Living outside the city is no guarantee of a ‘COVID-free paradise’

Data shows how virus spread early on and why rural areas may be facing a new risk

Ontario’s southern urban centres were the first and hardest hit by the COVID-19 pandemic, while some rural regions managed to stave off the virus for nearly 10 weeks before cases were reported, data collected by the Star shows.

While the first case in the province — a man in Toronto — was recorded on Jan. 23, it took six weeks before regions outside of Toronto reported cases of the coronavirus. For one more week, the virus would stay confined to southern Ontario. Then by week 10, it had spread across the province with the GTA as the epicentre.

Health units for Porcupine, Thunder Bay and Algoma in Ontario’s north of the province were free of confirmed cases until early March, with Thunder Bay not reporting a case until week 10 of the pandemic. In the south of the province, the health units of Haldimand-Norfolk, Lambton and Southwestern were also free of reported cases. Week10 directly followed Ontario’s March Break — March 16 to 20 — a time when it was feared returning vacationers would trigger a spike.

Now, as daily cases remain low province-wide, the challenge is protecting communities as the risk of a second wave looms.

That more densely populated regions fared worse early in the pandemic was to be expected and hints at what will keep transmission low in the weeks and months ahead, said Anna Banerji, an epidemiologist with the Dalla Lana School of Public Health.

Highly dense work spaces and communities tend to see a fast spread of the virus, she said. “The virus would spread more when there are people who are living or working or existing close together. And that allows the virus to go from one person to another, as we’re seeing in the meat processing plants (and) with the migrant workers.”

Now, the battle will be to keep case numbers low. The low population density that helped keep spread low in rural communities could also help to protect them — provided physical distancing is maintained. “You can go to a rural area and not see a lot of people. So you may not have as much COVID. But if you’re going to a rural area, and you’re going to a festival or you’re going to some other event where there’s a bunch of people,

specially indoors, you’re more likely to have a spread,” Banerji said.

Ashleigh Tuite, an epidemiologist with the Dalla Lana School of Public Health, warned that people should act responsibly, regardless of where in the province they happen to be. “You want to behave in a way that minimizes the likelihood that you would transmit infection to other people if you are infected.”

Duly important, she said, is that just because a community has no or few reported cases doesn’t mean that the virus isn’t present.

In harder-hit parts of the province, the people in the community who have been infected can actually help to fend off the virus later, Tuite said.

“The idea behind that is that if you have a community of people infected, people who have been infected and recovered effectively act as stops or barriers in terms of transmission,” she said. This is based on the assumption that people carry some level of immunity after contracting the virus, she said.

Immunity slows down the chains of transmission in communities, Tuite said. But, “if you don’t have any immune people in the population, those are people that go on to get infected” when outbreaks strike. She pointed to some evidence in harder-hit communities in the U.S. where more cases of the virus are having a “noticeable impact on transmission,” and slowing down transmission. “Basically, that immunity slows down the spread of infection in a community or in a population,” she said. In the context of Ontario, the question is whether “we had enough infection so far for that to be noticeable,” she said.