100 days of COVID in Hamilton: The catastrophe that never arrived
Hospitalizations, ICU stays and ventilator use were far below projections from the pandemic’s early days. But what’s next?
It was 100 days ago that Hamilton recorded its first COVID-19 case.
Seems a lifetime has passed since then, doesn’t it?
A hundred days ago, public health officials and the city’s two hospital systems were trying to chart a course through the unknown as the world came to grips with a pandemic.
The question they wrestled with as they tried to prepare their resources: Was Hamilton going to be more like Italy, which at the time was overwhelmed with infections and deaths, or more like South Korea, where strict measures and quick action contained the spread of COVID-19?
Somewhere right in between, it turns out. Dr. Zain Chagla is the co-medical director of infection control for St. Joseph’s Healthcare in Hamilton. He was one of the people trying to model what might happen as the pandemic unfolded in early March.
The city’s hospital systems came up with three scenarios. There was the Italy scenario “where things went off the rails very quickly,” Chagla said, a scenario where there was some dampening but cases increased on average by 25 per cent a day, and a scenario where more aggressive social distancing kept the rise in daily cases to about 15 per cent.
“Looking at the modelling data and comparing it to our numbers, our curve kind of fit that more aggressive model,” Chagla said.
At the 100-day mark, Hamilton’s rate of COVID-19 cases is 144 per 100,000 population, not nearly as low as South
Korea’s 24 cases per 100,000 people but nowhere near as high as Italy’s rate of 394 cases per 100,000.
The city’s death rate from COVID-19 is 7.8 per 100,000 population, which is a third of the Canadian rate and far below Italy’s death rate of 57 per 100,000 people.
Meanwhile, the city’s public health epidemiologists were working on their own projections and predicting significantly fewer hospitalizations than the hospital’s models.
“When you look at the projections and the concerns about the hospitals, the number of hospitalizations over this period of time is better than we were expecting,” said Dr. Doug Sider, an epidemiologist and physician with Hamilton’s public health department.
“It took a number of weeks where we got to a point where we could start to say no, we’re not facing a catastrophe, hospitals are not going to be overwhelmed.”
At the peak of Hamilton’s outbreak, forecast to arrive in late April, the city’s hospitals had projected a need for 250 hospital beds for COVID-19 patients at any one time. The forecast was for slightly more than 100 intensive care beds to be needed at the peak and about 100 ventilators.
“We have not even come close to that,” said Chagla. “At any given time within the two institutions, there’s been a handful of people in the intensive care unit. I don’t think at any given time our ICUs were anywhere near overwhelmed.”
Only 140 people in total have been hospitalized for COVID-19 over the first 100 days. Just 21 of them ended up in ICU and only 14 have required a ventilator.
About 15 per cent of Hamilton’s hospitalizations for COVID-19 required the ICU, a rate that’s significantly lower than Ontario’s rate of 21 per cent, Niagara’s rate of 23 per cent and Kitchener-Waterloo’s rate of 24 per cent of hospitalizations requiring the ICU.
And of the 140 people ever hospitalized, 64 of them arrived on a single day when the Rosslyn Retirement Residence was evacuated due to a horrific outbreak.
In April, Sider said, public health was projecting between 29 to 43 COVID-related deaths by the time the first wave wound down sometime in mid to late June. Currently, there have been 42 deaths, with 14 of those involving residents of the Rosslyn home.
Both Chagla and Sider point to three reasons for the city’s success in keeping the caseload manageable:
Distancing measures were put in place early and people adhered to those requirements.
“I think everyone has accepted and is living with physical distancing,” Sider said.
The number of cases in Hamilton was lower than other regions of Ontario when the travel and distancing restrictions were put in place in midMarch.
“Niagara got seeded very heavily from its traffic at the border, and Toronto and the GTA because of ... a lot of return travellers,” Chagla said, adding that while there is some travel in Hamilton, “it’s probably less of a degree than Niagara and Toronto.”
“So we had a slower start.”
Hamilton’s population isn’t as densely concentrated as it is in other parts of the GTA.
“We don’t have a lot of huge towers people live in,” Chagla said.
What does the future hold?
The benefit of hindsight shows Hamilton exceeded expectations during the first wave of the pandemic but that won’t necessarily hold true for what’s believed to be an inevitable second wave sometime during the fall or winter.
“I think it’s the million-dollar question — what’s going to happen to our community?” said Chagla.
A public health department projection suggests the nearly 800 cases identified so far represents about 20 per cent of the true number of COVID-19 infections in Hamilton.
If so, that would mean about 4,000 people — less than one per cent of the city’s population — may have built up some kind of immunity to the coronavirus.
That’s far from the 60 or 70 per cent needed to provide socalled herd immunity.
“We still have that susceptibility and I don’t think anyone’s got an easy answer,” said Sider.
“The one sobering thing is that we’ve never been successful in developing a coronavirus vaccine,” he added.
Over the summer, Chagla predicts there will be a “slow burn” of new COVID-19 cases — a few hospital admissions and a few ICU patients at any given time.
The success seen during the first wave should also be a positive sign for the next wave.
“We know a lot more, society is a lot more prepared,” said Chagla. “Things like universal masking are being debated in terms of long-term prevention of spread in the community, case and contact tracing are more up to snuff.
“I don’t think we’re going to see as much of a catastrophic scenario.”