Hospitalizations, deaths will follow Ontario's COVID-19 surge, but how many remains unclear

The fresh spike in new COVID-19 cases in Ontario is not yet bringing an equivalent spike in hospital patients or deaths from the coronavirus, but experts say it's too early to draw conclusions.  

Over the past week, as Premier Doug Ford and his government slapped new restrictions on private gatherings, Ontario reported an average of 335 new confirmed COVID-19 infections daily. That's triple the pace of the last week of August. 

So far, the rise in hospitalizations is nowhere near as steep. There were 65 patients with confirmed cases of COVID-19 in Ontario hospitals as of Monday. The hospitalization rate hit its low ebb in the third week of August, with a daily average of 38 patients in beds around the province.

However, hospitalizations and deaths are what epidemiologists call "lagging indicators" of the impact of a pandemic: you don't see those numbers rising until well after the infections were transmitted. 

"It's just unfortunately a matter of time," said Dr. Isaac Bogoch, infectious disease physician at Toronto General Hospital. 

"It takes weeks for those trends to start to be seen," he said in an interview with CBC News. "I don't think you need a crystal ball here to say, given that we've got a rise in cases in Ontario, there's going to be an expected rise in hospitalizations, and sadly, an expected rise in deaths associated with COVID-19."

Hospital officials in the Greater Toronto Area and Ottawa — the hot spots in the province's current surge — say they are seeing early signs of increasing admissions of people infected with the novel coronavirus. 

Still, the shift in the age of who's getting infected is one reason to hope that the impact of Ontario's current surge in COVID-19 cases could be less severe than the first wave. 

In the spring, the pandemic ripped through the province's long-term care homes and elderly population. In a span of just two months, it killed more than 2,000 people. More than 70 per cent of those who died by mid-May were aged 80 or older.  

Right now, more than half of Ontario's active cases — those considered to be infectious — are among people under the age of 40. Generally, younger age groups are less vulnerable to the most severe consequences of COVID-19, but not always. So far, just 12 Ontarians younger than 40 have died with a confirmed case of the virus. 

But that's no reason to take the current spike in cases casually, according to the experts. 

"The issue with this infection is that it's really, really contagious," said Bogoch. 

"It doesn't stay restricted to a single age cohort for long," he said. "Unfortunately, I think we're starting to see some early trends of this spreading beyond the 20-year-old age group and into older age groups."

Dr. Ian Brasg, an infectious disease physician at Humber River Hospital in Toronto, also warns against complacency about the current demographic trends in the COVID-19 pandemic in Ontario. 

"Are we going to see a spike in older age groups in a few weeks, based on who they're bubbling or sheltering with? That's my concern," he said in an interview with CBC News. 

Still, Brasg said he is hopeful that Ontario's current rise in COVID-19 infections will result in fewer deaths, so long as the province acts decisively. 

"A lot of that hope does stem from the much tighter controls that we have in our long-term care facilities, which were certainly a disproportionate source of deaths," said Brasg. "My hope is that, should those measures stand, we will be in a better position." 

However, he is concerned about the combination of fall weather forcing people to spend more time indoors, along with signs that many are letting up on physical distancing by coming in close, unmasked contact with wider circles of friends and acquaintances. 

"I worry about all of these things and worry that our current measures are not adequately addressing them," said Brasg. "It's sort of a perfect storm for increased caseload." 

Ontario's surging number of new coronavirus cases is indeed real, and not just a function of increased testing, as some skeptics have claimed. 

The province completed an average of around 25,600 tests per day in August. Over the past week, that average daily testing number was up by 32 per cent. 

The average number of confirmed new COVID-19 cases has accelerated far more quickly. 

On Sept. 1, the daily number of new cases (based on a five-day average) was running at 121. That doubled by Sept. 12. It tripled by Sept. 18. 

Another sign that has the medical community worried about what's to come is Ontario's rising test positivity rate. That's the percentage of people tested whose results show a confirmed case of COVID-19. 

Over the past week, the positivity rate was 0.99 per cent. That's double the rate of late August, and triple the rate of early August. 

The trends are behind the growing calls for the Ontario government to tighten pandemic measures.       

"These cases that we're seeing today were really acquired seven to 14 days ago. Any intervention that we have is going to take a minimum of 14 days before we start to see a change," said Bogoch.  

"This is like turning a cruise ship. It'll turn, but it's going to take a little bit of time before you change direction." 

At the peak of the spring wave of the pandemic, Ontario's hospitals had more than 1,000 patients with confirmed cases of COVID-19. By cancelling non-emergency surgeries, clearing beds of patients who could be accommodated outside acute care, and ramping up capacity, the hospital system was not overwhelmed. 

If the current spike brings a surge in admissions to wards and intensive care units, hospitals are ready, said Kevin Smith, the CEO of Toronto's University Hospital Network and an adviser to the provincial government on hospital capacity in the pandemic. 

However, he warns that extra demands on hospitals — such as deploying staff to help in long-term care and coronavirus testing — could have an impact. 

"It really depends on how well the rest of the [health-care] system is able to function," said Smith in an interview. 

"If hospitals were only expected to focus on what they normally do, which is acute care, then I think we're very well prepared," he said. "If though, they have to think about expanding their role beyond their traditional responsibilities, it's worrisome."