[Cambridge Journal of Regions, Economy and Society, 23 November 2022]

In recent months, more studies are emerging regarding how various nations and regions fared during the initial two years of the COVID-19 pandemic. Canada is cited as an example of a country that had performed reasonably well versus other countries with comparable infrastructures and health care systems (Razek et al., 2022). The reason is largely attributed to a combination of several public health measures coupled with widespread vaccination uptake, as a result of a country-wide vaccination campaign. This paper is based on a keynote talk given at the Autumn 2021 CJRES Annual Conference, by Dr. Isaac I. Bogoch. Dr Bogoch is an Associate Professor in the Department of Medicine at the University of Toronto, and an Infectious Diseases Consultant in the Division of Infectious Diseases at the Toronto General Hospital. Dr. Bogoch was a member of Ontario’s Vaccine Distribution Taskforce, which helped guide vaccine policy during the initial rollout of COVID-19 vaccines between December 2020 through August 2021. Dr. Bogoch explains the unique vaccine policy in the Province of Ontario and in particular the social innovation around prioritising the most vulnerable and disadvantaged neighbourhoods first, thus leading to an important intra-regional social policy view of vaccine efforts on the path beyond the ‘emergency phase’ of the COVID-19 pandemic. What is clearly obvious from his presentation is the heightened role of urban geography tools and techniques and intra-regional policy in vaccine equity efforts. Policy lessons learned in Ontario may help us sort out future urban, social, economic, epidemiologic and public health challenges and their sometimes-complex intersections in regions, economy and society.

Citerank: (11) 679746Steini BrownProfessor and Dean of the Dalla Lana School of Public Health at the University of Toronto.10019D3ABAB, 679755Ashleigh TuiteAshleigh Tuite is an Assistant Professor in the Epidemiology Division at the Dalla Lana School of Public Health at the University of Toronto.10019D3ABAB, 679757Beate SanderCanada Research Chair in Economics of Infectious Diseases and Director, Health Modeling & Health Economics and Population Health Economics Research at THETA (Toronto Health Economics and Technology Assessment Collaborative).10019D3ABAB, 679777David FismanI am a Professor in the Division of Epidemiology at Division of Epidemiology, Dalla Lana School of Public Health at the University of Toronto. I am a Full Member of the School of Graduate Studies. I also have cross-appointments at the Institute of Health Policy, Management and Evaluation and the Department of Medicine, Faculty of Medicine. I serve as a Consultant in Infectious Diseases at the University Health Network.10019D3ABAB, 679893Kumar MurtyProfessor Kumar Murty is in the Department of Mathematics at the University of Toronto. His research fields are Analytic Number Theory, Algebraic Number Theory, Arithmetic Algebraic Geometry and Information Security. He is the founder of the GANITA lab, co-founder of Prata Technologies and PerfectCloud. His interest in mathematics ranges from the pure study of the subject to its applications in data and information security.10019D3ABAB, 685230Doug ManuelDr. Manuel is a Medical Doctor with a Masters in Epidemiology and Royal College specialization in Public Health and Preventive Medicine. He is a Senior Scientist in the Clinical Epidemiology Program at Ottawa Hospital Research Institute, and a Professor in the Departments of Family Medicine and Epidemiology and Community Medicine.10019D3ABAB, 685420Hospitals16289D5D4, 701020CANMOD – PublicationsPublications by CANMOD Members144B5ACA0, 701037MfPH – Publications144B5ACA0, 704045Covid-19859FDEF6, 715390Mortality859FDEF6

[Science Briefs of the Ontario COVID-19 Science Advisory Table, 29 March 2021]

Background: As of March 28, 2021 new variants of concern (VOCs) account for 67% of all Ontario SARS-CoV-2 infections. The B.1.1.7 variant originally detected in Kent, United Kingdom accounts for more than 90% of all VOCs in Ontario, with emerging evidence that it is both more transmissible and virulent.

Questions: What are the risks of COVID-19 hospitalization, ICU admission and death caused by VOCs as compared with the early variants of SARS-CoV-2?

What is the early impact of new VOCs on Ontario’s healthcare system?

Findings: A retrospective cohort study of 26,314 people in Ontario testing positive for SARS-CoV-2 between February 7 and March 11, 2021, showed that 9,395 people (35.7%) infected with VOCs had a 62% relative increase in COVID-19 hospitalizations (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.41 to 1.87), a 114% relative increase in ICU admissions (OR 2.14, 95% CI 1.52 to 3.02), and a 40% relative increase in COVID-19 deaths (OR 1.40, 95% CI 1.01 to 1.94), after adjusting for age, sex and comorbidities.

A meta-analysis including the Ontario cohort study and additional cohort studies in the United Kingdom and Denmark showed that people infected with VOCs had a 63% higher risk of hospitalization (RR 1.63, 95% CI 1.44 to 1.83), a doubling of the risk of ICU admission (RR 2.03, 95% CI 1.69 to 2.45), and a 56% higher risk of all-cause death (RR 1.56, 95% CI 1.30 to 1.87). Estimates observed in different studies and regions were completely consistent, and the B.1.1.7 variant was dominant in all three jurisdictions over the study periods.

The number of people hospitalized with COVID-19 on March 28, 2021, is 21% higher than at the start of the province-wide lockdown during the second wave on December 26, 2020, while ICU occupancy is 28% higher.

Between December 14 to 20, 2020, there were 149 new admissions to ICU; people aged 59 years and younger accounted for 30% of admissions. Between March 15, 2021 and March 21, 2021, there were 157 new admissions to ICU; people aged 59 years and younger accounted for 46% of admissions.

Interpretation: The new VOCs will result in a considerably higher burden to Ontario’s health care system during the third wave compared to the impact of early SARS-CoV-2 variants during Ontario’s second wave.

Since the start of the third wave on March 1, 2021, the number of new cases of SARS-CoV-2 infection, and the COVID-19 hospital and ICU occupancies have surpassed prior thresholds at the start of the province-wide lockdown on December 26, 2020.