Public health units from other regions come to the rescue as Peel experiences surge in COVID-19 cases

Thestar.com
November 4, 2020

Public health units from across the province are helping shore up Peel’s COVID-19 response after a late-October surge of cases nearly forced officials to abandon contact tracing in the region.

After weeks of accelerating transmission, Peel has emerged as Ontario’s biggest COVID-19 hot spot with Brampton recording a test positivity rate of close to 10 per cent -- more than double that of its municipal neighbours.

As of Nov. 3, the region had an infection rate of 106 cases per 100,000 population per week, by far the highest COVID-19 infection rate in the province, according to the Star’s ongoing case count.

The swell in cases shows little sign of slowing even as the province signalled Tuesday that Peel could be allowed to resume indoor dining and fitness activities in the coming days after being in modified Stage 2 restrictions since the Thanksgiving weekend.

Peel’s Medical Officer of Health Dr. Lawrence Loh said the current restrictions have helped to keep the local epidemic somewhat under control, yet case numbers continue to increase across the region, especially in Brampton.

“That urges some level of caution going forward,” Loh told the Star on Tuesday morning. “As the province loosens restrictions for businesses we need a counterpoint of some variety on the other side to get our cases under control.”

The most recent data show that for the week of Oct. 18 to 24 Caledon recorded a test positivity rate of 4.6 per cent while Mississauga had a rate of 4.4 per cent. That same week, the proportion of COVID-19 tests coming back positive in Brampton was 9.6 per cent.

Even as cases rise, Peel has so far hung on to its contact tracing abilities -- a vital component of its COVID response -- by enlisting help from other public health units, Loh said. At the beginning of October, Toronto, Ottawa and Muskoka-Simcoe health units announced they would no longer call close contacts of people who tested positive for COVID-19, instead focusing efforts on high-risk outbreaks in congregate settings, such as schools, hospitals and long-term-care homes.

For Peel, it was the post-Thanksgiving surge of COVID-19 cases that threatened to overwhelm its contact tracing efforts, Loh said.

“By Oct. 21 we were at a precipice, starting to see a backlog of cases and not getting to people within 24 to 48 hours,” he said. “We were at risk.

“The analogy I like to use is every fire department eventually runs out of fire trucks if the fires keep spreading.”

Loh called Dr. David Williams, Ontario’s Chief Medical Officer of Health, that same day and asked for help.

“I told him we were starting to fall behind. Within the hour he sent an email to 17 of our health unit partners and we soon received offers of help.”

Loh said Peel can seamlessly accept assistance from other health units because the region switched to the province’s new case-and-contact management system in the summer, training staff during the lull in COVID-19 cases. Peel was the first big health region to make the switch to the new system in June, he said.

Since Oct. 21, 14 public health units with low COVID-19 case counts have offered to help Peel and 10 are currently assisting the region. In a statement to the Star, the Ministry of Health said “the province is providing up to 70 case-and-contact management staff to support Peel directly.”

That Peel’s COVID-19 transmission patterns largely centre on workplace and household clusters is another reason the region has so far been able to maintain contact tracing, Loh said. It’s easier to follow up with people’s close contacts within a known network rather than chasing down many isolated encounters, he said.

Peel public health staff triage cases before assigning them to other health units and do not pass on those that are complex or require language translation services, Loh said. During the last week of October, Peel averaged 210 new COVID-19 cases a day, with staff sending 60 or 70 of those cases to other health units to manage, he said.

“It might be five cases here and 10 cases there and another six cases there,” said Loh. “When it’s all added up, it’s helping us out huge right now, especially as our surge is continuing in our second wave.”

North Bay Parry Sound District Health Unit was among the first to take on some of Peel’s COVID-19 cases on Oct. 23. Since then, the unit has helped with an average of six cases per day for a total of 36 cases, said Dr. Jim Chirico, the unit’s medical officer of health. Hastings Prince Edward Counties Health Unit and Leeds, Grenville and Lanark District Health Unit also offered help on Oct. 23.

“The virus really doesn’t respect health unit boundaries; what happens in southern Ontario may very well occur in northern Ontario at any time,” said Chirico, adding that staff at his unit are learning valuable skills by assisting Peel. On Monday, his region was reporting no active COVID-19 cases.

“It benefits the entire province to have cases quickly contacted and their exposure investigated,” he said.

Even with the help of other health units, Peel is not meeting its contact tracing targets. Between Oct. 20 and 26, only 74 per cent of positive cases were contacted within one day, below its 90 per cent target.

Dr. Mahin Baqi, an infectious disease and infection control specialist at William Osler Health System, said the current test positivity rates for Peel are concerning, especially for Brampton.

Osler, which includes Brampton Civic Hospital, Etobicoke General Hospital and Peel Memorial Centre for Integrated Health and Wellness, recorded a COVID-19 test positivity rate of about 14 per cent in the last week of October, Baqi said. This rate includes those who were tested at Osler’s assessment centres, its COVID-19, Cold and Flu Clinic, its emergency departments and hospital in-patients.

“It’s something I’m very concerned about,” she said. “That means we have to be very careful. We have to be very strict as far as our screening protocols when people come into the hospital.”

Baqi said Peel, and particularly Brampton, need additional testing opportunities for its residents, many of whom are essential workers who aren’t able to work from home, who take public transit or carpool and who live in large multi-family or multi-generational households.

“We need to have a lot more pop-up testing and mobile testing … so going to the community as opposed to having them come to the testing sites,” she said. “It’s very hard for a lot of individuals to go out to these testing centres.”