Sunday, March 15, 2020

Toronto events come to a halt for COVID-19 Precautions

Update March 26: Ontario's virus growth rate is doubling approximately every 4 days, note New York doubles every 3 days. With 339 positive cases to date and community infection spreading, we should have about 100,000 infected people in Toronto by the end of April - a month ahead of my earlier prediction as the doubling rate is faster than the 6 day period used in the initial calculation. We will soon be able to know someone, or friends of someone we know that have been infected. Next stage might be a lock down as City parks and playgrounds were closed March 25.

Update March 16: Today, as part of the City of Toronto's ongoing response to COVID-19, Medical Officer of Health, Dr. Eileen de Villa is strongly recommending all bars, dine-in restaurants, nightclubs, and theatres close to further prevent the spread of COVID-19 effective 12:01 a.m., March 17, 2020. Also "We have recently seen a significant increase in cases of COVID-19, some of which are unlinked, and thus indicate community transmission. We continue to pursue rigorous investigations of these cases and their contacts." Community spread means that the possibility exists for exponential growth of infections. The most apt thing that I have seen on social media is the obvious connection between the recent lineups for limited supplies of toilet paper that will soon become lineups to get treatment in hospitals where limited beds, equipment, care and supplies are available. Given the choice I would gladly give up some of my tp.

Assuming that infected travelers have already come in from the US and other tourist destinations and not done a stellar job in self-isolation say, with a starting infected population of 200 people we would have 100,000 sick people by the end of May, over 1,000,000 people by the end of June and into the 70% of the population by the time the end of July comes around. The time is definitely now to quarantine Ontario and try to slow the spread of Covid-19. Forget about toilet paper, we have far worse things to contemplate now.

Back to original post............

This was the weekend that things changed in Toronto in response to the Novel Corona virus, COVID-19. Instead of just monitoring developments as the number of infected inched higher on a daily basis, with 63 in the city as of March 15, the City and the Province of Ontario have started closing things down and recommending the suspension of gatherings over 250 people. People went from worried to slightly panicked and thus the run on toilet paper, bleach and hand cleaner began: called the Great Toilet Paper Scare of 2020.

Starting Friday, March 13 the Ontario Minister of Education closed publicly-funded schools. The Government of Canada and Toronto's Chief Medical Officer of health both advised people to cancel nonessential travel outside of Canada. They have not closed public transit, or suggested you avoid public transit, but as of March 18 there will be significant service reductions on GO Transit. As of 12:01am Saturday, March 14 until April 5, 2020 the city has closed licensed childcare centres, March Break camps, programs and facilities. Travelers from outside Canada are requested to self-isolate for 14 days as people with no symptoms, including children, may have the virus and pass it on without anyone knowing.

Also closed are community and recreation centres, greenhouses and conservatories, arenas, pools, fitness centres, and ski hills, libraries, museum and galleries, civic centres, recreation centres, parks and Council and Committee meetings. You can check out affected city services on their webpage. Emergency services, TTC, garbage collection and water treatment, along with road maintenance will remain in service.

The challenge for Toronto, and indeed all of Canada, is to reduce the people exposed to the virus so that the amount of people that get sick at the same time is within the capabilities of our hospitals and health system - including our doctors, nurses and other support staff (see chart at top). This will also help to protect the most vulnerable people in our society like seniors and those with compromised immune systems.

With the recommended elimination of large public gatherings and city closures the dominoes of public and private events began to fall. Cancellations started right away with weekend events like The Home Show, Sugar Shack and the Saint Patrick Parade. Then events scheduled in the future started being cancelled - like next weeks Toronto Comicon. Now there remains very little open, you can't event go up the CN Tower, and post secondary schools are moving online. Companies are starting to ask employees to work from home where ever possible.

To educate myself I thought I would look up some things about the world's latest pandemic which can spread through close contact with infected individuals.

