Overwhelmed, Hamilton no longer collecting data on hardest hit by COVID-19; more restrictions coming

COVID-19 is spreading so fast in Hamilton that public health can't keep up and has stopped collecting key information about who is hit hardest by the pandemic.

That is concerning," Coun. Maureen Wilson said at the city's board of health meeting Monday. In the absence of that ongoing data, I'm really at a loss on how it's going to inform ... the kind of rigorous public policy and public health debates I think we should be responsible for having."

The city reported 155 new cases of COVID-19 on the same day Ontario's associate medical officer of health raised alarm about widespread transmission in Ontario that should make everyone worried, take notice and take assertive action."

The numbers we are seeing are scary," said Dr. Barbara Yaffe. Urgent action is required to address these worsening trends."

Hamilton had a record 110 COVID patients in hospital on Monday - 80 at Hamilton Health Sciences and 30 at St. Joseph's Healthcare.

The city reported two more deaths to bring Hamilton's pandemic death toll to 202. One of the new deaths is at the Meadows long-term-care home, bringing the death toll at the home to three. It's not clear if the other death is connected to an outbreak. One of the people who died was older than 80. The other was in their 70s.

Our hospitalizations and ICU patients remain at record levels and the number of people who have lost their lives remains unbearably high," said Yaffe. In fact, COVID-19 morbidity and mortality are at the highest levels we've seen since the start of the pandemic and our hospital and ICU capacity are under increasing pressure and strain."

Yaffe confirmed Ontario is not getting a curfew, but said new restrictions will be announced Tuesday when the province releases updated projections.

We are in a serious situation and serious measures need to be done," she said. The bottom line is people know what they should be doing ... It's a shame we have to wait for government to force them into doing the right thing."

Yaffe says roughly one in three people in Ontario are not following the public health rules. Hamilton has information that suggests the rate could be higher here.

We know ... from purchasing additional data ... that we do have higher levels of mobility in Hamilton," Dr. Elizabeth Richardson said at the board of health meeting. We're on the upper end of that scale for whatever reason."

Richardson has not ruled out putting in additional measures above and beyond what the province announces Tuesday.

I'm not sure how many more municipal levers there are," said Richardson. The municipality could decide to move forward with some additional pieces in order to ... close particular loopholes."

Richardson spoke strongly Monday about the need for sick pay and paid medical leave, saying they are key barriers to people following public health rules. Mayors and chairs from the 11 largest municipal governments across the Greater Toronto and Hamilton Area also demanded action on sick pay.

There are certainly things that prevent people from being able to ... reduce the level of risky behaviours," said Richardson. A lot of those things are about sick policy, they're about leaves ... they are about having to have multiple jobs in order to make a living ... Those other policy issues need to be addressed."

She also said public health is running into issues with people feeling stigmatized and not wanting their diagnosis to be known by friends or co-workers who need to quarantine.

We have a problem there," said Richardson. We're finding people don't want to tell us ... because they don't want everybody to know."

The hesitancy makes a tough job even harder as public health is already stretched to the limit with Hamilton's 1,490 active cases.

The per cent of COVID tests coming back positive hit 6.0 per cent Jan 11.

Richardson says it takes about three hours to investigate each case plus more time to reach out to contacts and follow those people over a 14-day period.

Public health has tried to ramp up - the federal and provincial governments have provided 33 contact tracers and 11 case management staff on top of the 21 public health nurses and two leaders it added in late December. Hamilton has 263 public health staff and eight other city workers on COVID with many putting in very significant" amounts of overtime - working 12 hours a day and seven days a week.

It's not even enough to make contact with half of newly reported cases within one day, with between 31 per cent and 49 per cent of cases between Dec. 25 and Jan 8 meeting that threshold.

Case management and contact tracing is becoming such an issue Ontario-wide that Richardson says the province is putting together a set of expectations for minimum requirements.

We're doing the best we can but we're not able to get to all," she said. Our approach to case and contact management has been revised to focus on areas where we can have the greatest impact."

Currently public health makes sure cases are isolating and reach out to contacts at highest risk.

This does mean that we are not collecting the extent of data that we once were," she said. A number of the social determinants such as place of residence ... do routinely get collected ... It's the added questions that were being asked, for example about racial background, ethnic background ... that are not being asked."

It's significant considering a past report on the social determinants of health have found wide disparities by race and income in those hardest hit by COVID-19.

Richardson said she can't commit to ever collecting the missing data.

It may be very difficult to follow up with those cases," she said. It's simply a matter of health human resources and ultimately whether people will want and be able to follow-up ... months to years after the fact."

Public health is also no longer able to determine trends in how people became infected with the virus.

In terms of the proportion of cases that are community acquired versus contact related this is part of the data ... that we are no longer able to collect in a timely enough way to comment on that and track that," said Richardson.

She described a steep increase in the number of new cases per week to 160 per 100,000 population in Hamilton - from 40 in November and 100 in the middle of December.

So far in the second wave, less than one-quarter of Hamilton cases have been in outbreaks - 1,439 of 6,213 infections. Nearly two-thirds of outbreak cases were in seniors' home.

In contrast, outbreaks account for nearly 89 per cent of the death toll - 127 of 143 deaths. Of those 127 outbreak deaths, the vast majority - 115 of them - were in seniors' homes. One death was in a workplace and 11 were from hospital outbreaks.

Those aged 20 to 29 have made up the biggest proportion of cases throughout the second wave in Hamilton. But the province says the numbers in children are starting to creep up with Yaffe describing as many as 20 per cent of tests coming back positive for those aged 12 to 13.

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com