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COVID-19 Pandemic in Ontario
Ongoing COVID-19 viral pandemic in Ontario, Canada
With increasing transmission province-wide, a state of emergency was declared by PremierDoug Ford on March 17, 2020, including the gradual implementation of restrictions on gatherings and commerce. On April 3, the province released modelling projecting that over the full course of the pandemic with no mitigation measures 100,000 deaths would have occurred, and with the then-current measures 3,000 to 15,000 deaths would occur. Projections for test-confirmed cases by April 30 were 12,500 (best case scenario), 80,000 (expected case scenario), and 300,000 (worst-case scenario).
From late spring to early summer, the majority of the deaths were residents of long-term care homes. In late April, one out of five of all long-term care homes in Ontario had an outbreak and 70% to 80% of all COVID-19 deaths had been in retirement and long-term care homes. Following medical assistance and observation by the Canadian Armed Forces, the military released a report detailing "a number of medical, professional and technical issues" amongst 'for-profit' long-term-care homes including neglect and lack of equipment and allegations of elder abuse.
From May through August, the province instituted a three-stage plan to lift economic restrictions, subject to the employment of social distancing and other guidelines, and continued restrictions on the sizes of gatherings. A plan was implemented for the return-to-class of public schools, involving more than 2 million children.
In early-September, the province showed a significant increase in new cases, along with similar spikes across the country in the provinces of British Columbia, Alberta, Quebec and Manitoba (or a 25% increase nationwide). Throughout the month, Ontario began to reintroduce some restrictions, with a focus on controlling spikes in the hotspots of Toronto, Peel Region and Ottawa. The province rolled back its reopening in the three hotspot regions to a "modified" stage 2 on October 10 for 28 days and on October 19, applied the same restrictions to York Region for 28 days.
^On March 30, Ontario changed how it counted recovered cases (counting all people 14 days past symptom onset as recovered).
On January 23, the first presumptive case in Canada was admitted to Sunnybrook Health Sciences Centre in Toronto and placed into a negative pressure chamber. The patient, a male in his 50s who travelled between Wuhan and Guangzhou before returning to Toronto on January 22, contacted emergency services following rapid onset symptoms. The presumption of infection in the patient was made after a rapid test was done at Public Health Ontario's Toronto laboratory, and was announced on January 25. Final testing conducted at the National Microbiology Laboratory in Winnipeg, Manitoba confirmed the presumptive case on January 27. Authorities said that the patient was experiencing respiratory problems but was in stable condition. His condition later improved and he was released from hospital on January 31.
On January 27, the Chief Medical Officer of Health of Ontario announced the man's wife as the second presumptive case. Officials reported that she was in good condition and that she was asymptomatic.
On January 31, the third case in Ontario (and the fourth case in Canada) was reported in the city of London. Officials said that the individual, a woman in her 20s and a student at University of Western Ontario, returned from Wuhan on January 23. She was asymptomatic and had tested negative at first, but additional advanced testing confirmed that the woman had low levels of the virus in her system. Officials said that the individual wore a mask during her voyage and she voluntarily entered self-isolation upon her return, making a full recovery after two or three days. On the same day, the Government of Ontario reported that 17 cases were under investigation within its provincial jurisdiction. Officials said that most of the individuals under investigation were awaiting results while in self-isolation at home. As of January 30, the associate medical officer of Ontario said that the province had conducted a total of 67 tests with 38 negative results. Officials said that all possible cases--including previous negative results--were being retested as additional assessments become available.
CFB Trenton in Trenton, Ontario was used as a quarantine facility for repatriated Canadians since February 7. By March 24, 13 positive cases for the virus of the repatriated citizens at CFB Trenton were reported.
On February 24, a fourth presumptive case in Ontario was announced of a woman in her 20s who presented to a hospital on February 21 with symptoms after travelling to Wuhan. The woman was tested locally with a positive test result and the sample was sent to the National Microbiology Laboratory in Winnipeg. On February 24, health officials in Ontario stated that all three previous cases in Ontario were "resolved", which means patients had two consecutive negative test results 24 hours apart and that the "system was working".
Five cases, two imported from each of Iran and the Grand Princess, and one from Las Vegas, were reported on March 6. Four more cases were reported to have been imported from Colorado, Washington, D.C., France, and Germany on March 8, bringing the total to 32.
