Experts point to ‘crucial’ week ahead after Ontario reports more than 1,000 infections on Sunday, a new all-time high

After Ontario reported its second consecutive record day for new COVID-19 infections Sunday, experts are pointing to the week ahead as a crucial" measuring stick for the province's second wave.

Ontario reported 1,042 new cases Sunday. The province's seven-day average for new infections - a better indicator of the overall trend than single-day numbers, experts say - also hit a new all-time high, now up to an average of 857 cases daily.

The totals suggest the second wave is getting worse, not better" in Ontario, said University Health Network infectious-disease specialist Dr. Abdu Sharkawy, adding there are other areas that are getting hotter," including Halton, where new restrictions are needed without delay."

Looking ahead, this week and the next week are going to be crucial" to gauging where Ontario's epidemic is headed, said Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto and Toronto General Hospital.

It's still too early to know whether modified Stage 2" restrictions in Toronto, Peel and Ottawa are slowing the virus's spread, he said.

We all have to take a deep breath in," he said, noting it can take two weeks for interventions to show up in case numbers. We won't see the first whiff of improvement until later this week ahead."

Sharkawy added the high weekend totals are almost certainly" a reflection of infections caught during Thanksgiving weekend get-togethers, adding Ontario saw similar increases about two weeks after Mother's Day and Labour Day.

In a statement, a spokesperson for Health Minister Christine Elliot said the provincial government is ready to take swift action as needed" to limit the spread of COVID-19.

It takes approximately two weeks for public health measures to show their full impact on the rates of COVID-19 transmission and other key criteria in communities," spokesperson Alexandra Hilkene wrote.

While today's data is concerning, the increase in cases may be the result of Thanksgiving gatherings. We continue to urge all Ontarians to do their part and not let their guard down by continuing to limit close contact and practice the public health measures that we know work and keep us safe."

Sunday was the first day in which Ontario's daily case total had surpassed 1,000. The previous record was set Saturday, with 978 cases.

The totals cap a week in which the province's reported totals have risen sharply despite a generally lower testing rate than earlier this month.

Locally, Ontario's hardest-hit regions continued to be responsible for the majority of new infections. The province reported another 309 cases in Toronto, 289 in Peel Region, 117 in York Region and 80 in Ottawa. Those four regions, the province's largest health units by population, are all currently in a modified Stage 2" over their high infection rate - York's restrictions came into force only last week.

In Toronto, the city's own long-term average also hit a new all-time high Sunday, up to 333 cases daily in the last week, according to the Star's count.

In a statement Sunday, the city's medical officer of health Eileen de Villa said current infection levels are exactly the reason we are urging people to limit contact as much as possible to people they live with."

It is still early days since the recent imposition of some limits on activities. It will take some more time to assess the success of these actions. In the meantime, I cannot stress enough how much rests on the decisions we make as individuals," she said.

If we limit our contact, keep our distance and wear our masks, we will contribute significantly to the ability to limit virus spread and that is the most important thing of all."

Mayor John Tory said he spoke to de Villa as well as Premier Doug Ford about the rising case numbers this weekend to coordinate our ongoing response."

We knew the recent public health interventions would take two to three weeks until we would start to see the benefits of such action and, just as importantly, for the effects of the Thanksgiving weekend to show," he said. Because of these factors, our public health officials have been warning that the numbers would get worse before they get better."

That is why we urged public health officials to provide advice on measures that would help stop the spread of COVID-19 in our community and why we urged the province to adopt those measures," Tory added.

I am still hopeful that some positive results from the interventions will begin to show themselves in the coming days, especially in light of the sacrifices being made by so many."

Meanwhile, the two other regions that may see new restrictions announced Monday also reported significant totals, with 52 new cases in Durham Region and 31 in Halton Region.

On Saturday, mayors from Halton and Durham lobbied against new restrictions for their regions, arguing instead for more targeted" measures.

I understand that everyone's health and well-being has to be the top concern. But I just don't think a return to Stage 2 is justified, based on the numbers," Mayor Dan Carter said in an interview Saturday. It would be devastating for the economy, especially in the restaurant industry."

As of Saturday evening, Durham and Halton had the sixth- and seventh-highest rate of new cases per capita in the province, at 35 and 34 cases per 100,000 people per week, respectively - less than half the population-adjusted rate in Toronto.

In the spring, Ontario's case average never exceeded 600 new cases daily. Because the province was testing much more narrowly at the time, experts say it's likely many relatively mild cases were not counted in the provincial data from the first wave.

Meanwhile, the province reported 38,769 tests were completed Saturday, down from more than 44,000 the day before.

According to the province's data, Ontario's labs were analyzing an average of around 45,000 COVID-19 tests daily earlier this month, just shy of a stated goal of around 50,000.

But testing rates have fallen since the province switched to appointment-only testing at local assessment centres, a move in part aimed at clearing a large backlog in uncompleted tests.

In the last seven days, the labs reported completing an average of nearly 36,000 tests daily.

Another seven deaths were reported Sunday; Ontario has now seen 3,093 people die in the pandemic.

On Saturday, Dr. Theresa Tam, Canada's chief public health officer, warned hospitalizations and deaths could rise in the coming weeks as the second wave continues.

The most severe outcomes tend to lag behind increased disease activity by one to several weeks, the concern is that we have yet to see the extent of severe impacts associated with the ongoing increase in COVID-19 disease activity," she wrote in a statement.

Looking ahead to the winter, Bogoch said he'll be closely watching whether infections start to grow rapidly in Ontario's vulnerable long-term care homes.

Those outbreaks were particularly deadly in the spring, and although nursing home infections are rising, they're not yet near the level of Ontario's first wave.

That drove our deaths," Bogoch said. If we can keep this out of long-term care homes we'll have done so much better."

With files from Josh Rubin and Sara Mojtehedzadeh

Ed Tubb is an assignment editor and a contributor focused on crime and justice for the Star. He is based in Toronto. Follow him on Twitter: @edtubb