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.

Summary

• Seniors 80 years of age and older have been disproportionally impacted by the pandemic, having the highest incidence rate and 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 is little difference in the median ages of those that were hospitalized or died due to the virus.
• Among those under the age of 35 years, more cases occur among males whereas among cases 45 years of age and older more are female.
• Visible minorities are highly over-represented among confirmed COVID-19 cases in Simcoe Muskoka. 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, nearly 40% 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 November 15th in Simcoe County is half of the overall provincial 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 and New Tecumseth had the highest weekly incidence rates last week among Simcoe Muskoka municipalities.
• 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

• Over the first four months of the pandemic, from March to June, approximately one-fifth (20%) of all cases in Simcoe Muskoka were associated with an institutional outbreak; however, this decreased to less than 10% in November (to date).
• Unfortunately, residents of long-term care and retirement homes have been the hardest hit by COVID-19, with one-third of cases succumbing to the illness.
• See the list of current institutional outbreaks for more details.
• There are currently four active school outbreaks in Simcoe Muskoka, including three outbreaks in Barrie at St. Joan of Acr Catholic High School, Warnica Public School and Willow Landing Elementary School. The previously declared outbreaks at Nottawasaga Pines Secondary School in Angus remains active. The outbreak at Our Lady of Grace Catholic School in Angus was declared over on November 23rd. All four schools remain open.
• 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.

COVID-19 Outbreaks in Simcoe Muskoka by Type of Setting

COVID-19 Outbreaks in Simcoe Muskoka Schools

COVID-19 Outbreak and Non-Outbreak Cases by Outcome

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 then increased to more than 24 cases per day by mid-November. 
• 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 COVID-19 infections decreased for all age groups until June, from July to September younger adults between the ages of 18 and 34 years have had the highest incidence rate - more than triple an other age group. In October, the incidence was highest among 80+ year olds which reflects the significant contribution of the outbreaks.So far in November rates among seniors 65 years of age and older are lower than what was observed in October.
• The rate of new cases among males and females since October have been the highest since the start of the pandemic.

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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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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Summary

• There were 144 new COVID-19 tests per 10,000 population in Simcoe County and 76 tests per 10,000 population in Muskoka District for the most recent week. In comparison the provincial testing rate was 185 tests per 10,000 population. This is the highest provincial testing rate reported for the past six weeks. NB: testing rates for the most recent week are incomplete and will change in future updates.
• The testing rates among Simcoe Muskoka residents have increased for all age groups, with the exception of those 80 years and older, from July to September when compared with April to June.
• The percent positivity rate in Simcoe County is 2.2% and 0.6% in Muskoka District compared to the provincial percent positivity rate of 3.5%. This was the highest weekly percent positivity in Simcoe County since May. A low percent positivity rate indicates the outbreak is under control, given more testing is finding a smaller and smaller proportion of positives.
• 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 Quarter

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

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Researchers from the University of Toronto have released a forecasting model - Design your own COVID-19 exit strategy - to help us understand the possible impacts of the COVID-19 pandemic in the next few months. Please see the linked presentation for use of the model and interpretation of findings.

In summary, the results suggest that as Ontario progresses through the provincial plan to re-open, physical distancing intensity will certainly decrease. In order to prevent a considerable increase in transmission and associated health and health care burden, to the extent possible we will need to:

• Primarily: maintain physical distancing as directed in the appropriate provincial plan’s phase, and use masks where physical distancing isn’t possible
• Also: increase testing intensity, and follow-up with cases and contacts

Simcoe Muskoka’s previous local model that included results to the end of April 2020 was quite accurate in its findings. The model had predicted that, with the use of the public health intervention ‘enhanced detection and moderate social distancing’, Simcoe Muskoka could expect 15 to 25 deaths and 170 to 300 reported cases by April 30th. In fact by May 1st, Simcoe Muskoka reported 20 deaths and 283 reported cases.

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.