On March 9, Ontario confirmed two new cases of coronavirus, bringing the total number of cases in the province to 34. They are an octogenarian and a septuagenarian from Toronto having travelled to Iran, where cases of COVID-19 had multiplied in recent weeks.
On March 10, a close contact of a previous case and a man who travelled to Switzerland were confirmed as Ontario's 35th and 36th case, respectively. Later the same day, a Sudbury man who attended the Prospectors & Developers Association of Canada (PDAC) conference in Toronto on March 2-3 was confirmed as the 37th positive case, and the first in northern Ontario.
On March 11, a 40-year-old man who recently travelled to Austria was confirmed as the first coronavirus case in Ottawa. The overall coronavirus case number in Ontario rose to 42 on the same day. On March 12, 17 new cases were confirmed including a baby boy who had recently visited the North York General Hospital in Toronto. That day, the total number of cases in Ontario increased to 59. On March 13, health officials reported 19 additional cases, bringing the number of cases to 79, and on the 14th, 24 more, making the total 103.
On March 18, an undisclosed player for the Ottawa Senators hockey team was tested positive. That day, 23 new cases were confirmed in Ontario that day, bringing the total number of cases to 212. A state of emergency was also declared in Peel Region and Simcoe County by Warden George Cornell. On March 20, Acting Mayor Jesse Helmer declared a state of emergency in the City of London.
On March 25, Ford and Finance MinisterRod Phillips introduced a $17-billion response package that includes an influx of cash for the health sector, direct payments to parents and tax breaks for businesses.
On March 26, a municipal state of emergency was declared in Kingston by Mayor Bryan Paterson due to two new cases of the virus announced by KFL&A Public Health. Three recent cases in the region had reported no prior close contact with known infected persons, causing health officials to conclude that community transmission is present in the region, and closures of several medical clinics.
In response to the anticipated increase in patients requiring critical care, the Ontario government announced on March 27 that over 3,000 ventilators were ready to be deployed in Ontario (compared to the current capacity of approximately 1,300 critical care beds with ventilators and 43 patients requiring critical care as of March 27).
On March 31, Mayor of Toronto John Tory announced that the city would cancel all city-led major events, festivals (including Toronto's Pride Parade, which was scheduled to take place on June 28), conferences, permits and cultural programs until June 30. Tory clarified that this does not necessarily restrict professional sporting events, but they are still covered under provincial restrictions on public gatherings.
On April 2, Lakeridge Health declared an outbreak of COVID-19 at Lakeridge Health Oshawa in Oshawa, and announced that one of its in-patient units would be temporarily closed after a hospital-acquired case of COVID-19 was transmitted to a health care worker treating the patient.
The next day, models were released which projected that public health measures in the province prevented an estimated 220,000 cases and 4,400 deaths up to that point. Between 3,000 and 15,000 deaths related to COVID-19 were predicted with the current public health measures over the course of the pandemic, compared to a total projected 100,000 deaths if no action were taken, and if further measures are taken, models showed projections as low as 12,500 additional cases and 200 additional deaths by the end of April. The models projected that by April 30 there would be 80,000 cases and 1600 deaths under the current interventions. In addition, the government projected a peak use of ICU beds of 1200 beds by April 18 under their best-case scenario (with over 3000 ICU beds required under the worst-case scenario by April 30).
On April 9, Ontario reported its first death of a healthcare worker, a man in his fifties in Brampton.
On April 14 during an emergency session, the Legislative Assembly voted to extend the provincial state of emergency through May 12.
The Canadian Armed Forces was deployed to five nursing homes in the Greater Toronto Area, in late April. (In Quebec, the CAF were deployed to 25 facilities.)
By May 4, 2020, outbreaks on four different inpatient units were declared at Toronto Western Hospital. The first was declared on April 18 while three others were declared on April 30. On May 10, another outbreak was declared on another floor at the hospital. While the term outbreak differs in definition by hospital, Toronto Western Hospital defines it as the confirmation of one positive patient per unit. On May 13, the hospital's emergency department declared an outbreak after five of its staff tested positive.
