COVID-19

Summary

• The B.1.1.7 variant, first detected in the United Kingdom in the fall of 2020, is the most common variant of concern (VOC) identified in Simcoe Muskoka. As of April 14, 2021 there are a total of 2,081 variant cases (B.1.1.7, P.1, B.1.351 and screened positive cases).
• As of April 14, 2021, there are 13 active COVID-19 outbreaks that have known variant cases.
• The 7-day moving average of new VOC/screened positive cases has quadrupled from 15 cases per day in early March to over 60 cases per day by the second week of April (Note: not including the most recent days due to reporting delays).
• Estimates suggest that the B.1.1.7 variant is 36% to 75% more contagious than the original COVID-19 strain. The P.1 and B.1.351 variants are also associated with increased transmissibility. (Public Health Ontario. Interim Guidance for Infection Prevention and Control of SARS-CoV-2 Variants of Concern for Health Care Settings. February 2021).
• For outbreaks in which 1 or more cases have been laboratory confirmed to have a VOC, there is a higher degree of certainty that other cases in the outbreaks will also have the VOC.
• Effective February 3, Public Health Ontario (PHO) and the Provincial Diagnostic Laboratory Network began screening all new positive COVID-19 specimens for known VOCs, in an effort to rapidly identify and mitigate against spread of VOCs in Ontario.Prior to February 3, not all specimens were tested for the variant and therefore the reported number of COVID-19 cases with a VOC in Simcoe Muskoka and elsewhere in the province are an underestimate.
• Variant testing is a two-step process with the screening occurring first, followed by whole genome sequencing (WGS) upon positive screening results. Delays in reporting of up to 10 days are possible for the initial screening, while WGS can take between 3 and 6 weeks depending on volume and laboratory capacity.
• Emerging VOCs have mutations in the virus genome that alter the characteristics and cause the virus to act differently in ways that are significant to public health. It’s important to understand that genetic mutations are expected, and some variants can spread and become predominant while others subside. Information on VOCs, including B.1.1.7 and others, can be accessed here
• Public health measures needed to help address the variant are the same as those in place right now. Visit SMDHU’s website for ‘Stop the Spread’ information as well of Public Health Ontario’s Evidence Brief on Public Health Measures Required for Rapid Control of Variants of Concern.
• Visit Public Health Ontario’s website for additional information about the different types of VOCs
  • UK B.1.1.7 variant
  • South Africa B.1.351 variant
  • Brazil P.1 variant.

Variant of Concern (VOC) Outbreaks with B.1.1.7 cases and/or Positive Screen Cases, Simcoe Muskoka

Variant of Concern (VOC) Outbreaks with B.1.1.7 cases and/or Positive Screen Cases Declared by Week, Simcoe County and Muskoka District

Variant of Concern (VOC) cases and/or Positive Screen Cases by Type of Case and Geography, Simcoe Muskoka

7 Day Rolling Average of New COVID-19 Cases with a Variant of Concern or a Screened Positive Result, Simcoe Muskoka

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Percent Positivity for Cases screened for Variants of Concern (VOCs)

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Summary​

• COVID-19 immunizations with the Pfizer-BioNTech vaccine began in Simcoe Muskoka on December 22, 2020. Primary care teams in Simcoe Muskoka began administering the AstraZeneca COVID-19 vaccine on March 12th, 2021. COVID-19 immunizations with the Moderna vaccine began in Simcoe Muskoka on March 15, 2021.
• The immunization data is presented in two ways:

 

• Dose administration data includes all doses administered in Simcoe Muskoka by the health unit, local hospitals, primary care providers and pharmacies. These include all doses administered, regardless of where the individual receiving the vaccine resides.
• Vaccine coverage data includes doses administered to residents of Simcoe Muskoka, regardless of where the vaccine was administered in Ontario. The total doses administered in Simcoe Muskoka will not equal the total number of first and second doses received by Simcoe Muskoka residents.

