By Sue Tiffin
The following are brief reports from a Haliburton, Kawartha, Pine Ridge (HKPR) district health unit press conference with medical officer of health Dr. Natalie Bocking, held virtually on Jan. 5.
Dr. Natalie Bocking spoke to the frustration that she knows people are feeling due to being in the third year of the pandemic, facing further public health measures and restrictions as a result of the spread of the Omicron variant and the fifth wave.
“At this point in time we are not looking to stop COVID-19 transmission,” Bocking said. “At this point in time we are looking to mitigate or decrease the impact on our acute care system. Our hospitals have already had to move to looking at cancelling non-elective procedures. What’s different about this wave of the pandemic compared to previous, is the number of absences of health care workers at our hospitals that is happening at the same time as a higher number of admissions which creates even further strain on the system so I think certainly in terms of short-term measures that we can do to try and keep our healthcare system safe and able to respond, those are measures that we need to take and [are] time-limited to get us through. As an individual or community member the most important thing you can be doing right now is following those basic public health measures.”
She acknowledged that it might feel like deja vu, referencing the movie Groundhog Day.
“There are certainly technical lessons learned about how we manage COVID-19, some of that changes based on the variant. But I do think a lot of it, our biggest lessons learned, are more kind of social, in that the best way we get through these waves is through kindness and compassion and empathy and that when we have done that the waves pass faster and we come out healthier on the other side.”
Changes to testing, outbreak reporting
As of the Jan. 5 media briefing, 4,288 cases of COVID-19 have been confirmed in the region since the beginning of the pandemic, and 1,013 cases were currently being recorded as active: 74 in Haliburton County, 381 in City of Kawartha Lakes and 550 in Northumberland County.
These numbers reflect infections in individuals that have been reported to public health through lab-positive confirmed results.
Bocking said that given changes in provincial criteria to access PCR testing – which has been reduced to those who work or live in high-risk settings or have high-risk medical conditions due to capacity in both local assessment centres throughout the province as well as at regional and central laboratories – the numbers being reported of confirmed cases are an underestimate of the actual cases in the community.
“We know that there are many individuals right now that might have symptoms consistent with COVID-19 or that may have tested positive with a rapid antigen test and are presumed to have COVID-19 infection and these individuals are not reflected in the numbers that are on our dashboard,” she said. “That being said, I think the dashboard which includes the numbers of confirmed PCR tests still is helpful to really indicate the general burden. Knowing that it’s an underestimate, these are still really large numbers that we’re seeing.”
Bocking said the HKPRD’s seven-day rolling incidence rate at that point was the highest it has ever been throughout the pandemic, at 509 cases per 100,000 population over the last week. Sixteen outbreaks had been reported throughout the region: eight of those outbreaks in long-term care homes or retirement homes, two of those outbreaks in correctional institutions and four in other group home settings or congregate care settings.
“We are not declaring general community outbreaks or other community location outbreaks but will continue to declare outbreaks in higher risk settings which includes different congregate care settings such as retirement homes or group homes,” Bocking said.
The region’s test positivity was also the highest it’s been in the pandemic, though still just below or around the provincial average.
“So calculated today but reflective of about a week ago, our test positivity is at 18 per cent,” Bocking said. “There are some health unit jurisdictions seeing test positivity of 30 per cent or higher so I think the numbers we’re seeing across all of these indicators are consistent with what’s being seen across the province.”
Omicron spread indicated in past 14 days
Bocking said reports over the past two weeks reflected a period of time with a significant change in epidemiology as Omicron provincially became the dominant variant. In the past 14 days, she said nine people had been admitted to hospital, a significant increase over the past while in which few hospitalizations had been reported. At the time of the briefing, four people were currently admitted to intensive care units.
“Among those people that have had severe enough COVID-19 illness and admitted to hospital as a result of that – just to give you a sense because it’s often a hot topic and people ask – of those nine, one of those individuals was not vaccinated at all and the remaining eight had received two doses of vaccine,” Bocking said. “We know that two doses of COVID-19 vaccine is, while still providing some protection against severe illness, does not provide the same level of protection as it did for the Delta variant hence … the push and the emphasis on booster doses.”
Four of those requiring hospital admission are between the ages of 70 and 89, said Bocking, noting almost half of the hospital admissions are among the older age population. Two were among 50- to 69-year-olds and two were among 30-to-49-year-olds.
In the past 14 days, still the predominant age groups have been younger adults, 20 to 29 and 30 to 39. “Although we certainly are seeing more among older age cohorts as well,” Bocking said.
Those testing positive asked to tell close contacts
For the average community case, Bocking said the health unit is now not doing case management and contact tracing. The health unit’s focus is on high-risk settings and outbreaks.
“I think across the province there’s no health unit that has the capacity to do the case management and contact tracing – for us, we’re receiving more than 100 new cases per day,” she said.
Bocking said that for individuals that don’t have access to PCR testing, but who might test positive through a Rapid Antigen Test, there is no requirement to report that to public health and there’s no mechanism to do that.
“So if you’re an average community person, you don’t work at a hospital or a long-term care home and you are fully vaccinated and do not have another medical condition that is interfering with your immune response and you have symptoms consistent with COVID, or you test positive on a rapid antigen test, the direction is to isolate at home for five days. And not just you isolating at home, but everyone in your household is also required to isolate at home with you regardless of their vaccination status. That’s different than what it was about a month ago. If that person is not vaccinated or they have another medical problem … then the requirement is to isolate for a full 10 days.”
For those who test positive or suspect they have COVID-19, Bocking said it’s the “collective community ask, since public health units are no longer doing this, for them to reach out to anyone that they have been in close contact with in the 48-hours prior to when their symptoms started, and let them know, ‘now I’m sick and you should be watching for symptoms as well.’”
High-risk contacts that don’t live with the individual don’t need to isolate at home but are asked to self-monitor and really look for signs or symptoms.
Bocking said, “the guidance around this is continuing to evolve,” and resources on the HKPRD health unit website are up to date.
Getting a boost
The health unit is looking to add information about booster shot statistics to its dashboard information online.
At the time of the media briefing, Bocking said throughout the HKPRD region, 66 per cent of those 70 or older had received their booster shot, while just about 50 per cent of those aged 50 and older had received their booster shot, and 37.5 per cent of those 18 and older had received their booster dose.
Vaccination in 5- to 11-year-olds
Within the HKPRD region, 39 per cent of kids aged five to 11 had received one dose of their vaccine.
“It’s about average for health units across the province,” said Bocking. “I think that number is certainly much lower than where we would like it to be. We know that vaccination among this age group will significantly help to reduce broader community transmission and help overall to both, prevent illness among that age group and to help bring the broader transmission of COVID-19 in the community under control.”
Between now and Feb. 4, Bocking said there were 8,900 appointments open for the 5 to 11 age group.