base it on trusting that people are telling us to the best of their ability.”
He said well over 90 per cent of people who have been in contact with someone with a confirmed case are being contacted.
“It’s a long-standing tried and true approach to communicable diseases,” he said of the process, which was in place prior to his own involvement in public health which began 40 years ago.
Request for more details on confirmed cases
Gemmill was asked by a member of the press if he thought reporting of confirmed case statistics could or should include more specific information about a person’s location, noting the town they live in rather than the broader county information that is currently reported. Requests have been made regarding this information to the Information and Privacy Commissioner of Ontario, with a decision expected to be made in the upcoming weeks.
“This is an ongoing issue that I think needs to get resolved,” said Gemmill. “It’s not an issue just here, it’s an issue in other places, I know. In the absence of provincial guidelines on how to do this, of course every local public health agency is doing their presentation of their case counts in different ways.”
Gemmill said he had gone over websites of different local public health agencies, to see how information was being shared.
“And it is a mixed bag, we’re not the only ones doing it by county,” he said, reiterating that the rationale for releasing information by county was to protect privacy information of those in rural areas with sparse population, and reduce potential for stigma. He looked forward to hearing from the Information and Privacy Commissioner.
“I actually welcome that, and we expect … that we’ll hear in the next couple of weeks about what is the right way to do this. We will be guided by that and whatever the Information and Privacy Commissioner suggests to us, we are going to do, and I hope that it will actually maybe set a standard for across Ontario so that everybody will be doing things in a similar way and we don’t have the inconsistency that causes questions.”
Gemmill said the bottom line is that everyone in the province should behave as though, when they are with other people, they are potentially being exposed, regardless of where confirmed cases have been identified, but that if the guidance returned from the Information and Privacy Commissioner suggested the health unit should be giving more information, they would.
“I believe in transparency and I believe that we should be giving as much information as people need to understand what’s going on. I think the most important thing to understand about this is that this winter’s virus is on the way up, in wave two, and people need to be guided by that.”