As provincial health officials say we have reached the peak of Ontario’s first wave of coronavirus cases, front-line workers in hospitals, clinics and long-term-care homes continue the relentless battle against infection.

From the growing number of people infected and dying, to the pressure placed on our intensive care units, as Premier Doug Ford said on Monday “there’s absolutely no way this fight is over.”

To give readers a sense of how Ontario is faring, we’ve chosen four data points that provide a snapshot of how the battle is playing out on various fronts and asked experts to give us their thoughts.

New Cases

There were 647 new cases of the virus reported between Sunday and Monday evenings, the largest 24-hour increase recorded in Ontario to date. With these new cases, there are now a total of 12,534 confirmed or probable cases of COVID-19 in Ontario, according to the Star’s survey of the province’s 34 public health units. Over the last six days, new cases of COVID-19 have grown at an average of about 5.5 per cent per day.

Todd Coleman, an epidemiologist and professor at Wilfrid Laurier University, cautions that new cases must be looked at in the context of who is being tested.

“Many of the asymptomatic people that we’ve been hearing about aren’t getting tested,” he said. “So any new confirmatory tests per day is always dependent on those patients who have had contact with the health care system. If there is a large proportion of people who can be asymptomatic, then the number of new cases reported every day is likely not a true reflection of what’s actually circulating in the population.”

Deaths

A total of 657 people have died from COVID-19 in Ontario as of Monday. This includes 47 new deaths reported since 5 p.m. Sunday. The average daily growth rate of deaths over the last five days is about 8 per cent.

Experts have warned not to read too much into these numbers, as they don’t reflect the whole picture of how different populations could react to the virus.

“We see for example, the critical cases tend to be the people who are older, so that could be a reflection of the outbreak happening in an older population,” explained Coleman, adding that the death rate is reflective of infections from a few weeks ago. Since it takes approximately five-and-a-half days for symptoms to appear, “it would be a little bit longer for symptoms to worsen (and) become critical, to hit that point where people are dying,” he said.

“If you want to make comparisons across space or over time to determine lethality…. you really have to control for differences between the ages and sexes” of the people affected by the virus, explained Sue Bondy, associate professor of epidemiology at the Dalla Lana School of Public Health. In a group of people that is young and healthy, there would be very few people dying of their illnesses, she said. But “if you have the same number of people who are elderly with a lot of medical consequences, then they don’t have as long a life expectancy and they’re much more vulnerable,” meaning their death rate is much higher.

GTA cases vs. rest of Ontario

The number of new cases in the GTA continues to rise while new infections outside the GTA are staying relatively constant. Outside the GTA, the province reached its peak of new daily cases on April 1, when there were 254 recorded cases. This daily number has declined slightly and has remained largely flat since. On the other hand, the GTA continues to have single-day highs of new cases.

As a point of comparison, the GTA recorded 473 new cases on Monday, while the rest of the province recorded 196.

Coleman says population density is a factor in the growth of GTA cases, meaning the probability of coming into contact with another person is higher. On top of that, because there are so many more cases of the virus in the GTA — the prevalence is higher — “that means the probability of coming into contact with an infected person is also higher.” He also stressed again that it’s important to remember that not everyone who might be carrying the virus is getting tested.

Hospitalizations

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On Monday, Public Health Ontario reported that there are 802 patients in hospital with COVID-19 as of April 18, the date for which the most recent data is available. Of those, 247 were in critical care, including 193 on ventilators.

But data from Critical Care Services Ontario, a provincial agency set up to help the health-care system better manage critical-care resources, shows that the number of people on ventilators since March 29 has remained relatively flat.

Coleman says this constant number suggests a dynamic situation in which people are both being put on ICUs at a similar rate that others are being taken off, either because they have recovered or died. “So you’ve got that constant flow happening,” he said. The data also shows that ventilator shortages are not currently an issue with about 80 per cent ventilator capacity remaining across the province’s health regions.

Beate Sander, a scientist at the University Health Network, said hospitals run close to 100 per cent ICU capacity in regular circumstances.

What is important to keep in mind, she said, is how many COVID-19 patients are in an ICU versus patients there for other reasons. “When COVID-19 started and we had the first patients … most hospitals stopped all kinds of different procedures and surgeries,” such as transplants or cardiac procedures. Since these procedures typically require a day or two in the ICU to recover, care beds were opened up to accommodate a potential influx of COVID-19 patients.

“Many of those services (have been) stopped completely or at least, scaled down quite substantially to open up beds for COVID-19 patients. And so what’s happening now is you basically don’t need all of those beds at this point in time, which is a good thing,” Sander said.