Canadian Armed Forces Brigadier General C. J. J. Mialkowski filed a report on conditions in the five Toronto-area nursing homes, in which they were assisting, on May 14. It did not reach the Defence Minister until a week later, after which there was a delay in notifying the Province of Ontario. The document alleges extreme conditions and abuse.
With the weather getting warmer, on Saturday, May 23, 2020, estimates of 10,000 mostly young people grouped into Trinity Bellwoods Park in Toronto's west end. Public outrage ensued as well as condemnation from Premier Ford and Toronto's medical officer of health Eileen de Villa. After making a tour of the city's parks, speaking with citizens, Mayor John Tory was also seen at the park and was criticized for lack of social distancing and improperly wearing a mask. He publicly apologized for his actions to the following day. No social distancing fines were placed, however, there were several issued for public urination. Police presence was increased the following day to prevent any subsequent large gatherings. The following week, 'social distancing circles' were painted on the lawn in the park modelled after similar tactics used in San Francisco and New York City.
On May 30, the Ontario government announced a "COVID-19 recovery rate" for electricity effective June 1 to October 31. The new rate of 12.8 cents per kilowatt-hour replaces the "off-peak" rate of 10.1 cents per kilowatt hour that was in effect since March 24.
Sunday service at Central United Church in the Markham neighbourhood of Unionville is livestreamed online during the pandemic
On June 1, Premier Doug Ford announced that the province will extend the state of emergency for another 28 days past the current expiration date of June 2, 2020.
On June 4, Minister of Economic Development Vic Fedeli announced the resumption of non-essential short-term rentals for "lodges, cabins, cottages, homes, condominiums and B&Bs" from June 5.
On June 24, Ontario extended the state of emergency to July 15 and Premier Ford stated that he is "hopeful that another extension of the Declaration of Emergency will not be needed."
On June 29, after an extended period of provincial decline in new cases, extensive testing done in Windsor-Essex revealed a spike in numbers amongst migrant agriculture workers, including one farm being responsible for 175 cases.
On July 8, the Ontario government extended the state of emergency for another week, until July 22.
On July 16, the government announced that provincial emergency orders will be extended until July 29.
On July 17, the province entered Stage 3 of reopening except for the Golden Horseshoe, Haldimand-Norfolk, Lambton, and Windsor-Essex.
On August 12, the province allowed Windsor-Essex to enter Stage 3 of reopening, the final region to do so. By late-August, the rate of new cases had slowed significantly, along with the rest of the country, with periodic spikes.
After a considerable increase in new cases (the largest influx since late July) in late summer, the Ford government on September 8 announced it would put a four-week hold on the further lifting of restrictions. It was also the heavily-debated first day of public school for many parts of the province, with at least COVID-19 cases reported in Ottawa-area Catholic schools and teachers in a Mississauga Catholic school refusing work until proper personal protective equipment was provided.
On September 10, Premier Ford criticized the federal government for not actively enforcing the Quarantine Act. Continuing an upward trend of new infections, on September 11, Ontario had its highest daily rate of new infections since June 29.
On September 11, the Ontario government released a website to track COVID-19 cases in public schools.
On September 13, the Ontario Hospital Association (OHA) stated that the province was "losing ground" due to the recent surge in cases, mainly centred on Toronto, Peel Region and Ottawa. Ontario reached over 300 new daily cases on September 14, the highest daily increase since June 5. On September 17, the province announced new restrictions on the size of private and "unmonitored" gatherings in the three regions.
On September 18, the province had over 400 new cases, the highest number since June 2.
On September 22, the province saw an increase of 478 cases, the highest daily increase since May 2. The Ford government announced they had ordered 5.1 million flu shots, encouraging the Ontario public to be vaccinated this year to avoid further burdening the hospital system. In an effort to reduce burden on provincial assessment centres, the province began to expand testing at local pharmacies (beginning primarily within current hotspots) and encourage asymptomatic patients to obtain appointments at them instead of assessment centres. On September 25, new province-wide restrictions were introduced on operating hours for bars and restaurants, restricting the sale of alcohol to an 11 pm last call, and the closure of the establishment at midnight. All strip clubs were ordered fully closed.
