There has been a significant spike in respiratory complaints and influenza-like-illness (ILI) reported across many public health units and emergency departments in Toronto and the surrounding region in the last 72 hours.
The ILI Mapper is intended as a tool to provide real-time surveillance of the flu and ILIs. With reporting from 97 per cent of hospitals across the province, the region has flipped from code green (low risk) to code red (high risk) in recent days.
There are four colours used by the ILI Mapper to measure the severity of respiratory-related illness in Ontario – green, yellow, orange and red. The colours correspond to the percentage of respiratory-related visits to emergency departments.
According to the ILI Mapper, the red code is applied when respiratory-related emergency department visits are greater than 15 per cent of the total number of visits, and pneumonia or ILI-related admissions are greater than 12 per cent of total admissions.
In such scenarios, the website states that, “significant impacts on the health care system are expected due to influenza virus activity. Emergency Departments are likely being inundated with respiratory-related visits. High potential for increased rates of admissions for pneumonia and influenza.”
David Fisman, Division Head in Epidemiology at the University of Toronto’s Dalla Lana School of Public Health, says “If you go back, you’ll see it was red when it was the actual flu season, and then very green right up to now. The default presumption should be that it has to be COVID-19.”
Compared to available data from past years, the spike appears historically unprecedented.
The data for emergency department visits for respiratory-related illness as a percentage of all visits to hospitals has never occurred at this period in the flu season in the last five years and is on a par with the worst peaks of past flu seasons.
“That’s a huge jump,” said Fisman. “It’s out of season, it’s not influenza. There’s a possibility that it’s some other respiratory virus, but given the exponential growth curve in confirmed and recognized cases [of COVID-19] to date, I doubt it.”
Graph showing respiratory-related illness as a percentage of all visits shows a pronounced spike in red.
A Ministry of Health spokesperson asked to provide information on how many of the cases of respiratory-related illness may be COVID-19 related was unavailable to provide confirmation.
Jordana Goldman, a spokesperson for the University Health Network (which includes Toronto Western and Toronto General hospitals), says “Those individuals would be tested for a variety of illnesses. We have sufficient supplies for hospitalized patients at present. Supplies are on order and the province has a pandemic supply as well.”
She adds that “Assessment Centres have opened and we expect people to be assessed there for respiratory complaints and sent to our emergency departments if the symptoms are severe enough to warrant further investigation or hospitalization. If someone comes to the emergency department, they may be sent to an Assessment Centre if their symptoms are mild or triaged for treatment in the emergency department.”
Jennifer Stranges, a community relations advisor for Unity Health Toronto (St. Michael’s Hospital) says “I can share that we plan to open our two assessment centres (on Monday, March 16), and that Unity Health Toronto is well-positioned and prepared to respond to new cases.”
Repiratory-related illnesses now make up almost 19 per cent of emergency department hospital visits in Ontario.
In Ontario, the percentage of all emergency department visits that are respiratory-related has risen to 18.7 per cent, which is up 67 per cent over the last seven days. For the Toronto Public Health Unit, the percentage of all emergency department visits that are respiratory-related has risen to 24 per cent, which is up 143 per cent over the last seven days.
Toronto-based emergency room physician Qassim Tejpar says he has observed a rise in ILI at his hospital during the last week.
“Definitely a larger than normal proportion of our patient visits have involved respiratory complaints,” he says. “We have had a handful of patients test positive for COVID-19.”
But he says that “The vast majority have been minor and were discharged home with or without testing for COVID-19 and influenza, with instructions to self isolate for two weeks.”
At this time, the absolute number of in-patient admissions for pneumonia and ILI to participating hospitals is not out of the ordinary. But that should not necessarily be interpreted as a sign that there is no reason for concern.
“It’s one of the things that makes [COVID-19] so hard to fight,” says Fisman. “By the time people are reacting, the ICUs are filling up. That’s what comes up in the Chinese data.”
When asked if the sudden spike in the data could be attributable to public awareness (or panic), Fisman is skeptical.
As late as Sunday afternoon, the ILI Mapper displayed a green, or “seasonal” ILI projection for the week. The ILI Mapper only tracks data from emergency departments, not from the recently established COVID-19 screening centres.
Fisman expressed concern that the ILI Mapper is not being used adequately as the surveillance tool it was intended to be.
“The point of this tool is to map out some codes because you don’t always see things with diagnosis,” explained Fisman. “Ontario is supposed to have surveillance for precisely this reason, to discover illness in places where we didn’t think it was.”