Northeastern Ontario has emerged as a COVID-19 hotspot in recent weeks: of the health units with the four highest case rates in the province, three are in the region. Algoma, Timiskaming, and the Sudbury and Manitoulin Districts are sitting at 282.26, 149.9, and 136.67 per 100,000 people — the provincial average is 46.63.
The sudden spread of the virus in the northeast is in contrast to previous waves, when urban centres such as Toronto, Ottawa, and Peel and York regions often saw the highest rates. TVO.org speaks with experts about the challenges facing these areas and what we do and don’t know about what’s driving the spread.
Throughout most of October, Sudbury’s active case count stayed well below 100, rising from 47 cases on October 7 to 69 cases on October 18. But by October 28, the number had climbed to 125. That day, Public Health Sudbury and Districts released a statement warning of a surge: “While the province of Ontario is seeing improvements in COVID-19 case counts, trends in Greater Sudbury are going in the opposite direction.” Public Health Sudbury & Districts had 189 active cases then, or a rate of 96.2 per 100,000. By November 8, there were 231 active cases.
Our journalism depends on you.
You can count on TVO to cover the stories others don’t—to fill the gaps in the ever-changing media landscape. But we can’t do this without you.
Since then, schools have been sites of new outbreaks in the region. Fifteen separate outbreaks were declared in school-related environments, including three bus lines — accounting for more than half of the total outbreaks declared in November. On November 26, the Sudbury Star reported that 99 of the 261 active cases in the region, or about 37.9 per cent of the cases within the health unit, were associated with schools. “We’re continuing to see cases throughout all settings and sectors (for example, social gatherings, workplaces and schools), and not one sector or setting is responsible for the recent surge in cases,” PHSD told TVO.org via email. As of December 2, there are 324 active cases within the unit.
For most of October, Algoma Public Health didn’t exceed 10 active cases in a given day. But from October 23 to 24, active cases went from 10 to 19. Case numbers rose significantly the next month: on November 12, the health unit issued warning of a surge after hitting 98 active cases. Six days later, active cases more than doubled, reaching 201. On November 30, there were 323 active cases — a rate of 285.6 per 100,000 people (the provincewide average was 46.9).
Public-health officials in the region have struggled to piece together how the spread occurred. “When we see cases rise and surge in any region, especially our own, everyone really wants to know: Why now? It will take a long time before we truly understand the dynamics of the transmission patterns that we’re seeing,” says Medical Officer of Health Jennifer Loo. Case rates in nearby northern Michigan have been high relative to those in Ontario: the week of November 16 to 22 saw seven-day case rates of 186.7 per 100,000 people in the state’s Upper Peninsula. Prior to the lifting of cross-border travel restrictions on November 8, Loo says, there were around 200 essential workers travelling to and from the United States daily: “Though we do always have a proportion of cases that are linked to international travel. That is not the majority of current cases at this present time.”
[embedded content]Agenda segment, November 19, 2021: What’s driving COVID cases in Sault Ste. Marie?
Throughout much of the pandemic, the Timiskaming district has gone untouched by COVID-19. In October, the daily case count never exceeded 10. The rise began November 15, when there were 15 cases, up from nine the previous day. On November 20, Timiskaming hit 29 active cases; the next day, the number soared to 46. On November 26, the number of cases peaked at 80 — a rate of 239.7 cases per 100,000 for the health unit. (That same day, the provincewide average was 39.07.)
Glenn Corneil, Timiskaming’s medical officer of health, says the health unit’s small population — 33,365 — is part of why case rates quickly swelled to some of the highest in the province. “For our case rates [per 100,000], with our population, you multiply [active cases] by three,” he says. Still, the health unit announced increased measures on November 23.
Corneil attributes the surge of cases to community spread: “Basically, we don’t know where the person acquires the infection. And the concern with that is it means there’s more [spread] going on the community than we’re aware of.” While there are four active outbreaks in the district, including two in schools, Corneil says they’re all “in the small size — of less than five to 10 cases right now.” But rising cases have also driven spread within households. “That’s where we tend to see vaccine breakthrough: when somebody has had prolonged close contact with a positive case. Most of the time with our families, the index case [who brought COVID-19 into the household] in that situation has been unvaccinated or ineligible to be vaccinated,” he says, noting that around 75 per cent of reported cases have come from unvaccinated or partially vaccinated people.
What’s being done?
All three health units have announced enhanced restrictions to try to control spread. Sudbury was the first to act: on October 28, the unit issued a class order mandating self-isolation for those who test positive, have symptoms, are awaiting testing, or are a close contact of a positive case. On November 8, it instituted a return to indoor-capacity limits, the enforcement of mask-wearing, and proof of vaccination for kids aged 12 and up in organized sports. Algoma followed suit on November 15 with a class order mandating self-isolation, a return to capacity limits, and proof of vaccination; Timiskaming did the same eight days later.
