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The Epidemiology of COVID-19 in Canada in 2020: the Pre-Vaccine Era February 2021

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The Epidemiology of COVID-19 in Canada in 2020: the Pre-Vaccine Era February 2021 The Epidemiology of COVID-19 in Canada in 2020: The Pre-Vaccine Era February 2021 An RSC Policy Briefing The Epidemiology of COVID-19 in Canada in 2020: The Pre-Vaccine Era An RSC Policy Briefing Authors Wendy Sligl (Chair) University of Alberta David Waldner University of Alberta Jennie Johnstone University of Toronto Robyn Harrison University of Alberta Duncan Webster Dalhousie University Lynora Saxinger University of Alberta Peer Review Monitor Tom Marrie, FRSC Dalhousie University Peer Reviewers Nick Daneman University of Toronto Rob Fowler University of Toronto Srinivas Murthy The University of British Columbia David Patrick The University of British Columbia Dan Reid Dalhousie University Robert Strang Chief Medical Officer of Health, Nova Scotia Suggested citation for Policy Briefing Report: Waldner D, Harrison R, Johnstone J, Saxinger L, Webster D, Sligl W. The Epidemiology of COVID-19 in Canada in 2020: The Pre-Vaccine Era. Royal Society of Canada. 2021 Cover Art Christine De Vuono, For Your Own Good, (2020) Over the course of the pandemic, those in long term care facilities have been hit hardest with the impact of COVID-19 outbreaks. The response has been to lock down care homes and ban visitors, volunteers and even care packages, as attempts to stop the virus from entering the facility. This had the unintended, but very real consequence of isolating our most vulnerable from those who care for and love them. “For Your Own Good”, made of 100 carved figures from identical bars of soap, then placed in mason jars, which in turn are placed on shelves, allow us to look in on the miniature elderly figures, who look out at us. Although the pandemic has forced this isolation, it only amplifies what many elderly historically endure within our society on a chronic and routine basis. Land Acknowledgement The headquarters of the Royal Society of Canada is located in Ottawa, the traditional and unceded territory of the Algonquin Nation. The opinions expressed in this report are those of the authors and do not necessarily represent those of the Royal Society of Canada. 1 Background on the Policy Briefing Report Process Established by the President of the Royal Society of Canada in April 2020, the RSC Task Force on COVID-19 was mandated to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of Working Groups to rapidly develop Policy Briefings, with the objective of supporting policy makers with evidence to inform their decisions. About the Authors Robyn A. Harrison, Clinical Professor at the University of Alberta and Provincial Communicable Disease Consultant with Alberta Health Services Jennie Johnstone, Associate Professor, Laboratory Medicine and Pathobiology, University of Toronto and Medical Director of Infection Prevention and Control, Sinai Health Lynora Saxinger, co-Chair of the Alberta COVID-19 Scientific Advisory Group and Associate Professor of Medicine at the University of Alberta Wendy Sligl, Professor, Department of Critical Care Medicine and Division of Infectious Diseases in the Department of Medicine at the University of Alberta David Waldner, Clinical Lecturer, Division of Infectious Diseases, Department of Medicine at the University of Alberta Duncan Webster, Medical Microbiologist at the Saint John Regional Hospital and Associate Professor of Medicine at Dalhousie University An RSC Policy Briefing 2 Table of Contents Executive Summary ................................................................................................................4 Overview of COVID-19 Epidemiology in Canada ...................................................................9 Public Health Response and Mitigating Transmission ..........................................................12 Key Concepts ........................................................................................................................12 Differences between provinces and territories ....................................................................14 Masking Policies ...................................................................................................................17 Testing Strategies .................................................................................................................18 COVID-19 in Canadian Workplaces ......................................................................................20 Healthcare workers ...............................................................................................................21 Business, Industry, Public Service Settings, and Outbreaks ................................................23 Mitigating risk day-to-day in workplace settings .................................................................26 COVID-19 in Long-term Care in Canada ..............................................................................27 Delayed Preparation .............................................................................................................27 Systemic Gaps ......................................................................................................................27 Resident Factors ...................................................................................................................28 Outbreak Response ..............................................................................................................28 Approach to Visitors in Long-term Care ..............................................................................29 Clinical Presentation and Outcomes ....................................................................................29 COVID-19 and the Education System in Canada ..................................................................29 School closures, re-opening and home-schooling ................................................................29 Incidence and transmission within schools ...........................................................................31 Experience after school re-opening .....................................................................................34 Severe COVID-19 disease in Canada ...................................................................................36 Risk factors for Severe COVID-19 ........................................................................................36 Presentation ..........................................................................................................................37 Mortality ................................................................................................................................38 ICU capacity ..........................................................................................................................39 Multisystem Inflammatory Syndrome in Children (MIS-C) ...................................................40 Post-acute COVID or prolonged post COVID-19 symptoms...............................................40 COVID-19 in Vulnerable Populations in Canada ...................................................................41 Indigenous Peoples ..............................................................................................................41 Racial Disparity – Ethnic Minorities & Newcomers to Canada ............................................42 People Who Use Drugs ........................................................................................................43 People Who Are Homeless ...................................................................................................44 People Who Are Incarcerated ..............................................................................................45 Sex and Gender Disparities ..................................................................................................46 People Living With Disability ................................................................................................47 References ...........................................................................................................................49 The Epidemiology of COVID-19 in Canada in 2020: The Pre-Vaccine Era 3 Executive Summary Overview of COVID-19 Epidemiology in Canada • Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), predominantly manifests as pneumonia, however, COVID-19 can also present with an array of extrapulmonary signs and symptoms. • As of December 5, 2020, there have been 408,921 cases of COVID-19 in Canada and 1,088 cases per 100,000 people. • The first wave of the COVID-19 epidemic in Canada peaked in mid-April 2020 with subsequent reduction in cases due to various public health interventions. • As the epidemic has progressed Canadians have become less adherent to public health recommendations, and these trends in self-reported public behaviour coincided with a national R0 exceeding 1.0 in early August 2020, and the emergence of a “second wave”. • As of early December 2020, Canada’s case fatality rate (CFR), which represents the proportion of deaths among individuals diagnosed clinically with COVID-19, is 3.4%. Public Health Response and Mitigating Transmission Key Concepts • Public health strategies strive to lessen the severity of the pandemic. • Prevention of spread and amplification of cases within healthcare settings, including long- term care homes, is paramount. • General practices
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