On September 28, Ontario reported 700 new cases, its highest daily record throughout the pandemic. Premier Ford explained that "we know that we are in the second wave and we know that it will be worse than the first wave but what we don't know yet is how bad the second wave will be." The OHA proposed that Toronto and Ottawa be rolled back to Phase 2 restrictions (which would, among other restrictions, order the closure of bars and restaurants to indoor dining), citing evidence that indoor dining was a "significant driver" of rising cases. The OHA stated that "without public health measures in place to limit opportunities for disease transmission, Ontario will soon see higher numbers of hospitalizations, admissions to intensive care units and more death."
A COVID-19 Assessment Centre in Richmond Hill
On October 2, Ontario announced 732 new cases -- its largest increase to-date. The testing backlog increased significantly to over 90,000 tests. A one-time increase of 74 deaths was also added, due to a "data review" by Toronto Public Health accounting for deaths from earlier that had not yet been included in the provincial total.
Amid these spikes, Ford announced that new capacity limits on bars, event facilities, gyms, and restaurants would be implemented in the hotspots of Peel, Ottawa, and Toronto, and a province-wide mandate on the wearing of face masks when social distancing is not possible, would take effect on October 3. He also announced that provincial testing centres would be limited to appointments only in order to manage their testing capacity and that the moratorium on reduced restrictions would be extended for another four weeks. Ford urged residents of the province to limit contact with people from outside their immediate household (especially during the Thanksgiving holiday), explaining that "we're in a second wave of COVID-19 and as Premier it's my duty to protect the people."
On October 9, Ontario announced that Peel, Ottawa, and Toronto would be rolled back to Modified Stage 2 for 28 days from October 10. This came as the province surpassed its daily record of new cases for the second consecutive day. Province-wide, the government also recommended that residents stay home except for essential activities, and avoid non-essential interprovincial travel (especially to and from hotspots). On October 16, Premier Ford announced that York Region will also be rolled back to Modified Stage 2 for 28 days from October 19.
On October 19, Ontario recommended that kids not go out trick-or-treating in those parts of the province that have been hardest hit by a resurgence in COVID-19 cases.
On March 15, Ontario Lottery and Gaming Corporation (OLG) ordered the closure of all provincial casinos. On March 17, Premier Ford declared a provincial state of emergency, prohibiting public gatherings larger than 50 people, and ordering the closure of all schools, child care services, libraries, indoor recreation facilities, dine-in bars and restaurants, and all cinemas, theatres, and concert venues. Ford stated the "vast majority" of businesses were not affected by the order, promising that "essential services and essential needs will be available to every individual and families.
On March 20 further measures were announced, including waiving the three-month waiting period for Ontario Health Insurance Plan (OHIP) coverage, the launch of an e-learning portal, and extended privileges for hospitals to re-deploy staff.
On March 23, Ford ordered all "non-essential" businesses closed by 11:59 p.m. A list of 74 "essential" businesses was published later in the day. On March 27 at 2:00 p.m. ET, Alert Ready was activated on all radio stations, television broadcasters and LTE wireless networks in Ontario, broadcasting an emergency alert warning those returning from international travel of their obligation to self-isolate for 14 days under the Quarantine Act.
On March 30, the Ontario government extended the state of emergency through April 13, and also ordered the province-wide closure of all outdoor recreational amenities, including beaches, playgrounds and sports facilities (several Ontario municipalities including Toronto, had already ordered similar closures of their recreational amenities several days prior to the province-wide order).
On April 3, it was announced the number of "essential" businesses would be reduced to 44 beginning 11:59 p.m. on April 4; this included Ontario Cannabis Store and the halting of most non-essential construction, including industrial construction, and residential construction that did not begin before April 4, but excluding "critical" infrastructure projects. On May 27, all existing public health orders were extended through June 9, 2020.
On April 27, Premier Ford released "A Framework for Reopening our Province", a roadmap detailing a "gradual" lifting of economic restrictions. The process was divided into three stages, with the first intending to allow reopening outdoor spaces, businesses that can "immediately meet or modify operations" to allow a larger number of participants in certain types of gatherings, and allow the resumption of some non-elective medical procedures. Stage 2 would allow additional businesses and outdoor spaces to reopen, and increase the limit on participants in gatherings. Stage 3 would contain further relaxation of prior restrictions, although restrictions on large public gatherings will remain in place indefinitely. After the process began in mid-May, the entirety of the province reached Stage 3 in mid-August.
