We may be past the COVID-19 peak but we'll still see more cases

At the tail-end of Friday's conference call on the local COVID-19 situation, Ottawa's chief medical officer of health delivered some very welcome news.

"I do believe we're in the post-peak period when it comes to community-based infections," Dr. Vera Etches told reporters.

More than eight weeks after the city recorded its first official case of the coronavirus, we appear to be over the hump. And yet, in the days and possibly weeks to come, the numbers of positive cases in Ottawa will almost certainly increase.

So is Friday's revelation actually reason to celebrate? Sure who doesn't need a reason to celebrate these days? but we should do socautiously.

Institutional outbreaks have larger ramifications

First, it's important to note that Etches said we've reached the peak for community transmission cases only.

Until the end of March, those casesmade up most of the COVID-19 tally in Ottawa. And that makes sense, as many of the early positive cases were travel-related. As travel was more restricted, and we physically distanced ourselves from one another, the numbers began to level off.

Since early April, the vast majority of new cases have come from 25 institutions, including long-term care homes, some of which have been devastated by the illness.

Of the total 1,372 lab-confirmed cases as of Friday, 575 of them, or 42 per cent, are connected to institutions. Even more devastating is the fact that a whopping 84 per cent of the 76 Ottawans who've died from COVID-19 were residents in thesefacilities.

Outbreaks in long-term care aren't analogous to what's happening in the city at large, said Etches, "but you can't ignore what's happening at long-term care because if a lot of these homes have outbreaks, the source of infection goes back into the community."

In fact, reporters heard Friday that two residents at the city-run Peter D. Clark long-term care home who've tested positive contracted the coronavirus from an employee. Indeed, front-line workers are among the most likely community members to become ill with COVID-19 and, unknowingly, to spread it.

More testing, more cases

Second and this is also good news Ottawa Public Health (OPH) are testing more people.

Last weekend, 24 paramedics helped swab 1,700 residents and staff in nine of the worst-hit long-term care facilities in Ottawa. Plans are underway to test all other homes as well as in coming weeks, which will give officials a much better understanding of how much COVID-19 has spread in institutional settings.

But more testing also means there will likely be more positive cases reported.

Last Saturday, for example, OPH reported just 26 new cases. Then, after a weekend of increased testing in care homes, the number of new lab-confirmed cases shot up into the high 60s and 70s.

Residents over the age of 60 who have symptoms should get tested, OPH says

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Vera Etches, Ottawas chief medical officer of health, says anyone over the age of 60 who is experiencing symptoms should get tested at one of the citys assessment centres.

Etches also announced Friday anyone 60 or older with any symptoms that could be coronavirus-related can now be tested at one the city's assessment or care clinic centres.

The results will give officials a clearer picture of how many people actually have COVID-19 and help them track down close contacts of positive cases.But the expanded testing will also likely deliver more positive results that, in weeks past, we may not have known about.

Up until now, we've been told that if we had manageable symptoms and weren't health-care workers or in contact with someone who has already tested positive we should self-isolate at home. So the expanded criteria will very likely capture new cases that would have previously fallen through the cracks.

More weight on hospitalizations

So on the one hand, we may be past the community peak for COVID-19, but we also may see increased numbers of positive cases.

At the same time, the province says it'll look at lifting some physical distancing restrictions since new cases have been in the decline for at least a couple of weeks.

That's a lot of mixed messages.

In Ottawa, officials tend to put a bit more emphasis on the number of hospitalizations as opposed to confirmed cases to determine how COVID-19 is spreading, because it's a more constant measure.

"I still feel more confident in the models that are based on hospitalization," said Etches. "Hospitalizations are hard to fake. They are a true reflection of the burden of illness in the community, because a certain proportion of people are going to get ill enough to go to hospital, and that's not likely to change."

Dr. Doug Manuel, an epidemiologist and data scientist at The Ottawa Hospital Research Institute, led the city's COVID-19 modelling. He's urging his colleagues in the medical world for more timely and widespread use of hospitalization data to study the spread of COVID-19.

But Manuel says even current hospital statistics should be delved into more deeply.

For example, the current "census" data shows how many total patients with COVID-19 are in hospital at a certain time, when it might be more useful tracking trends on how manypatients are admitted each day a slight challenge, as people are often diagnosed well after being admitted.

And while the number of COVID-19 patients, including those in intensive care, had been in decline for more than a week, the graph edged back up on the weekend. Those extra hospital patients came largely from long-term care homes, according to public health officials.

Even with hospitalization data, experts will want to tease out the variables that will help them to better understand where the coronavirus spread is really happening.

Testing doesn't prevent illness

So how are we supposed to understand the myriad numbers and charts that will play such a big role in when we can see our family and friends, or hang out in the park?

It's complicated. If total number of positive cases increases, but hospitalizations decrease, we may be headed in the right direction. If hospitalizations continue to rise, that's a problem.

In addition to new cases and hospitalizations, officials will be watching for a fall in the number of cases that can't be traced to a source if most cases are traceable, it makes the illness far more containable.

Key to moving forward will also be monitoring what happens each time any restrictions are relaxed and moving quickly if the number of serious cases increases.

Testing is important because it's information, but it's also not needed to "prevent the transmission of infection," said Etches.

"What's necessary to stop transmission," she said, "is to stop people from interacting with each other."