 

• As of April 14, 2021 Simcoe Muskoka District Health Unit, in partnership with the Royal Victoria Regional Health Centre (RVH), regional health sector, municipal partnerships, and local primary care teams have administered nearly 132,000 vaccine doses which includes over 6,500 AstraZeneca doses administered by primary care teams in Simcoe Muskoka. Local pharmacies have also administered over 8,800 doses of the AstraZenca vaccine to adults 55 years and older. There have also been more than 1,150 doses administered to health care workers in South Simcoe by Southlake Regional Health Centre; however, these doses are not included in the data presented in the tables and charts below.
• Over 90% of Long Term Care (LTC) and Retirement Home (RH) residents in Simcoe Muskoka have received their first dose of vaccine, with the majority having already received their second dose.
• More than three-quarters of LTC and RH staff and essential caregivers affiliated with homes in Simcoe Muskoka have received their first dose of vaccine.
• As of April 14, 2021, over 125,250 (or 20%) of Simcoe Muskoka’s residents have received their first dose of vaccine, with approximately 19,400 of these individuals also receiving their second dose.
• Nearly 25,000 seniors 80 years of age and older living in Simcoe Muskoka received their first dose of vaccine, which represents 83% of individuals in this age group. In addition, over 17,600 (or more than three-quarters) of seniors 75 to 79 years of age have also received their first dose of vaccine.
• Recent National Advisory Committee on Immunization (NACI) guidelines now allow for up to 4 months between the 1st and 2nd dose of all authorized two-dose COVID-19 vaccines. Limited populations remain eligible in Ontario for the original 2^nd dose interval.
• For more information about the vaccine roll-out in Simcoe Muskoka, visit SMDHU’s vaccine and immunization page as well as the provincial website.

COVID-19 Vaccines Administered by Product, in Simcoe Muskoka

COVID-19 Vaccine Doses Administered per Day, in Simcoe Muskoka

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COVID-19 Immunization Coverage by Age Group among Simcoe Muskoka Residents

Cumulative Number of Individuals Immunized by Day, Simcoe Muskoka

COVID-19 is found to impact certain populations more than others – provincially as well as in Simcoe Muskoka. Social determinants of health (SDOH), such as gender, socioeconomic position and race/ethnicity are factors that potentially put people at increased risk and severity of COVID-19 infection. The reasons for this are still emerging but may include:

• Existing health disparities linked to social and economic factors
• Stress and lack of advantage caused by racism and other forms of discrimination
• Challenges in participating in the public health response to COVID-19, including:

   

  • difficulties in limiting COVID-19 exposure because of being an essential worker, and
  • difficulties in physical distancing because of overcrowding.

   

• Inequitable access to health care and social services.

Previous Simcoe Muskoka District Health Unit (SMDHU) research has shown a higher rate of COVID-19 infection among people living in areas where residents come from a wide range of ethnic backgrounds and cultures.

Research done in other jurisdictions has also identified factors such as living in low-income areas as having an influence on the impact of COVID-19 illness, however these patterns have not been reflected in our local data.

Voluntary questions on race, language and income are being asked of residents who contract COVID-19, by SMDHU case investigators as of July 21, 2020. Data reported below exclude those who choose not to answer one or more of these questions. Due to the recent increase in cases and the need to streamline case investigations, these questions have been temporarily removed from case interviews as of December 11, 2020.

Summary

• Seniors 80 years of age and older have been disproportionally impacted by the pandemic, having the highest case fatality rate.
• The median age of recovered cases has been decreasing since July (37 years), when compared with the median age from March to June (46 years); however, there has been little change in the median ages of those that were hospitalized or died due to the virus since July.
• Among those under the age of 80 years, more cases occur among males whereas among cases 80 years of age and older, more are female.
• Visible minorities are highly over-represented among confirmed COVID-19 cases in Simcoe Muskoka. Nearly half of all COVID-19 cases in Simcoe Muskoka that have provided information about their race report being a visible minority. In comparison, visible minorities only represent 7% of Simcoe Muskoka’s total population.
• Individuals who report a non-official language (neither English nor French) as their mother tongue represent 10% of the Simcoe Muskoka population. However, 43% of local COVID-19 cases report mother tongues other than English and French.