1. Can you spread the virus in the air? Yes, coughing and sneezing can spread small droplets. Can it live in the air? Yes, it can survive in the air for up to 3 hours. Can it live on surfaces? Yes, but this is not thought to be the main source of spread. How long will it live on other surfaces? Up to three days.

2. How fast does it spread? Doubling of the virus is happening approximately every six days with each person infecting approximately 2.28 people. Social isolation strategies can reduce the speed of the virus spread.

3. Is there Community Spread, or circulating locally in Toronto? Community spread means that instead of being infected by a known, sick traveler coming into Toronto, the infection source is unknown. As of March 15 the City of Toronto says "Currently, COVID-19 is not circulating locally in Toronto. However, given the global circumstances, Toronto Public Health is actively working with City and health partners to plan for the potential of local spread." It is now free range!!! See March 16 update above for the first indication of community spread. It is amazing what changes in one day during this historic time.

Looking at the numbers of confirmed positive cases in Toronto, which started as two in late January, 2020 and rose to 29 on March 12 and now, as of March 15 Toronto has 63 positive cases - if it was doubling each week then the cases would be around 256. New cases have been from people coming into Canada, or those close to the travelers. So the people must either be self-isolating or the confirmed cases are not adequately known - from people not going to the doctor, or tests not being done. In Ontario as of March 15 only 8,465 people have been tested. There are also quite a number of people in Toronto and the GTA who are awaiting results of the Covid-19 testing.

In America there is community spread and Canada and the US are very interdependent and have a large amount of people that travel between the countries. It seems only a matter of time before community spread starts in Toronto. Rumours that visitors at Canadian airports are not being medically screened suggest that the numbers infected with the virus will rapidly start to increase soon. The CDC in the United States has now recommended that any gathering over 50 people be cancelled for the next two months

4. Is it worse that the flu? Yes, Covid-19 has a death rate of 1.4 to 2.3, which means that it kills more that 14 times that of regular flu. From WHO-China after 5-6 days from infection about 80% of people will get mild to moderate disease, 13.8% will get severe diseases and 6.1% will get critical disease. Highest risk is skewed for older people (60 plus) and those with underlying health conditions.

Our World in Data graph showing symptoms of coronavirus

5. How many people will get the virus? 30 to 70% of people are expected to get the virus. In Toronto that means that potentially 890,000 to 2,030,000 people could be infected. That will be a lot of people (20% or 178,000 to 406,000) that may have to go to the hospital with stronger symptoms. Hospitals will get overloaded unless the numbers are brought down over time.

6. What can we do? From John Hopkins Medicine, "Practice Hand Hygiene and Respiratory Etiquette. If you do leave your home to go to a care facility, wear a mask so your coughs and sneezes are less likely to infect others. (Masks are NOT recommended for healthy people in the general population.). Wash your hands thoroughly (for at least 20 seconds) after sneezing, blowing your nose, coughing or using the bathroom, and before preparing or eating food. If you cough or sneeze, do so into the bend of your elbow, not your hand. Or use a tissue, and then throw it away immediately afterward. At home, clean often-touched surfaces such as doors and doorknobs, cabinet handles, bathroom hardware, tabletops, phones, tablets and keyboards regularly with disinfectant." Remember to stay calm, try things like counting your toilet paper rolls. Check out the Government of Canada page on being prepared.

7. How long will large gatherings and travel be stopped? Probably at least the two months that the CDC recommended even though Toronto is closing facilities and services for one month at this time. Hopefully by early summer the heat will reduce the spread of the virus and we can start to return to attending our favourite bars, restaurants, sports, concerts and other events.

The other challenge will be for people that have precarious employment, depend on tips, have low incomes and those that lack health insurance coverage. Plus it is likely that Canada will slip into a recession in 2020. We must try to get our society back to normal as fast as possible. Hopefully a vaccine will be available sometime in 2021 that can help us fight back against Covid-19. The vaccine is expected to take 18 months to produce, even as clinical trials will start in April of 2020.

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