COVID-19 Windsor and Essex County: March 20, 2020 to May 15, 2020

Purpose

• Providing an epidemiologic summary of COVID-19 activity in Windsor and Essex County (WEC) to date

Source

• Windsor-Essex County Health Unit, Infectious Disease Prevention (IDP) database, extracted by Windsor-Essex County Health Unit [2020/05/14].

• Ontario Ministry of Health, integrated Public Health Information System (iPHIS) database, extracted by Windsor-Essex County Health Unit [2020/05/14].

• Ontario Agency for Health Protection and Promotion (Public Health Ontario). Epidemiologic Summary: COVID-19 in Ontario – January 15, 2020 to May 13, 2020). Toronto, ON: Queen’s Printer for Ontario; 2020.

Highlights

• At the time of reporting, there are 751 confirmed cases of COVID-19 in WEC between March 20th and May 14th.

• Overall, cases of COVID-19 in WEC continue to decrease. • The incident rate of COVID-19 in WEC is higher compared to Chatham-Kent, Lambton County

and the overall rate in Ontario. • Between May 5th and May 11th, approximately 3% of the tests on average returned as positive

for COVID-19 when tested for COVID-19. • Facility wide testing in 38 long-term care and retirement homes has indicated that 0.9% of

residents and 0.4% of staff were asymptomatic and positive for COVID-19. • The age of the cases range from 8 to 101 years with females accounting for approximately 57%

of all cases compared to approximately 42% in males. One percent of cases had an unknown sex o Among females, 24% of all female cases were among those 80 years or older o Among males, 19% of all male cases were among those between 20 to 29 years.

• Approximately 63% of the cases reside in the City of Windsor. • Currently, the majority of cases are due to close contacts with individuals that were positive for

COVID-19. • 28% of the confirmed COVID-19 cases are healthcare workers and of these 210 healthcare

workers, 26% of HCW reported travelled to Michigan prior to becoming ill. • Of the COVID-19 cases reporting a risk factor, 22% had a cardiovascular condition, 11% had

diabetes and 10% had asthma. • 37% of cases reported having either a chronic or underlying condition or being

immunocompromised. • Coughing 85% was the most commonly reported symptom among cases with COVID-19

reporting any symptoms followed by fatigue (63%), malaise (62%) and fever (61%). • Approximately 27% of cases are still in self-isolation while 52% of cases have resolved.

• Approximately 73% of the deaths have occurred in individuals 80 years or older. o 63% of the deaths were in females and 37% in males.

• The overall case fatality rate in WEC is 8.3%. When stratified by long-term care and retirement homes, the case fatality rate within long-term care and retirement homes is 16.4%.

• The trajectory of the doubling rate for COVID-19, since the first reported case, in Windsor is more than five days.

• The day-over-day doubling time has been increasing in Windsor-Essex, Ontario and Canada with the Windsor-Essex doubling time generally higher compared to the province and country since the middle of April.

• The mean R0 value is 0.86 indicating a decrease in community spread of COVID-19

May 15, 2020

COVID-19 Epidemiological SummaryContent covered:• Hospital Admissions based on syndromes• Epidemic curves

• By 1) Overall; 2) 3-day moving average; 3) Community vs. LTCH/RH• Regional & provincial rates• Percent positivity of COVID-19 tests• Symptomatic vs. Asymptomatic COVID-19 cases in LTCH/RH• Age & sex distribution• Distribution by municipality• Exposure history• Travel History• Healthcare worker status• Top medical risk factors• Symptoms• Hospitalizations• Outcomes• Breakdown by deaths• Doubling time• Mean R0

Hospital Admissions Based on Syndromes (asthma, influenza-like-illness, pneumonia, sepsis or suspect COVID)