Unlike other areas in Ontario where COVID-19 cases living in low income are more impacted by the virus, Simcoe Muskoka COVID-19 data shows that those with higher income and those living in areas with less material deprivation (i.e. moderately and well-resourced areas) are more likely to be a COVID-19 case.

COVID-19 Age-Specific Incidence, Case Hospitalization and Case Fatality Rates

Median Age of COVID-19 Cases by Outcome and Time Period

COVID-19 Cases by Sex and Age Group

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COVID-19 Cases by Age Group and Current Status

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COVID-19 Cases by Visible Minority Status, Simcoe Muskoka

COVID-19 Cases by Mother Tongue, Simcoe Muskoka

COVID-19 Cases by Household Income, Simcoe Muskoka

Before race, income or language information was asked of people who were confirmed COVID-19 cases, SMDHU did an analysis by looking at specific geographic areas and the groups of people living within them to determine impacts of COVID-19 on the various sub-populations. This is called an area-based analysis and it describes where people live, but may not reflect the experience of all individuals living in these areas. It serves as a proxy to explain the individual experience.

Interestingly, the findings from the initial area-based analysis and the more recent data collected when confirmed COVID-19 cases were asked for detailed personal and household information are comparable. In both instances, areas with higher ethno-cultural diversity and higher incomes experience higher impacts of COVID-19.

COVID-19 Incidence Rate by Material Deprivation, Area-based Analysis

COVID-19 Incidence Rate by Ethno-Cultural Diversity, Area-based Analysis

Summary

• The weekly incidence rate of new COVID-19 infections for the week starting April 4th in Simcoe Muskoka was 111 cases per 100,000 population, which was 46% higher than the previous week. This is the highest weekly incidence rate ever recorded for Simcoe Muskoka. The overall provincial incidence rate remains significantly higher than the local rate.
• The vast majority of COVID-19 cases in Simcoe Muskoka reside in Barrie, Bradford West Gwillimbury, New Tecumseth, Essa, and Innisfil.    
• Bradford West Gwillimbury had the highest weekly incidence rate for the fifth consecutive week, with a weekly incidence rate above 300 new cases per 100,000 population. New Tecumseth had a weekly incidence rate of over 200 new cases per 100,000 population last week. Adjala-Tosorontio, Barrie, Essa, Innisfil, Tiny and Lake of Bays also had a weekly incidence rate above 100 new cases per 100,000 population last week. 
• Click here to view the epidemic curve by municipality.

COVID-19 Weekly Incidence Rates, by Geographic Area

COVID-19 Cases by Municipality and Current Status

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COVID-19 Cases by Municipality and Month

Weekly COVID-19 Incidence Rate per 100,000 by Municipality

Summary

• Unfortunately, residents of long-term care and retirement homes have been the hardest hit by COVID-19, with one-quarter of cases succumbing to the illness.
• See the list of current institutional outbreaks for more details.
• There have been more than 1,500 cases associated with local outbreaks since the start of the pandemic. In January approximately 20% of new outbreak cases were associated with community, workplace or educational settings with the remainder associated with institutional and congregate settings. In March, more than three-quarters of local outbreak cases were associated with workplace or educational setting outbreaks. This excludes cases that are associated with outbreaks outside of SMDHU.
• There are currently five active school outbreaks: St. Angela Merci Catholic School in Bradford, W.H. Day Public School in Bradford, Good Shepherd Catholic School in Barrie, Holy Trinity Catholic High School in Bradford, and Alcona Glen Public School in Innisfil.
• For more information and data about COVID-19 and school impacts, visit the Province of Ontario’s COVID-19 cases in schools and child care centres website.

