A little more than a year ago, the province released sobering statistics about how many people might die as a result of COVID-19, which was then relatively new and poorly understood.
The estimate was 3,000 to 15,000 over two years. Extrapolating from those figures, Toronto’s medical officer of health, Dr. Eileen de Villa, said Toronto could expect to see between 600 and 3,000 deaths.
On Saturday, Toronto hit the terrible marker of 3,011 dead.
“There’s no excuse for us to be in this position,” said Dr. Lisa Salamon-Switzman, an emergency physician who works at Scarborough Health Network.
“This was preventable.”
Salamon-Switzman blames the provincial decision to loosen restrictions in many public health units in February for fuelling the most recent wave of illness.
The third wave has been marked by the rapid spread of more transmissible and virulent variants of the virus.
But variant transmissions alone didn’t get us here, she said.
“We knew about the variants — we knew it was a different beast.”
It wasn’t just Ontario — leaders in countries around the world seemed inured to the warnings from doctors and scientists that the variants of concern spread more quickly and result in more serious illness, said Dr. Peter Juni, the scientific director of Ontario’s COVID-19 Science Advisory Table since July.
Juni feels that experts did their best to make politicians understand that the variants of concern were fundamentally different.
“Many, many politicians internationally struggled with the inconvenient truth here, that we’re talking about a much more transmissible variant that also includes a higher severity of disease,” said Juni.
“The challenge is, there is always this belief that what works before, also will work again.”
Juni said Ontario fared well relative to many other Western nations during the first and second waves of the pandemic. But not Wave 3 — Juni nearly resigned from the table in protest last week, after Premier Doug Ford announced measures to control the spread of the virus, including closing playgrounds, that were not rooted in science, while failing to move on measures that experts believe could decrease transmission — including paid sick days for workers.
Ford has blamed vaccine supply issues for the current crisis, which has seen acute care beds in hospitals in Toronto fill up; Sick Kids hospital admit adults to ICU, and dozens of patients a day ferried by ambulance, helicopter and plane to hospitals outside the city.
In an alarming new trend revealed by Ontario’s chief coroner on Thursday, an average of two people a day have been dying at home within the past two weeks because with the variants, symptoms can progress much more quickly. People don’t even have time to get to the hospital.
This third wave in Ontario, is “probably at (its) peak right now,” according to epidemiologist Dr. David Fisman.
“The difficulty with that is that communicable disease systems are governed by human behaviour which can change based on risk perception,” Fisman said. “So if people say ‘yay, it’s over,’ that’s likely to precipitate a future surge. What I can say is that based on current dynamics I would anticipate that this wave has about 40 days left to go, if we continue on as we are now.”
Fisman added that more young people have been infected during this wave. The good news is that while the Spanish Flu included a fourth wave, that’s unlikely to happen here, now that vaccines are being administered.
“We’re very lucky with the vaccine,” said Fisman.
The hope is that vaccines — the city hit one million shots delivered on Friday — will continue to have a positive impact. The vaccine program has already kept more of the elderly who are in institutional settings — nearly all of whom have been vaccinated — from becoming infected in the third wave.
Whereas it was common to see husbands and wives admitted to hospital together in the first wave, now it’s mothers and daughters, said Salamon-Switzman.
Toronto has borne more than its share of deaths in the province. It comprises about 20 per cent of the province’s population and has recorded 38 per cent of the deaths, which total nearly 8,000 across the province.
“These are fellow Torontonians and they all have relatives and family and coworkers and friends that were left behind,” Mayor John Tory said Thursday.
He said he was horrified by the estimates when they were made a year ago, and he’s horrified by the numbers of deaths that have been posted since, but he points out that a year ago, the situation was much different.
“At that time, the variants were unknown to us, and I think they have proven to be something that seems to get people sicker, faster and more easily,” said Tory. “We had never heard of the variants last spring and nobody knew that. I think that is a major factor in all of this.”
The first wave decimated long-term-care homes and brought the number of dead to 1,000 by June 18, just 89 days after the Toronto’s first death was reported on March 22.
The deaths were overwhelmingly among seniors: more than 95 per cent of victims were over the age of 60. More than 80 per cent of the deaths resulted from outbreaks in health-care settings, including long-term-care homes. Only one death of a person under 40 was reported in the first wave.
By the end of the July, Toronto reopened most businesses and public spaces, and something approaching normal life began. People congregated on outdoor patios.
The worst was yet to come.
It took another 203 days before Toronto reported its 2,000th death on Jan. 7, 2021, near the peak of infections at the top of the city’s deadly Wave 2.
Those second 1,000 deaths came slowly then all at once — much like the second wave itself. For a stretch of several months, fewer and fewer people were dying each day in the city until about October, when the virus began tearing through nursing homes again.
By early January, Toronto was in the thick of it. Cases were as high as they ever got in Wave 2, but the death rate was still climbing and wouldn’t peak for another week.
A vaccination program in long-term-care homes was underway, but it wasn’t yet having a significant impact on who was dying from COVID-19. As in Wave 1, the second 1,000 deaths were overwhelmingly seniors. Again, more than 95 per cent were people over 60, with most deaths still happening as a result of outbreaks at institutions.
It took another to reach the tragic milestone of 3,000 deaths in Toronto — from the deadliest days of Wave 2, to an improvement in February, to the swift rise of Wave 3, fuelled by the more-transmissible variants of concern.
The deaths since January highlight the impact of vaccinations. The vast majority of Toronto’s third 1,000 deaths were still seniors, but the source of infection changed somewhat. There were relatively fewer deaths among those 90-plus, a significant proportion of whom are in long-term-care homes.
The source of infection was moving from nursing homes into the community.
Less than 10 per cent of Toronto’s first 1,000 deaths were due to infections acquired in the community. Among the third, that number is slightly more than 35 per cent.
More younger people are dying, too, although the overall total remains relatively low. There were four deaths in Toronto among patients under 40 from the start of the pandemic to mid-January. There have been 12 since.
“The first wave was, as a geriatrician, extraordinarily traumatic, watching people you care for being neglected and having this horrific tragedy in long-term-care homes,” said Dr. Nathan Stall, a staff geriatrician at Sinai Health Systems and a member of the Ontario COVID-19 Science Advisory Table.
“The second wave was unforgivable, what we did to long-term-care residents, because we knew better.
“This third wave is just so shameful — blowing through every single stop sign and warning sign that were erected by scientists, physicians, citizens, advocacy groups.”
Family physician Dr. Jennifer Kwan, who has been using charts and data to inform the public about COVID-19, said much could have been different had officials followed the recommendations being made by scientists and doctors.
“Instead, painful cycles of ineffective half-measures were implemented, which led to exacerbating and prolonging the economic damage and health consequences,” said Kwan.
“How many deaths should we now prepare ourselves for in Toronto and across the province? I can’t predict this — would need modellers to do this. But regardless, the answer would be ‘too many,’ and mostly preventable.”
Salamon-Switzman says one only need look at the number of ICU beds that are occupied to understand how many more people may die. She’s always hated using ICU beds as a metric. Because each bed to her is a person, fighting for their life against COVID-19, a fate that at this point in the pandemic, could have been avoided.
Never did she think we’d be in a wave like this, so late in the game.
“If you asked me, back in March last year, I thought that maybe by now, we’d be still wearing masks, but we would be back to living somewhat normally.
“I didn’t think we’d be back in complete lockdown-at-home orders: no school, back to home-schooling. This is worse than last year.”