On June 12, Chief Medical Officer of Health David Williams issued guidelines for "social circles" -- allowance for families to expand their interactions with up to 10 people (including themselves) from outside of their immediate household.
On September 17, in response to a surge in new cases in parts of the province, it was announced that the maximum size of "unmonitored social gatherings and organized public events" in the Ottawa, Peel, and Toronto regions would be reduced from 50 people indoors and 100 outdoors, to 10 indoors and 25 outdoors. Organizers of events that violate this restriction can be fined a minimum of $10,000, on top of the existing $750 fine for violating Ontario public health orders. Ford stated that the rule was primarily intended to target events occurring in parks and private locations, and that staffed facilities not targeted under the rule (such as banquet halls, cinemas, convention centres, and restaurants) have employed safety protocols compliant with the province's health guidance.
On September 19, the aforementioned restrictions on private gatherings were extended province-wide. On September 25, it was announced that effective September 26 province-wide, strip clubs would be ordered closed, and that all bars, restaurants and nightclubs would be required to end the sale of alcoholic beverages at 11:00 p.m. and close their dining rooms between midnight and 5:00 a.m. nightly.
On October 2, Premier Ford announced that the wearing of face masks would become mandatory province-wide in all public spaces and workplaces when social distancing is not possible, effective October 3. A number of health regions had already implemented similar mandates at the regional level.
In addition, new restrictions were introduced in the Ottawa, Peel, and Toronto regions; bars and restaurants must collect contact information from all patrons for contact tracing purposes, and are capped at a capacity of 100 people and six patrons per table. Event facilities were capped at a capacity of 50 people total (rather than 50 per room) and also subject to the six-person cap. Gyms are also capped at 50 patrons, and exercise classes were capped at 10.
Due to heightened cases in the regions, Peel, Ottawa, and Toronto were rolled back to Modified Stage 2 from October 10 to November 7, reinstating closures of indoor dining areas, casinos, cinemas and theatres, gyms, and personal care services that require the removal of face masks. All gatherings are capped at 10 people indoors and 25 outdoors, and team sports are restricted to practices only, with scrimmages and games prohibited. Wedding receptions were also prohibited following the Thanksgiving long weekend. Schools and places of worship will continue operations. On October 16, it was announced that York Region will also be placed under Modified Stage 2 beginning October 19.
Schools and Daycares
Notice of school closure at a YCDSB high school in Markham. Note the stated reopening date in what was initially expected to be a brief lockdown.
On March 12, the provincial government announced that publicly funded schools would be closed for an additional two weeks after March Break until April 5. On March 24. Premier Ford announced that the reopening of schools would be delayed indefinitely past the original April 6 target.
On March 31, Premier Ford announced that in-person classes would remain suspended through at least May 4; in tandem, Minister of EducationStephen Lecce announced the second phase of its "Learn from Home" program, which would involve "teacher-led" instruction delivered via distance education.
On April 14, Premier Ford delayed the reopening of public schools once again, on April 26 it was announced that there were plans to resume in-person classes on May 31. On May 19, Premier Ford announced that all public schools would remain closed through the end of the semester, with plans to pursue in-person classes when the next school year begins in September.
Return to class
For the next school year, Lecce presented three scenarios: full online learning, a hybrid of online and in=class learning, and a return to full-time in class learning. On July 30, it was announced that that elementary schools would return to class full-time, while high schools in 24 districts with higher enrollment would use a hybrid model, alternating daily between in-person and online instruction to reduce class sizes, with physical classes conducted in cohorts of 15 students each. Students in grade 4 and higher would be required to wear a face mask, parents would have the option to opt out of in-person classes in favour of online classes, and high school students with special needs would be able to attend in-person daily if they are not capable of using remote learning. The province allocated $309 million in funding to cover the costs of additional cleaning supplies, protective equipment, and staffing.
The plan faced criticism from parents, educators, and health care professionals, noting that some schools had insufficient ventilation and that there was no reduction in elementary school class sizes--with only 1 metre of distancing specified between desks. Lecce stated that the distance of desks was in conjunction with the use of masks. The hashtag "#UnsafeSeptember" was used on Twitter to publicize concerns regarding the back-to-school plan. A poll conducted by Maru/Blue in mid-August suggested 38% of parents surveyed were not going to send their children back to school, and a majority believed they stood with teachers and that there should be a staggered start to the school year.