Change in Active COVID-19 Outbreaks by Category, Simcoe Muskoka

Summary of COVID-19 Outbreaks by Category, Simcoe Muskoka

COVID-19 Outbreaks in Simcoe Muskoka Schools

COVID-19 Outbreaks in Simcoe Muskoka Child Care Settings

COVID-19 Outbreaks in Simcoe Muskoka Workplaces

COVID-19 Outbreaks in Simcoe Muskoka Institutions

COVID-19 Outbreaks in Simcoe Muskoka Community Settings

COVID-19 Outbreaks in Simcoe Muskoka Congregate Settings

Summary

• The daily moving average of new cases declined from mid-January to early March to approximately 35 cases per day; however, the moving average has been above 90 cases per day since April 6th (excluding the most recent days due to reporting delays).
• The age-specific rates in March were higher than in February for children (<18 years), and middle-aged adults (35-64 years). Rates in March were similar for seniors (65+ years) and younger adults (18-34 years) when compared with February.
• The effective reproductive number for a given period of time or Rt is the average number of secondary cases that a new case will infect. If Rt is greater than one it indicates that the spread of COVID-19 in Simcoe Muskoka is growing, and if Rt is less than one, the spread of COVID-19 is slowing and containment/mitigation efforts may be working to keep the outbreak under control.
• While the rate of new infections among females was higher than males in January, this difference was mainly due to a higher number of female cases associated with institutional outbreaks. The rates for males were higher than females in February and March.

Epidemic Curve by Date of Symptom Onset

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7 Day Rolling Average of New COVID-19 Cases

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Cases Acquired in the Community

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New COVID-19 Hospitalizations

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New COVID-19 Deaths

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COVID-19 Case Fatality Rates by Month

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COVID-19 Age-Specific Case Fatality Rates by Month

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Cumulative COVID-19 Cases by Date of Reported

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7-Day Rolling Average of the Median Reproductive Number (Rt)

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Age-Specific Incidence Rate of COVID-19 Infections by Month

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Active COVID-19 Hospitalizations and ICU Admissions

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Summary

• There were 247 new COVID-19 tests per 10,000 population in Simcoe County and 135 tests per 10,000 population in Muskoka District for the most recent week (April 4th). In comparison the provincial testing rate was 243 tests per 10,000 population. NB: testing rates for the most recent week are incomplete and will change in future updates.
• The percent positivity rate in Simcoe County is 6.6% and 3.9% in Muskoka District compared to the provincial percent positivity rate of 6.6%. The percent positivity for both Simcoe County and Muskoka District are at their highest levels since the start of the pandemic. The percent positivity in Muskoka was nearly twice as high as the previous week. A low percent positivity rate indicates the outbreak is under control, given more testing is finding a smaller and smaller proportion of positives.
   

COVID-19 Testing Rate (per 10,000), Simcoe Muskoka and Ontario

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COVID-19 Percent Positivity Rate, Simcoe Muskoka and Ontario

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COVID-19 Testing Rate (per 10,000), Simcoe Muskoka by Age Group and Week

COVID-19 Percent Positivity Rate, Simcoe Muskoka by Age Group and Week

Models of the COVID-19 pandemic are hypothetical scenarios that are used to show what could happen under certain conditions; however, they are not predictions of the future because the pandemic continues to change.

The provincial government has a Science Advisory Table that releases models periodically on projections and other topics. The most recent provincial modelling released on April 2, 2021 states that projections depend entirely on system-level public health measures and vaccination. Essential workers are keeping things moving and bearing the brunt of the pandemic. Vaccination and control of workplace outbreaks will be critical.

Other provincial highlights include:

• The third wave is here and being driven by variants of concern. Younger Ontarians are ending up in hospital. Risk of ICU admission is 2 x higher and risk of death is 1.5 x higher for the B.1.1.7 variant.
• COVID-19 threatens health system ability to deal with regular ICU admissions and the ability to care for all patients.
• Vaccination is not reaching the highest risk communities, delaying its impact as an effective strategy.
• School disruptions have a significant and highly inequitable impact on students, parents and society. Further disruptions should be minimized.
• Stay-at-home orders will control the surge, protect access to care, and increase the chance of the summer Ontarians want.