Amid the rise of cases in schools, the Sudbury unit issued a set of “strong recommendations” to organizations and businesses, including schools, on November 26. They include “symptom screening, increased hand hygiene, masking requirements, cohorting, enhanced ventilation and staff PPE requirements.” (Algoma has made similar recommendations.) The health unit has assigned a team of public-health nurses to schools and issued rapid-antigen tests for students and staff.
Although case rates in such health units as Algoma have been much higher than the provincial average was during the height of the third wave — when provincewide lockdowns were implemented — Loo says the key difference in the fourth wave has been the efficacy of the vaccines. “When Ontario was at 130 cases per 100,000, the province was in lockdown because there was a high risk of our hospitals getting overrun,” she says. “We are putting additional measures in place so that it doesn’t skyrocket higher and jeopardize our hospital capacity. But we continue to have schools and businesses open in the midst of these protective measures, because of, in large part, the protection of vaccines.”
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.
OTTAWA — While she has helped several migrant workers access abortion services in Canada, Evelyn Encalada Grez said one woman comes to mind.
“The migrant woman was so afraid of being found out that she needed to be taken by somebody else outside of the farm for a medical appointment,” said Encalada Grez, a transnational researcher and advocate for migrant workers who has been studying the subject for more than 20 years.
On the day she came to pick the woman up to bring her to Toronto to meet health-care workers who could perform the procedure, it was raining.
Because the woman was so worried about being seen, she met Encalada Grez far away from the farm in the Niagara region where she worked.
“When I met her in the designated place where we agreed to meet, she was soaking, soaking, soaking, and I’m like, ‘Why does it feel like I’m doing something wrong?’” Encalada Grez recalled.
“What if she didn’t have a friend or know anyone that does this type of grassroots work, what would have happened to her and her life?”
This experience is similar to many others Encalada Grez has had taking migrant workers to access an abortion. Moving in secrecy off farm property feels like organizing a heist.
Migrant women in Canada face profound barriers in accessing health care, especially when it comes to pregnancy. They often hide their pregnancies because if employers find out, they may send them home or refuse to hire them next season. Workers typically live on their employer’s property and lack the privacy to discreetly seek care. Many live in remote, rural areas where abortion access is already sparse and transportation is hard to come by. And they face the added challenge of being unable to receive health care in their first language.
Another major barrier is cost, said Elene Lam, executive director of Butterfly, an organization of sex workers, social, legal and health professionals that advocates for the rights of Asian and migrant sex workers.
The migrant workers Lam advocates for typically lack provincial health-care coverage, and are required to pay out of pocket, she said. Depending on the stage of pregnancy, that can cost anywhere between a few hundred dollars and up to $1,500.
While many migrant workers can access public health care, not all of them can, said Lindsay Larios, assistant professor at the University of Manitoba, who studies precarious migration and reproductive justice.
This can be a result of having to wait the three-month period after arrival, during which time they must rely on private insurance. To get it, their employers have to file paperwork that sometimes doesn’t get filed.
If they face issues with renewing work permits or visas, that can also mean a lapse in their immigration status.
When it comes to abortion, there is a lot of stigma around migrant workers having intimate or sexual relationships, said Larios.
She cited research that shows migrant workers are told by officials in their home countries or in Canada, or by their employers, that they should abstain from sexual relationships.
“Workers themselves feel that there’s a real risk to their job — for example, not being hired back the following year — if they are seen as problematic employees who are transgressing this accepted unofficial policy,” she said.
Despite the fact that the abortion pill, mifepristone, became available in Canada at the beginning of 2017, this has not necessarily translated into better access to abortion for migrant workers, said Larios and Lam.
The treatment, also known as medical abortion, can be done safely at home rather than requiring a trip to a clinic or hospital, but still requires a prescription from a doctor and costs hundreds of dollars if a patient has to pay out of pocket, Larios said.
Mohini Datta-Ray, executive director at Planned Parenthood Toronto, pointed out that medical abortion has very uncomfortable effects. It causes a lot of cramping, bleeding and pain, and is very debilitating for about a week or so, she said.
Given the few protections migrant workers have around their health, and how little it can take to deport them for an illness, disability or other scenario that makes them less valuable in the eyes of the employer, “it’s just not the solution that you would think at first glance, if you’re not in caught in this very impossible situation,” said Datta-Ray.
If the federal government cares about abortion access, it could grant “status for all,” a campaign to grant permanent residency for all temporary migrant workers and families with precarious legal status, said Frederique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.
