Enhanced Epidemiological Summary COVID-19 and Severe Outcomes in Ontario - Public ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Enhanced Epidemiological Summary
COVID-19 and Severe Outcomes in Ontario
This report includes information available from the integrated Public Health Information System (iPHIS)
as of 4 p.m. on May 14, 2020 and from the Toronto Public Health Coronavirus Rapid Entry System
(CORES) and Ottawa Public Health COVID-19 Ottawa Database (COD) as of 2 p.m. May 14, 2020. This
report is an update from the original version published April 28, 2020.
Purpose
This report provides a focused analysis of the severity of illness among laboratory-confirmed COVID-19
cases reported in Ontario using data from the integrated Public Health Information System (iPHIS), the
Toronto Public Health Coronavirus Rapid Entry System (CORES) and Ottawa Public Health COVID-19
Ottawa Database (The COD). It includes information on hospitalizations, admissions to intensive care
unit (ICU) and deaths. All data in this report are preliminary and may change as more case reports and
case details are received.
Additional details on the status of COVID-19 cases in Ontario by geography, demographic features and
outcomes are provided in the Daily Epidemiologic Summary which is available on the Ministry of
Health’s website, as well as the Ontario COVID-19 Data Tool which is available on Public Health Ontario’s
website.
Highlights
From January 15 to May 14, 2020, 21,922 confirmed cases of COVID-19 were reported in
Ontario for a cumulative incidence rate of 147.5 cases per 100,000 population. Of these cases,
2,779 (12.7%) were hospitalized, 633 (2.9%) were admitted to ICU and 1,825 (8.3%) deaths were
reported (Table 1).
Overall, cases aged 60 years and older accounted for the highest proportion of all
hospitalizations (68.8%), ICU admissions (61.1%) and deaths (95.3%) (Table 2). In contrast, cases
in this age range accounted for 42.7% of all reported cases.
A total of 5,714 cases reported at least one comorbid condition (Table 3). The proportion of
hospitalizations, ICU admissions, and deaths was higher among cases reporting at least one
comorbidity (23.5%, 6.1% and 11.7%, respectively) compared to those not reporting any
comorbidities (8.9%, 1.7% and 7.1%, respectively) (Tables 4a and 4b).
The median time from symptom onset to hospitalization was seven days and from symptom
onset to death was eleven days (Table 5).
Overview of COVID-19 Cases with Severe Illness
From January 15 to May 14, 2020, 21,922 confirmed cases of COVID-19 were reported in Ontario for a
cumulative incidence rate of 147.5 cases per 100,000 population. Among these cases, 2,779 (12.7%)
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 1were hospitalized, 633 (2.9%) were admitted to ICU and 1,825 (8.3%) deaths were reported (Table 1).
Overall, the median ages of cases experiencing severe outcomes, such as hospitalization (70 years) or
deaths (86 years), were higher than the median age of all confirmed cases (55 years). While 42.1% of all
reported cases were male, males comprised a higher proportion of hospitalizations (54.4%) and ICU
admissions (65.2%), but not deaths (44.9%).
Table 1. Confirmed cases of COVID-19 with severe outcomes: Ontario, January 15, 2020 to
May 14, 2020
Blank cell Number % of total Rate per Median Minimum- Number % of male
of cases cases 100,000 age in maximum of male cases
population years age in cases within
(N=21,922)
within years each level
each within of severity
level of each level
severity of severity
Total cases 21,922 100.0 147.5 55 1-111 9,225 42.1
Hospitalization 2,779 12.7 18.7 70 5-105 1,511 54.4
ICU 633 2.9 4.3 63 23-99 413 65.2
Deaths 1,825 8.3 12.3 86 20-105 819 44.9
Notes:
1
Cases may report more than one measure of illness severity.
Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System
(CORES) database, The COVID-19 Ottawa Database (The COD), IntelliHEALTH ONTARIO database.
Temporal Trends
Figure 1 shows the number of confirmed COVID-19 cases reported in Ontario. Cases are shown by
episode date (an estimate of illness onset) and classified by severity levels with only the most severe
outcome shown for each case. Due to delays in reporting as well as delays between disease onset and
date of hospitalization or death, both case counts and in particular counts for severe outcomes are
incomplete for the most recent dates and should be interpreted with caution.