In Simcoe Muskoka, the following graph shows the modeled projections based on constant daily increases and decreases of 1%, 3% and 5%.

7-Day Rolling Average of New COVID-19 Cases with Various Projections

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Cases are assigned to the Simcoe Muskoka District Health Unit based on the address of the patient when the health unit conducts their investigation, not the location of the hospital the patient was seen at. For cases that reside outside of Ontario, cases are assigned to the health unit that is actively following up with the patient.

Data for confirmed COVID-19 cases are from the Case and Contact Management (CCM) Management System. Data for confirmed COVID-19 outbreaks are from the Integrated Public Health Information System (iPHIS). Data related to COVID-19 testing are from the Ontario Laboratories Information System (OLIS). Data related to immunizations are from COVax-ON.

Case Type Definitions:

• Active cases are confirmed COVID-19 cases that are currently self-isolating, are under isolation precautions or are in hospital (including those in an ICU bed or on a ventilator). Excludes those with unknown status. 
• Sporadic cases are those not associated with an outbreak at an institution, workplace, community setting, educational setting or congregate setting in Ontario. These infections are usually acquired from travel, within the community or from a close contact with a known case.
• Institutional outbreak cases are COVID-19 cases that are lined to long-term care homes, retirement homes, hospitals, correctional facilities. Applies to residents, staff, volunteers and third party service providers. Institutions may be located in Simcoe Muskoka or in other health unit jurisdictions. The health unit is only able to comment on institutional outbreaks in our area.
• Workplace outbreak cases are confirmed COVID-19 cases that are linked to a place of employment that is not open to the public (e.g., farms, food processing plants, manufacturing). Excludes institutions, congregate settings, educational settings and community setting workplaces. Applies to employees and employers. Based on epidemiological investigation of cases in employees of a workplace who worked in proximity and at the same time of other confirmed cases. Workplaces may be located in Simcoe Muskoka or in other health unit jurisdictions. The health unit is only able to comment on workplace outbreaks in our area.
• Community outbreak cases are confirmed COVID-19 cases linked to workplaces that are open to the public (e.g., restaurants, bars, funeral homes, gyms, community centres, personal service settings etc.), community events (e.g., concerts) or social gatherings. Based on epidemiological investigation of cases that were in close proximity and at the same time of other confirmed cases at the facility, event or gathering. These community settings may be located in Simcoe Muskoka or in other health unit jurisdictions. The health unit is only able to comment on community setting outbreaks in our area.
• Congregate settings outbreak cases are confirmed COVID-19 cases linked to settings in which people temporarily or permanently reside such as group homes, supportive housing or shelters. Applies to residents and staff. Based on epidemiological investigation of cases in residents/staff of a congregate setting who were in proximity and at the same time of other confirmed cases. Congregate settings may be located in Simcoe Muskoka or in other health unit jurisdictions. The health unit is only able to comment on congregate setting outbreaks in our area.
• Educational settings outbreak cases are confirmed COVID-19 cases linked to child care centres, elementary and secondary schools as well as trades school, college and university. Applies to students and staff. Based on epidemiological investigation of cases in students/staff of an educational setting who were in proximity and at the same time of other confirmed cases. Educational settings may be located in Simcoe Muskoka or in other health unit jurisdictions. The health unit is only able to comment on educational setting outbreaks in our area.
• For all of the above, only cases where the Simcoe Muskoka District Health Unit is the investigating health unit (previously referred to as responsible health unit) are included.