On August 26, details were issued regarding how positive cases will be handled. In the event of a positive case, the entire cohort will be dismissed and required to self-isolate for 14 days. Students may return to class if they have not developed symptoms during the 14-day period. However, they will not be required to receive a test. Schools may be shut down entirely if the local health unit determines that "potential widespread transmission" is occurring. The same day, the federal government announced a $2 billion funding toward schools in Canada, of which Ontario will receive $763 million with the first tranche of $381 million arriving in the fall.
The Toronto District School Board, Canada's largest, debated and later decided to delay the reopening of schools until September 15, one week later than the initial September 8 date. A survey by the board suggested 70% of students would be returning to in class school and 30% of students would be opting for learning from home.
September 8, the first day of school for many in the province, proved to have complications, including five Ottawa-area schools reporting outbreaks and teachers in Mississauga refusing to work until proper personal protective equipment was provided.
On May 14, it was announced that Stage 1 of Ontario's lifting of restrictions would take begin May 20, focusing primarily on "workplaces that are well-positioned to follow public health advice to maintain physical distancing, implement workplace safety guidance and limit gatherings". Certain outdoor recreation activities that are part of Stage 1 were allowed to resume on May 16, for the Victoria Day long weekend.
On June 8, it was announced that Stage 2 would be implemented across most of the province, excluding 10 Southern Ontario health regions primarily in the Greater Toronto and Hamilton Area and along the Canada-United States border (such as Windsor-Essex County) due to a large number of active cases. In addition, Ford announced that the cap on gathering sizes would be increased to 10 province-wide regardless of phase, and that there would be a moratorium on evictions through the end of August of small businesses which are eligible for the Canada Emergency Commercial Rent Assistance program. On June 15, the Durham, Halton, Haldimand-Norfolk, Hamilton, Lambton, Niagara, and York health regions were allowed to enter Stage 2.
On June 22, it was announced that Peel and Toronto would be allowed to enter Stage 2 on June 24. Windsor-Essex was still excluded from Stage 2 due to outbreaks involving the agriculture industry. On June 24, it was announced that most of Windsor-Essex would be allowed to enter Stage 2 on June 25, excluding Kingsville and Leamington.
On July 3, Premier Ford stated that he did not have a specific timetable for Stage 3; "You see what's happening [in the United States] when you move too quickly, you see what's happening south of the border. We don't want that happening up here."
By August 12, after a region-by-region roll-out, all regions in Ontario had entered Stage 3. On September 8, in response to growing case numbers, the provincial government announced a moratorium on further lifting of restrictions (such as expansion of "social circles" and gatherings) for at least four weeks, besides those already ongoing (such as schools, and reopening of selected casinos on September 26).
May 14 (outdoor activities)
Stage 1 includes eased restrictions on the following:
Province-wide, regardless of their stage or not, were given some looser restrictions. Social gatherings were extended to include up to ten people. Places of worship are allowed to operate at 30% of their normal capacity.
Stage 2 allows certain businesses to reopen, with heavy restrictions:
Personal and personal care services
Restaurants & bars (outdoor patio service only)
Shopping malls & centres
Film & TV
Tour & guide services
Water recreational facilities
Outdoor recreational facilities
Beaches, parks & camping
Outdoor recreational team sports
Drive-in & drive-thru venues
Weddings, funerals and similar gatherings
Attractions & heritage institutions
Small outdoor events (such as cultural celebrations, animal shows and fundraisers)
Gatherings capped at 50 indoors and 100 outdoors.
Most businesses and activities not covered under Stage 2 (such as cinemas and theatres, dine-in restaurants, indoor gyms, recreation and attractions, etc.) are allowed to resume operations with social distancing and capacity limits enforced per-industry, unless otherwise prohibited.
Certain activities remain prohibited, including amusement parks, bathhouses, buffet service, casino table games, dancing at bars or restaurants, overnight children's camps, oxygen bars, saunas, steam rooms, and contact sports that involve "prolonged" contact.