2020-05-15

September 1st May 10th

Influenza peak in 2018/19 & 2019/20

4.5

5.5

6.5

7.5

8.5

9.5

10.5

11.5

12.5

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19

% o

f all

adm

issi

ons

Surveillance week

2018/19 2019/2020

Epidemic Curve by Symptom Onset Date

2020-05-15

0

5

10

15

20

25

30

# of

con

firm

ed C

OVI

D-19

cas

es

Symptom Onset Date

**illness that began during this time may not yet be reported**

Epidemic Curve by 3-Day Moving Average

2020-05-15

0

5

10

15

20

25

# of

con

firm

ed C

OVI

D-19

cas

es

Symptom onset date

**illness that began during this time may not yet be reported**

Epidemic Curve by Community vs. LTCH/RH by Symptom Onset Date

2020-05-15

0

5

10

15

20

25

30

# of

con

firm

ed C

OVI

D-19

cas

es

Community LTCH/RH

**illness that began during this time may not yet be reported**

**Alternative** Epidemic Curve by Community vs. LTCH/RH by Symptom Onset Date

2020-05-15

0

2

4

6

8

10

12

14

16

18

20

# of

con

firm

ed C

OVI

D-19

cas

es

Date

Community LTCH/RH

**illness that began during this time may not yet be reported**

Regional & Provincial Rates

2020-05-15

231

194 191175 172 168 163 161 154

12294 91 85 83

145

0

50

100

150

200

250

Rate

per

100

,000

pop

ulat

ion

Geography

Percent Positivity of People Tested for COVID-19

2020-05-15

0%

10%

20%

30%

40%

50%

60%

0

100

200

300

400

500

600

700

800

900

1000

% o

f tes

ts p

ositi

ve fo

r CO

VID-

19

Tota

l # o

f tes

ts

Date

Total Tests % of tests positive

Symptomatic Vs. Asymptomatic Positives

2020-05-15

1.7%

0.9%

2.1%

0.4%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Symptomatic Positive Asymptomatic Positive

% o

f tes

ts

Test Results*

Residents Staff

Age & Sex Distribution

2020-05-15

0 to 19years

20 to29

years

30 to39

years

40 to49

years

50 to59

years

60 to69

years

70 to79

years

80+years

Males 2% 19% 17% 14% 14% 11% 8% 15%Females 1% 16% 12% 14% 16% 11% 7% 24%

0%

5%

10%

15%

20%

25%

% o

f kno

wn

conf

irmed

cas

es

Distribution of COVID-19 Cases by Municipality

2020-05-15

Amherstburg3%

Essex3% Kingsville

12%

LaSalle3%

Lakeshore4%

Leamington9%

Tecumseh3%

Windsor63%

Exposure History by Reported Date

2020-05-15

0

10

20

30

40

50

60

# of

con

firm

ed C

OVI

D-19

cas

es

Reported Date

Travel Close Contact Community Transmission

COVID-19 Cases by Healthcare Worker

2020-05-15

55

15547

464

30

0

50

100

150

200

250

300

350

400

450

500

Healthcare worker Visited a healthcare facility

Not applicable Unknown

# of

con

firm

ed C

OVI

D-19

cas

es

Healthcare worker status

Travelled to Michigan

All other HCWs

Top Medical Risk Factors

2020-05-15

22%

11% 10%8% 7% 7% 6% 5%

3%

0%

5%

10%

15%

20%

25%

% o

f CO

VID-

19 c

ases

Top Medical Risk Factor

Underlying Health Conditions

2020-05-15

Chronic/ Underlying/

Immunocompromised37%

None63%

Most Common Symptoms

2020-05-15

85%

63% 62% 61%54%

44% 41% 40% 37% 35% 33%

0%10%20%30%40%50%60%70%80%90%

% o

f con

firm

ed C

OVI

D-19

cas

es

Symptom

Hospitalizations

2020-05-15

0

10

20

30

40

50

60

70

# of

con

firm

ed C

OVI

D-19

cas

es

Date

Hospitalizations ICU Field Hospital

Outcomes

2020-05-15

Resolved51.5%

Deceased8.3%

Self-isolating26.6%

Hospitalized3.1%

ICU0.4%

Unknown10.1%

Age & Sex Breakdown of COVID-19 Deaths

2020-05-15

0% 0% 0% 2% 3%8%

15%

73%

37%

63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

0 to 19years

20 to29

years

30 to39

years

40 to49

years

50 to59

years

60 to69

years

70 to79

years

80+years

Male Female

% o

f con

firm

ed C

OVI

D-19

dea

ths

Age Group & Sex

Case Fatality Rate

2020-05-15

3.2%

16.4%

8.3% 8.4%

31.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Community LTCH/RH Overall WEC Ontario OntarioLTCH/RH

Case

fata

lity

(%)

Setting

Doubling Time (Cumulative Comparison)

2020-05-15

1

10

100

1000

10000

100000

1000000

10000000

100000000

1000000000

Mar/20 Mar/28 Apr/05 Apr/13 Apr/21 Apr/29 May/07 May/15

Tota

l con

firm

ed c

ases

of C

OVI

D-19

Days Since First Case Reported

Doubling Time (Day over Day Comparison)

2020-05-15

1

10

100

28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May 9-May

Doub

ling

Tim

e (lo

g10)

Reported Date

ONT Doubling Time WECHU Doubling Time Canada Doubling Time

Mean R0

2020-05-15

0

0.5

1

1.5

2

2.5

3

Mea

n R0

Date of Symptom Onset

Summary• Case counts in Windsor-Essex continues to

decline even with increased testing• 2% of tests were positive for COVID-19 in the

past 7 days• Case-fatality rates are higher in long-term care

and retirement settings compared to the community

• Doubling time of cases is generally similar to the province and the country

• R0 < 1 signaling a decline in community spread

2020-05-15