Action Canada supports the call because it knows without that, people will continue to go without abortion, Chabot said.
Encalada Grez echoed this and added that the government must reform temporary foreign worker programs so that employees are not tied to one employer and can have the freedom to go elsewhere, reducing the likelihood of exploitation.
“We need to be more accountable to the people that Canada brings in,” she said.
The office of Carla Qualtrough, minister of employment and workforce development, has not yet responded to a request for comment.
This report by The Canadian Press was first published May 28, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
That’s what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she’d moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she’d planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.
Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.
By January, the 58-year-old had a distended stomach, looking — in her own words — “about nine months pregnant.” Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.
After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.
“It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel,” she said.
An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?
“Had I maybe been able to see the doctors earlier, I would not be in Stage 3,” she said. “I might have been a Stage 2.”
951,000 fewer cancer screenings in Ontario
More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic.
“We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont.
“We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival.”
One review of Ontario’s breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.
Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.
WATCH | Late-stage cancer being diagnosed in Canadian ERs:
Hospital emergency rooms are seeing a wave of patients being diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctors’ offices to close or pivot to virtual appointments, leading to fewer cancer screenings.
That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa,in a May commentary piece for the journal Canadian Family Physician.
“The impact of COVID-19 on cancer is far-reaching:screening backlogs, delayed workup of symptomatic patients and abnormal screening results, anddelays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person,” she wrote.
“It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to those cancers being diagnosed at a more advanced stage.
Tough accessing care in a ‘timely way’
The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance,suggests a paper published in the Journal of the Canadian Association of Gastroenterology.
“Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery,” said the study’s lead author, Dr. Catherine Forse, in a call with CBC News.
“In addition, we found that patients were more likely to have large tumours.”
In some cases — like Labrador-Summers’s situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.
Shuttered family physician offices, a shift to telemedicine, and some patients’ fears surrounding COVID-19 may all have played a role.
“It became harder for patients to access care and to access it in a timely way,” Hanna said.
“At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out.”
Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she’s now diagnosing more patients with serious cancers, including several just in the last few months.
“So previously, it may have been localized or something small, but now we’re actually seeing metastatic cancer that we’re diagnosing,” she explained.
Lessons for future pandemics
Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.
Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.
“It was an example of what happens when you don’t have the regular screening, or those wellness visits,” said the Toronto resident and mother of two.
“I most likely would have had earlier-stage cancer if it had been sooner.”
Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.
“We need to make sure that we’ve got enough capacity in our health system to be able to flex, and that’s what we really didn’t have going into this,” she said.
For Labrador-Summers, it’s hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she’d just met. Her mind raced with questions about the future and concerns for her family.
“My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn’t know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal,” she recalled.
“So again, I’m alone, trying to process all of this.”
A screening following Labrador-Summers’ surgery and chemotherapy treatment wound up finding more cancer.
The U.S. Centers for Disease Control and Prevention (CDC) on Friday published recommendations by its group of independent experts on a smallpox vaccine that limit its use to only people who work closely with viruses such as monkeypox.
The Jynneos vaccine, made by Bavarian Nordic, will be available for certain healthcare workers and laboratory personnel at a time when monkeypox infections has spread in Europe, United States and beyond.
The vaccine was approved in the United States in 2019 to prevent smallpox and monkeypox in high risk adults aged 18 and older.
CDC officials earlier this week said they were in the process of releasing some doses of the Jynneos vaccine for people in contact with known monkeypox patients.
Officials said there were over 100 million doses of an older smallpox vaccine called ACAM2000, made by Emergent BioSolutions , which has significant side effects.
Monkeypox is a mild viral infection that is endemic in certain parts of Africa, but the recent outbreak in countries where the virus doesn’t usually spread has raised concerns.
So far, there are about 300 confirmed or suspected cases in around 20 countries where the virus was not previously circulating. The World Health Organization has called for quick action from countries to contain the Monkeypox spread.
The CDC said its experts’ recommendations are meant for clinical laboratory personnel performing diagnostic tests for orthopoxviruses such as smallpox and monkeypox, laboratory people doing research on the viruses and healthcare workers who administer the ACAM2000 vaccine or care for patients infected with orthopoxviruses.
The publication of the vote by the CDC’s Advisory Committee on Immunization Practices, which took place in November last year, formalizes the recommendations.
Both ACAM2000 and Jynneos are available for prevention of orthopoxvirus infections among at-risk people, the CDC said on Friday. (Reporting by Manas Mishra and Amruta Khandekar in Bengaluru; Editing by Krishna Chandra Eluri and Shailesh Kuber)
Privacy & Cookies Policy
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.