Canada

Why experts aren't declaring victory yet despite fewer COVID-19 deaths so far in Ontario's 2nd wave

As Ontario's daily COVID-19 case counts have risen this fall, those with an eye on the data may see reason for optimism in the lower numbers of deaths. 

In the spring, the province experienced a wave of fatalities. Typically, there were between 20 and 60 reported deaths a day. By mid-May, nearly 2,000 Ontarians had died. 

Since cases began rising again in September, the daily number of people dying from COVID-19 has been noticeably lower in comparison, ranging between one and 10 per day. 

"There's a definite trend towards improvement, but with a caveat," Dr. Nathan Stall, a geriatrician at Sinai Health in Toronto, told CBC News. "We haven't observed where that trend is going to end up."

Health officials in Ontario are also registering some concern, pointing out a recent increase in long-term care home deaths despite an overall projection of slowing growth in novel coronavirus cases.

Although it's too soon to tell what the impact of the second wave will ultimately be, Stall said, he and other experts have some theories about what's behind the fall data to this point — and what could be coming next.

Learning about the virus

In the beginning of the pandemic, hospitals were "taken unaware," said Dr. Amol Verma, a physician and scientist at St. Michael's Hospital in Toronto. "There was a lot of chaos."

Over eight months, Verma said, he and his colleagues have learned to detect the virus earlier and treat it more effectively.

A pharmacist displays an ampoule of Dexamethasone at the Erasme Hospital in Brussels, Belgium. Dexamethasone is one of several corticosteroids found to improve survival rates of COVID-19 patients sick enough to be in intensive care. (Yves Herman/Reuters)

During the summer, steroids emerged as a fruitful treatment, he said. COVID-19 patients are also more likely to get supplemental oxygen sooner, which can have a "life-saving benefit," he said.

"Someone who gets COVID-19 today is more likely to survive and have a better outcome than someone who got COVID-19 in the spring."

Widespread testing, younger patients 

The segments of the population that are contracting the virus right now may be even more important to the lower death numbers, Verma said.

In the most recent provincial data, from Thursday, more than half of new cases were among people under 40 — carrying on a trend seen for several months.

"It's infecting younger, healthier people right now," he said. "And we're testing more than in the spring."

Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, agrees those are critical factors. 

WATCH |Fewer people are dying during second wave, but that might not last, experts warn: 

Epidemiologist Raywat Deonandan says we are seeing a reduced number of COVID-19 deaths during the second wave because the long-term care population is better protected, but he warns that is starting to change.

But that may be where the good news ends. 

Deonandan said that COVID-19 comes with a built-in "lagging issue," in that it takes time for the virus to develop and get worse and then to spread from younger to older populations.  

"It may just be a matter of waiting," he said. "Wait a few weeks and the death rates might rise."

Long-term care residents remain at risk

That's exactly the concern of Stall, the Sinai Health geriatrician — especially when it comes to Ontario's still vulnerable long-term care homes.

Although there have been improvements since the spring's devastating outbreaks — when such issues as insufficient knowledge and lack of personal protective equipment hastened the spread of the virus — Stall said problems such as crowding and under-staffing continue to pose a threat.

"For long-term care, it's not possible that we could do worse than we did the first time around. It's really hard to imagine that," he said.

A chart indicating the number of COVID-19 deaths per day in Ontario. The sudden spike in early October consists of previously unreported deaths from the spring and summer that turned up in a data review conducted by the province. (Ontario Public Health)

Ontario's newest numbers, released on Thursday, show that the risk for long-term care residents remains.

In Thursday's update, Dr. Adalsteinn Brown, who is advising the province on its pandemic response, said deaths in long-term care homes are increasing sharply.

"We have more [long-term care] deaths in the last week — 27 — than we did between the entire period between Aug. 15 and Oct. 8," he said. 

Little 'wiggle room' in hospitals

If more people become critically ill with the virus, doctors such as Stall and Verma are also warning that Ontario hospitals may be less equipped to receive them than in the spring — and less able to help out if long-term care homes are once again plunged into crisis.

In the first wave of the virus, hospital capacity was created by putting off surgeries and other treatments. Many people also refrained from visiting hospital emergency rooms.

Now, Stall said, Ontario hospitals are once again running at between 80 and 100 per cent capacity, and surgeries have resumed. The upcoming flu season could increase the strain even further, doctors are warning.

"We have very little wiggle room," Stall said.

"The system has to eat all of these cases at some point," he said. "I don't know many people who are declaring victory. And I would be very cautious to do so."

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