More than 80 Toronto health-care facilities and shelters are experiencing outbreaks of COVID-19 as experts warn the city's daily new cases could continue to spike, even as the number of cases province-wide may be levelling off.

The latest available data from Toronto Public Health paints a stark picture of the pandemic's widespread reach in many of the city's densely-packed settings. At least 45 outbreaks are happening in long-term care facilities across the city, along with 14 retirement homes, 13 hospital settings, and nine shelters and respite sites.

"The more you hone in on Toronto, the worse it looks," said David Fisman, an epidemiologist with the University of Toronto's Dalla Lana School of Public Health. "It isn't moving around in the community; it's in institutions."

In total, 102 deaths — primarily in long-term care homes — and 1,000 cases have been reported at these Toronto sites so far, including 929 cases in health-care settings and 69 in the shelter system.

Those cases make up close to a third of the 3,000 infected individuals reported across the city — with Toronto's full case count roughly a third of all 9,500 or so cases reported across Ontario.

"As goes Toronto, so will the province," Fisman said. "In mathematical modelling, we talk about this place having a lot of gravity. It's like Jupiter; it impacts everything orbiting around it."

And so far, Fisman's modelling on new daily counts suggests while the province may be past its peak of cases — a so-called "flattening" of the modelling curve — Toronto still hasn't hit that point, and could see the number of confirmed infections continue to rise.

Testing may not stop 'carnage'

The city's role as the epicentre of the illness in Ontario isn't surprising given the Toronto's size and density, but Fisman stressed the ripple effect on other regions, like city-dwellers spreading the virus to cottage country, could continue to be detrimental to the province as a whole.

Like Fisman, Toronto medical officer of health Dr. Eileen De Villa also expects local case counts will tick upwards, but she attributes that likelihood to expanded provincial testing capturing more cases in shelters and long-term care homes.

"Things are absolutely improving here in Toronto, perhaps not exactly in the same trajectory as the rest of the province," she added.

Toronto Public Health defines outbreaks as a localized increase in an institution, or a specific ward or floor within an institution, in the rate of infection or illness, "above that which is expected."

While many outbreaks remain small, various facilities are experiencing crippling case counts and deaths.

One single long-term care home in the city, Eatonville Care Centre in Etobicoke, has been the scene of a staggering 111 confirmed cases and at least 30 deaths, according to the latest public health data.

Speaking to reporters on Friday, the province's associate medical officer of health Dr. Barbara Yaffe stressed the need for continued testing province-wide to identify cases as soon as possible, adding that's "exactly what's happening."

But Fisman said the latest widespread testing strategy won't stop the "carnage" in Toronto facilities.

Currently, the guidelines don't recommend automatic testing of every single person in long-term care or other congregate settings, instead focusing primarily on people with symptoms.

"It's like watching someone deal with a house that's on fire and say, 'I think we could really manage this by spraying water on just the left-hand side of the house,'" Fisman said.

A staff member at an Ontario long-term care home is wearing full personal protective equipment amid an outbreak among the residents. (Evan Mitsui/CBC)

Access to those tests for the city's large homeless population is also a key issue, according to one downtown Toronto emergency physician, who CBC News is not identifying as he isn't authorized to speak publicly by his employer.

While many people experiencing homelessness may have symptoms and fit the province's criteria to get tested, the physician said it's not provided directly within the city's shelter system — forcing a rising number of people experiencing homelessness to use downtown emergency rooms.

"It's taking at least a day for test results to come back, so they're sitting there for a day. There can be dozens," the physician said. "Emergency rooms in downtown are being kind of overwhelmed because there's no other place for isolation."

And in those tight, enclosed areas, he warned, there is a risk of people transmitting the virus to other patients and staff.

Toronto’s Eatonville long-term care home, pictured on April 13, 2020, is in the midst of a COVID-19 outbreak. (Evan Tsuyoshi Mitsui/CBC)

'It's a powder keg'

The city's board of health chair, Joe Cressy, said another key issue in Toronto has been the number of front-line health-care workers employed by multiple facilities.

"Long-term care homes, along with private and non-profit seniors' and retirement residences, are a hotbed for transmission and potential fatalities," he said. "We've known since day one it's a powder keg."

In mid-March, the city moved to ensure long-term care workers in 10 city-owned facilities picked a workplace of choice, while offering to move part-time workers up to full-time hours with wage enhancements, he said.

A recent similar provincial order limiting workers to one facility, Cressy added, came a "month too late."

Given the greater challenges faced by a large, dense place like Toronto, public health officials stress the city — and the province as a whole — need to maintain physical distancing measures to keep people apart.

"We are not out of the woods," Yaffe said.

"We have to keep doing what we're doing."