A total of 190 people have died of COVID-19 in Toronto, and residents were warned on Tuesday that there will be a second wave of novel coronavirus infections in the city.

The city now has a total of 3,820 cases, which includes 3,462 confirmed and 358 classified as probable. A total of 223 people have recovered.

Of the total number of cases, 281 people are in hospital with 109 in intensive care units. The new total represents an increase of 138 cases since Monday.

Dr. Eileen de Villa, the city's medical officer of health, told reporters at a daily news briefing that the city needs to ensure its health care system remains strong because the system will have to manage the second wave.

"We know that we will experience another COVID-19 wave because we have yet to reach a high level of immunity in our community," she said.

"We will continue to see COVID-19 spreading in our community until we start to experience herd immunity. This will not happen until many people are infected with COVID-19 and recover and they build immunity that lasts, or we develop a vaccine."

De Villa, who presented a series of slides to show data about the disease in a larger context, noted that the trajectory of COVID-19 cases is lower in Toronto, Ontario and Canada than it is for such countries as Spain and the U.S., which have seen a large number of cases since outbreaks began.

The slide shows that the trajectory for cases of COVID-19 is lower for Toronto, Ontario and Canada than other countries such as Spain and the United States (City of Toronto)

"We believe, at this point, that the number of cases to date in Canada, Ontario and locally in Toronto is lower than originally forecasted. This is due in part to the strong public health measures that were put in place early in our outbreak and the fact that our residents took these measures seriously," she said.

"Thank you everyone for following the advice to stay home and practise physical distancing. I know it has been difficult but I hope you are now seeing the benefits of these actions."

De Villa added the city is currently in the "peak period" of its community outbreak, but how long that period will last remains a question.

"I use the term 'peak period' because a peak is really not just one day, nor is it one number, as the number of cases on any day during the peak will vary. The reality is that we will only know when we have hit our peak for COVID-19 cases after it has passed," she said.

The data shows the actual number of cases experienced in Toronto over time.

This slide shows the actual number of cases experienced in Toronto over time. (City of Toronto)

De Villa said data helps the city understand how it has used the resources of the healthcare system resources during the outbreak. The data also shows the curve currently flattening.

She added that the city can track the impact of the collective work being done to prevent the health care system from being overburdened. As the city moves down the curve, the data helps Toronto Public Health to plan and when to ease physical distancing measures, she said.

"It is critical that we ensure that we have healthcare resources and capacity in place to manage outbreaks we are seeing among vulnerable groups including our long-term care homes and shelter settings," she said.

The data shows the number of hospitalizations, intensive care unit admissions and deaths to date.

This slide shows how the city can now look back to understand what has happened in Toronto. It shows the number of hospitalizations, intensive care unit admissions and deaths to date. (City of Toronto)

The final slide, according to De Villa, shows the "tale of the two outbreaks" in the city.

De Villa noted that females represent about 60 per cent of the cases in long-term care homes, retirement homes, chronic care and hospital settings, a fact she attributed to females living on average longer than males and making up a larger proportion of the people in these settings. Women are also more likely to be employed in these places, she said.

De Villa said the city will continue to see COVID-19 spreading in its long-term care homes, which are experiencing their own distinct outbreaks.

"We should expect to see more cases in these settings," De Villa said.

(Toronto Public Health)

Two institutions, in particular, are recording significant outbreaks. Eatonville Care Centre, a privately run long-term care home in Etobicoke, has 144 cases and has recorded 34 deaths. Meanwhile, Willowdale Welcome Centre, a shelter for refugees in North York, has 110 positive cases.

City receives shipment of 3 million masks

Mayor John Tory says the city has received a shipment of three million surgical masks that will be used primarily in long-term care homes and shelters for people experiencing homelessness.

The city ordered the masks from AMG Medical Inc., a distributor based in Montreal, and the masks arrived in two shipments. The first shipment of one million arrived on April 17, while the final shipment of two million arrived on Tuesday.

"The new masks have been inspected and staff have confirmed masks are as ordered and have passed inspection," Tory said.

Before the city received the shipment, the city had enough surgical masks to last 52 days at the current consumption rate and 25 days in the worst case scenario. The new inventory means the city has about 127 days worth of stock at the current consumption rate and about 60 more days in the worst case scenario.

In a news release, the city said it continuing to look for suppliers of personal protective equipment (PPE).

"This new influx of PPE will ensure staff can continue to help the most vulnerable Torontonians in our shelters and long-term care facilities," the city said in a news release on Tuesday.

Toronto area could lose 355,000 jobs

In a joint statement, the mayors of municipalities in the Greater Toronto and Hamilton Area (GTHA) said it is estimated that the Toronto Census Metropolitan Area alone is projected to lose 355,000 jobs because of COVID-19.

An underground food court in downtown Toronto is closed during the pandemic. (Turgut Yeter/CBC)

That number represents 28 per cent of GDP, along with with $894 million in lost wages and $3.7 billion in revenue losses for businesses.

"This will be felt right across the GTHA but it also threatens the provincial and national economies," the mayors said in the statement.

Tory said the mayors and chairs met by video conference on Tuesday to discuss the impacts of COVID-19 on the region and how they can work together to get the economy restarted when the time comes.

Canada needs GTHA to recover economically, Tory says

Tory noted that the time will be determined not by politics, but by science and under the guidance of public health officials.

"A strong recovery right here in the GTHA is crucial to healing the economic damage done by COVID-19 and helping the families and businesses all governments have been working to protect throughout this emergency," the statement reads.

"Ontario's economy and Canada's economy need the GTHA to come back stronger than ever when the restart begins."

Today I met by video conference with the Mayors and Regional Chairs of the GTHA to discuss the impacts of <a href="https://twitter.com/hashtag/COVID19?src=hash&ref_src=twsrc%5Etfw">#COVID19</a> on the region and how our municipalities can work together on an a united regional economic restart and recovery. <a href="https://t.co/y5At92MHHk">pic.twitter.com/y5At92MHHk</a> —@JohnTory

Tory said the mayors and chairs agreed that they need to work together to reopen the economy, to share information about their respective financial positions and to explore ways to obtain financial support from other governments.



"A strong recovery needs strong cities and strong regions," Tory said.

5 decommissioned TTC buses to transport patients

The TTC and Toronto Paramedic Services, meanwhile, have repurposed five decommissioned TTC buses to transport ambulatory and stretcher-bound patients, including those on ventilators.

Each bus can transport three stretcher-bound patients, eight to ten ambulatory patients, depending on space needed for physical distancing, and three paramedics and a driver, the city said in a news release on Tuesday.

An inside look at a decommissioned TTC bus that has been turned into an emergency transport vehicle during the pandemic. (City of Toronto)

"The converted buses represent a key component of the city's contingency planning to support seamless, efficient, and timely patient care, while also providing important surge capacity during the COVID-19 pandemic," the city said.

Crews completed modifications to three vehicles on Monday and the city said the emergency transport buses will soon be on the road, responding to calls as needed. Modifications to two more buses are underway.

TTC bus drivers will drive the vehicles, while paramedics will tend to the needs of patients.

"I am extremely proud of the innovation and cooperation across our city government to fight COVID-19," Tory said.