COVID-19

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 January 3rd in Simcoe Muskoka was above 80 cases per 100,000 population for the first time since the start of the pandemic and was 22% higher than the previous week. The overall provincial incidence rate remains significantly higher than the local rate; the provincial incidence rate also increased this past week by 21% from the previous week. 
• The vast majority of COVID-19 cases in Simcoe Muskoka reside in Barrie, Bradford West Gwillimbury, New Tecumseth, Essa, and Innisfil. 
• The weekly incidence rate in Barrie was 83 new cases per 100,000 population this past week, which is similar to the previous week. Approximately one-quarter of all active cases reside in Barrie.
• Bradford West-Gwillimbury had the highest weekly incidence rate last week by far at 233 new cases per 100,000, followed by New Tecumseth at 159 new cases per 100,000 and Essa at 104.5 new cases per 100,000. No other municipality had a weekly incidence above 100 new cases per 100,000 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 nearly 800 cases associated with local outbreaks since the start of the pandemic. From March to October, approximately 75% of these cases were linked to long-term care and retirement home outbreaks and more than 20% were linked to workplace outbreaks. From November to December, outbreak-associated cases were distributed relatively evenly across institutional settings, congregate settings, educational settings, and workplaces. So far in January only 10% of new outbreak cases are associated with workplace or educational settings with the remainder associated with institutional and congregate settings.
• There are currently zero active school outbreaks in Simcoe Muskoka.
• 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 seven-day moving average of new COVID-19 cases in Simcoe Muskoka steadily increased from early August to early October, from less than one case per day to more than 16 cases per day. The moving average dropped to 12 cases per day in mid-October; however, it increased to over 60 cases per day by early January.
• 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.
• Young adults (18 to 34 years) have had the highest rate of new cases since the start of the second wave of the pandemic; however, the rates have increased significantly across all age groups since August.
• While the rate of new COVID-19 infections among females was higher than males in the first wave of the pandemic, the rate among males were higher than females from September to November. The rate in December was nearly identical for males and females.

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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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 235 new COVID-19 tests per 10,000 population in Simcoe County and 124 tests per 10,000 population in Muskoka District for the most recent week. In comparison the provincial testing rate was 263 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 3.7% and 0.4% in Muskoka District compared to the provincial percent positivity rate of 6.2%. This is the highest percent positivity for Ontario and Simcoe County since April. A low percent positivity rate indicates the outbreak is under control, given more testing is finding a smaller and smaller proportion of positives.
• The weekly percent positivity in Simcoe Muskoka has been highest among children and youth under 20 years of age for the past two weeks. Testing rates remain highest among seniors 80 years of age and older.
• The percent positivity rate among Simcoe Muskoka adult males between 30 and 59 years of age is approximately twice as high as adult females of the same age. 

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.

A provincial model released on January 12, 2021 showed possible scenarios to mid-February 2021, under the assumption of constant daily growth in confirmed COVID-19 cases. At 3% daily growth the projected daily COVID-19 case count for Ontario was approximately 7000 cases by January 30 and 10,000 cases by February 15. At 1% growth, the projections are 5,000 cases per day by February 15.

Other highlights include:
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• Growth in cases has accelerated and is over 7% on the worst days.
• Almost 40% of long-term care (LTC) homes have active COVID-19 outbreaks. Since January 1^st, 198 LTC residents and 2 LTC staff have died of COVID-19. Forecasts suggest more deaths in wave 2 in longterm care than in wave 1.
• COVID-19 ICU occupancy is now over 400 beds. Surgeries are being cancelled and the access to care deficit will continue to increase with real consequences for health.
• Mobility, and contacts between people have not decreased with the current restrictions. Survey data show that the majority of Ontarians are helping limit spread by following them. However, case numbers will not decline until more of the population follows their example.
• A new variant of concern of SARS-CoV-2 (B117) could drive much higher case counts, ICU occupancy and mortality if community transmission occurs. The doubling time for cases could drop by more than two-thirds. This new variant is now in Ontario.
• Without significant reductions in contacts, the health system will be overwhelmed and mortality will exceed the first wave totals before a vaccine has time to take effect.

In Simcoe Muskoka, the following graph shows the modeled projections based on constant daily growth rates of 1%, 3% and 5%. For the most recent week (January 3 -9, 2021), the average daily growth in confirmed cases was 1.8%. Based on projections, if this level of growth continues, there will be approximately 750 cases reported during the week of January 31 - February 6, 2021 or about 107 cases per day with a projected weekly incidence rate of 125 cases per 100,000 population.

Other scenarios show that if the number of confirmed cases continues to rise, resulting in a higher average daily growth rate, for example 3% growth, there could be as many as 150 cases per day in Simcoe Muskoka by early-February, 2021.

7-Day Rolling Average of New COVID-19 Cases with Various Growth 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 taken from the Case and Contact Management (CCM) Management System. Data for confirmed COVID-19 outbreaks are taken from the Integrated Public Health Information System (iPHIS). Data related to COVID-19 testing are taken from the Ontario Laboratories Information System (OLIS).

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.