This is a graph of the COVID-19 test-confirmed cases per day separated in two groups: 1. Cases that are part of an outbreak in an institutional setting (e.g., long-term care home, retirement home, hospital, group home, shelter, correctional facility, other). 2. All other cases (i.e., the community at-large). Source: data.ontario.ca
Public Health Ontario has six testing laboratories to which samples can be sent. The main laboratory is the top four floors of the MaRS Centre in downtown Toronto. As of early April, accounting firm KPMG has been contracted to organize all the labs in the province that are capable of microbial testing. In addition to the six public health labs, this includes 10 hospital networks and three private lab networks, including Dynacare and LifeLabs.
Access to testing is set by Public Health Ontario who publishes a guidance document that defines the conditions for an individual to be tested. Conditions have included close contact with a test-confirmed case, recent travel, admission to hospital for serious symptoms, healthcare worker, longterm care home resident, etc. The set of conditions has been updated repeatedly from January to April 2020, at times reducing access and at other times increasing access to testing. Starting in March, the public health units across the province have opened over 70 assessment centres, which members of the public can visit if directed by a health professional. These range from mobile units, to walk-up locations, to drive-through locations. This diverts potentially infected people from hospitals and doctors' offices. If warranted, the centre will collect a swab from a visitor for testing. Swabs are also collected at hospitals and by public health officials, for example, at long-term care facilities.
Since many cases are not tested, the number of test-confirmed cases, which are the infection numbers reported by the Ontario government, should not be misconstrued as the actual number of infections, which have been estimated to be substantially higher. Unlike some countries, the number of suspected or probable infections is not reported by the Ontario government.
In an effort to reduce a burden on provincial assessment centres amid a continued surge in cases, Ford announced on September 23 announced that it would expand testing of asymptomatic people by-appointment into pharmacies across the province, beginning with 60 locations by September 25. He also announced plans to deploy saliva-based rapid testing at three hospitals in Toronto. Accordingly, the province announced on September 24 that it would discourage asymptomatic patients from receiving tests at assessment centres.
Amount of testing
The COVID-19 testing rates in Ontario from March to May 2020. Points are data and lines are a 4-day moving average. Source: data.ontario.ca
In late March and April, Ontario was performing the lowest number of tests per capita of all the provinces. As of early May 2020, among the larger provinces, Ontario is second to Alberta and ahead of British Columbia and Quebec in daily tests per capita.
In mid-April, polling firms Forum Research and Mainstreet Research released results of a pair of surveys about COVID-19 symptom prevalence and testing. Four to five thousand Ontario households were randomly selected. Of them, 2% of households contained someone who had been tested by April 12, increasing to 5% on April 19, whereas the incidence of COVID-19 symptoms in a household decreased from one in five to one in seven households. The second survey indicated that one-third of Ontarians report an underlying condition that might aggravate a COVID-19 infection.
Since January 2020, Ontario has been increasing its capacity to perform testing based on RT-PCR. Various factors have impeded this increase, including shortages of reagent chemicals for the RT-PCR machines and shortages of validated swabs. To tackle these challenges, labs have adapted. In particular, RT-PCR machines from multiple manufactures have been obtained, each of which takes different sets of chemicals. New suppliers of swabs have been found but each must be tested and validated to perform properly. Returning tests results to individuals is automated with an online portal.
On March 18, The Toronto Star reported that test results announced by the provincial government were several days old, with turnaround times increasing from 24 hours to 4 days, leading the government to "making decisions based on old information". The province was only able to process around 2,000 tests per day by March 19, which caused the backlog. The backlog increased to over 8,000 unprocessed samples on March 24 with patients waiting at least four days for results, partially due to fact that private and university laboratories are not allowed to process samples.
More backlogs emerged in September and October amid increased demand for tests and a heightened caseload, reaching 68,000 by the weekend of October 4. On October 5, CBC News reported that COVID-19 tests administered at pharmacies were being sent to Quest Diagnostics laboratories in California for processing by means of the local partner for the scheme, In-Common Laboratories (ICL).