Status definitions:

• Recovered: a confirmed COVID-19 case that is 14 days past symptom onset that is without fever and has improving symptoms and is not currently hospitalized.
• Ever Hospitalized: a confirmed COVID-19 case that has ever been admitted to hospital. This includes any patients that have ever been admitted to an intensive care unit and those that have ever been on a ventilator in hospital.
• Hospitalized Never in ICU: confirmed COVID-19 case that has ever been admitted to hospital but has never been admitted to an intensive care unit nor been on a ventilator in hospital.
• Hospitalized - ICU: confirmed COVID-19 case that has ever been admitted to an intensive care unit or been on a ventilator in hospital.
• Currently Hospitalized: a confirmed COVID-19 case that has not recovered and is currently admitted to hospital. This includes any patients that are currently admitted to an intensive care unit and those that are currently on a ventilator in hospital.
• Self-Isolating: A confirmed COVID-19 case that has not recovered and is not currently hospitalized that is self-isolating at home.
• Isolation Precautions: A confirmed COVID-19 case that has not recovered and is not currently hospitalized resides in an institution (e.g. a long-term care home) and is under isolation precautions within the institution.

Acquisition definitions:

• Travel: most likely acquisition of illness is from travel outside of Ontario.
• Close Contact: most likely acquisition of illness is from close contact with another confirmed COVID-19 case.
• Exposures include: close personal contact, shared airspace, and household contact. This excludes anyone with travel history within 14 days of symptom onset.
• Community-Acquired: signifies a sporadic case in an individual where most likely the acquisition of illness is from somewhere within the community but not associated with a community outbreak. This also excludes transmission due to travel and due to close contact with a known case.
• Educational Setting Outbreak-Related: a confirmed COVID-19 case that is a student/attendee or staff of an educational setting (child care centres, elementary and secondary schools as well as trades schools, colleges and universities) where an outbreak has been declared.
• Institutional Outbreak-Related: a confirmed COVID-19 case that is a resident or staff member of a long-term care institution, retirement home, correction facility or hospital. These types of transmissions are often referred to as nosocomial.
• Workplace Outbreak-Related: multiple confirmed COVID-19 cases in employees of a workplace that is not open to the public who worked in proximity and at the same time of other confirmed cases and, based on epidemiological investigation, a higher level of disease transmission within the workplace than what would be expected given current local COVID-19 activity and incidence in the community.
• Community Outbreak-Related: multiple confirmed COVID-19 cases in individuals who attended a community event or social gathering at the same time of other confirmed cases, and based on epidemiological investigation, were deemed to be potentially infectious during the event or may have acquired the infection while attending the event.
• Congregate Setting Outbreak-Related: a confirmed COVID-19 case that is a resident or staff member of facilities in which people temporarily or permanently reside such as group homes, supportive housing or shelters. These cases are not included in either the institutional or workplace outbreak cases.
• Undetermined: most likely acquisition of illness is not clear and investigation is complete.
• Under Investigation: a confirmed COVID-19 case with current status under investigation at the time of reporting.

Please note that 95% confidence intervals were not included on the charts and tables for simplicity; however, statistical significance between groups (e.g. geographic areas and age groups) was determined by non-overlapping confidence intervals.

Starting on March 26, 2021 due to changes in testing methods at PHO, B.1.1.7 cases will include confirmed B.1.1.7 lineage based on whole genome sequencing, and presumed B.1.1.7 cases based on a positive PCR test for the N501Y mutation and a negative PCR test for the E484K mutation. This has resulted in a large number of cases previously reported as screened positive being re-assessed as B.1.1.7 variant cases. Samples which screen positive for both the N501Y and E484K mutations continued to move forward with whole genome sequencing to identify specific variants. Additional details about Variant of Concern testing are available from Public Health Ontario.

Vaccine Coverage (1^st Dose): The percent of individuals residing in Simcoe Muskoka that received their first dose of any COVID-19 vaccine, regardless of where they received their vaccine in Ontario.

Vaccine Coverage (2^nd Dose): The percent of individuals residing in Simcoe Muskoka that received their second dose of any COVID-19 vaccine, regardless of where they received their vaccine in Ontario.