Management of testing in Ontario
Officials for Public Health Ontario include the following individuals:
Dr. Vanessa Allen, chief of medical microbiology with Public Health Ontario
Dr. Peter Donnelly, president and CEO of Public Health Ontario (on leave as of April 9, 2020)
Colleen Geiger, interim president and CEO of Public Health Ontario (as of April 9, 2020)
Dr. David Williams, Ontario's chief medical officer
Dr. Barbara Yaffe, Ontario's associate chief medical officer of health
In early April, the Ministry of Health brought in a multinational accounting firm KPMG to assist in the organization and optimization of testing capacity in Ontario. Premier Doug Ford said on April 8 that he was losing his patience with Ontario's inadequate testing numbers, showing testing capacity was not being fully utilized. Later that day, the province appointed a former Toronto public health head, Dr. David McKeown to troubleshoot and rethink the province's response to the pandemic. The following day on April 9, amid mounting criticism of the province's testing, the president and CEO of Public Health Ontario Dr. Peter Donnelly temporarily stepped down for medical reasons and was replaced in the interim by Colleen Geiger, Public Health Ontario's chief of strategy, stakeholder relations, information and knowledge.
Long-term care homes
On April 15, 2020, the Ontario Nurses' Association released a statement saying that long-term care (LTC) homes pre-COVID-19 were already understaffed, but now they are in "crisis" mode. Prior to the pandemic, long-term care home staff who were part-time or casual staff were allowed to work at multiple locations, increasing the risk of transmission and spread between LTC homes. The province issued a new Emergency Order on March 28 that introduced temporary additional staff members to help in the facilities and allowed homes more flexibility in staff deployment. Many LTC homes in Ontario are considered old and small and feature shared bedrooms, increasing the difficulty in isolating sick residents from those who are well.
On April 15, CBC reported that the Ontario Ministry of Long-Term Care had conducted resident quality inspections (RQI) at only nine out of 626 long-term care homes in the province in 2019, down from a bare majority in 2018 and larger proportions from 2015 to 2017. RQIs are proactive, unannounced and more comprehensive than the other main category of care home inspections in the province, complaint and critical incident inspections, where facilities know of the impending scrutiny in advance; the 2018 Long Term Care Homes Public Inquiry noted that "focusing only on specific complaints or critical incidents could lead to missing systemic issues." As of 15 April 2020[update], 114 care facilities in Ontario had experienced COVID-19 outbreaks, and those that had multiple COVID-19 deaths last had their RQI in 2018 or earlier.
As of April 7, Ontario reported that there are 51 long-term care homes in the province that are experiencing COVID-19 outbreaks, and by April 10, it had surged to 69 LTC homes in Ontario. Some LTC workers pointed to a lack of personal protective equipment as a cause of the outbreaks. By April 21, 121 outbreaks have been reported in long-term care homes.
On April 8, the Ontario Ministry of Health released directives to ramp up coronavirus testing and infection control. Also, new residents entering a home must be isolated for 14 days and tested within that period. The directives also require that all long-term care home staff and essential visitors for gravely ill residents wear surgical masks, "whether the home is in outbreak or not." LTC homes are expected to take "all reasonable steps" to follow the new long-term care rules. Prior to this directive, LTC staff were not required to wear masks or other PPE, and testing levels were considered low for at-risk seniors and LTC staff.
On April 28, Chief Public Health Officer Theresa Tam stated that as many of 79 percent of Canada's COVID-19 fatalities occurred in long-term care homes, with Ontario and Quebec accounting for most of the cases.
Assistance from the Canadian Armed Forces at five Toronto-area nursing homes, beginning in April, led to a report by the Brigadier General in charge documenting extreme conditions and abuse. The Ontario Ombudsman announced the launch an investigation into long-term care facilities on June 1.
As of August 19, 2020[update], the following LTC homes in Ontario have 10 or more confirmed COVID-19 related deaths:
Regional public health experts suggested that Ontario's initial incremental response -- adding new voluntary measures piece by piece -- had been ineffective. Businesses of all sizes remained open, and unnecessary social contacts continued. Describing Ontario's efforts to battle COVID-19 as piecemeal and ineffective, Dr. Shanker Nesathurai, who was one of Ontario's 34 regional medical officers of health, urged his colleagues to band together and use more powerful measures to contain the pandemic than provincial leaders had endorsed by the third week of March. In an email, Dr. Nesathurai, who worked for Haldimand Norfolk Health Unit, wrote on March 19 that Ontario's response had undermined the province's attempt to contain the outbreak, as businesses remain open and travellers ignore advice to self-isolate.