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 2Figure 1. Confirmed cases of COVID-19 by ranked levels of severity and episode date: Ontario, January 15, 2020 to May 14, 2020 (n=21,922) Notes: 1 Cases were classified based on the most severe outcome reported using the following hierarchy from highest to lowest severity: death > ICU > hospitalization. For example, a hospitalized case that was also treated in an ICU would be assigned to the illness severity measure of ICU. 2 The episode date is an estimate of symptom onset in a case. It is calculated hierarchically based on either the date of symptom onset, specimen collection/test date, or the date reported to public health. 3 Interpret case counts for the most recent days (approximately 14 days, as shown in light grey shading) with caution due to reporting lags. 4 Cases with missing episode dates are excluded. Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System (CORES) database, The COVID-19 Ottawa Database (The COD). COVID-19 in Ontario: January 15, 2020 to May 14, 2020 3
Age Distribution
Overall, cases aged 60 years and older accounted for the highest proportion of all hospitalizations
(68.8%), ICU admissions (61.1%) and deaths (95.3%), but only 42.7% of all cases and 24.4% of the
Ontario population (Table 2, Figures 2a-c). Of particular note, while cases aged 80 to 89 and 90 years
and older accounted for the largest proportion (70.7%) of all deaths, cases in these age groups only
accounted for 29.9% of all hospitalizations and 10.9% of all ICU admissions. Only 15 cases have been
hospitalized and one admitted to the ICU among those 19 years and younger, with no deaths reported in
this age group.
Table 2. Age distribution of confirmed cases of COVID-19 by severity of illness indicators:
Ontario, January 15, 2020 to May 14, 2020
% of all
Age Number of Number of Number % of all Number of Number % of all Number
hospital
group hospital hospital of cases ICU ICU of deaths of
admissions
(years)k admissions admissions admitted admissions admissions deaths (N=1,825) deaths
(N=2,779)
cell per to ICU (N=633) per per
100,000 100,000 100,000Figure 2a. Age distribution of all confirmed cases of COVID-19 compared to those resulting in hospitalization: Ontario, January 15, 2020 – May 14, 2020 Figure 2b. Age distribution of all confirmed cases of COVID-19 compared to those resulting in ICU admission: Ontario, January 15, 2020 – May 14, 2020 COVID-19 in Ontario: January 15, 2020 to May 14, 2020 5
Figure 2c. Age distribution of all confirmed cases of COVID-19 compared to those resulting in death: Ontario, January 15, 2020 – May 14, 2020 Notes: 1 Cases may report more than one measure of severity. As a result, the sum of the number of hospitalizations, ICU admission and deaths will not equal the total number of cases. 2 Cases with missing or unknown age were excluded from this analysis. Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System (CORES) database, The COVID-19 Ottawa Database (The COD). Cases with Comorbid Conditions Adults aged 65 years and older and people of any age who have serious underlying medical conditions may be at higher risk for severe illness from COVID-19. Among 21,922 confirmed COVID-19 cases, 26.1% (5,714) reported at least one comorbid condition (Table 3). The median age of cases with at least one comorbid condition was 59 years (range 1 to 104 years) and 44.0% were male. In comparison, the median age among persons not reporting any comorbidity was 54 years (range 1 to 111 years) and 41.3% were male. Cases reporting at least one comorbidity accounted for approximately half of all hospitalizations (48.4%), 55.5% of ICU admissions and 36.8% of deaths. The most commonly reported comorbidities among all cases were cardiovascular conditions (7.7%), followed by asthma and/or COPD (4.7%) and diabetes (4.4%). The proportion of hospitalizations, cases treated in the ICU, and deaths was higher among cases reporting at least one medical comorbidity (23.5%, 6.1% and 11.7%, respectively) compared to those not reporting any comorbidities (8.9%, 1.7% and 7.1%, respectively) (Tables 4a and 4b). COVID-19 in Ontario: January 15, 2020 to May 14, 2020 6
Table 3. Severe illness from COVID-19 among people with comorbid conditions: Ontario,
January 15, 2020 to May 14, 2020
Comorbid Number % of all Number of % of all Number % of all Number % of all
conditions of cases cases hospital hospital of cases ICU of deaths
(N=21,922) admissions admissions admitted admissions deaths (N=1,825)
(N=2,779) to ICU (N=633)
No
16,208 73.9 1,435 51.6 282 44.5 1,154 63.2
comorbidity
At least one
medical 5,714 26.1 1,344 48.4 351 55.5 671 36.8
comorbidity
Asthma
1,020 4.7 234 8.4 65 10.3 106 5.8
and/or COPD
Cancer 362 1.7 140 5 28 4.4 77 4.2
Cardiovascular
1,696 7.7 541 19.5 144 22.7 356 19.5
Disease
Immuno-
256 1.2 85 3.1 19 3 43 2.4
Compromised
Diabetes 968 4.4 339 12.2 99 15.6 190 10.4
Notes:
1
Cases may report more than one measure of severity.
2
Cases may report multiple comorbidities. As a result, the sum of the number of comorbidities will not equal the
total number of cases.
Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System
(CORES) database, The COVID-19 Ottawa Database (The COD).
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 7Table 4a. Age distribution of confirmed COVID-19 cases reporting at least one comorbid
condition (N=5,714): Ontario, January 15 – May 14, 2020
Age-
Age group Number of Number of Age- Number Age-specific Number of
specific
(years) cases hospital specific of cases ICU deaths
deaths (%)
admissions hospital admitted admissions
(case
admissions to ICU (%)
fatality)
(%)Notes:
1
Cases may report more than one measure of severity.
2
Cases with information indicating at least one comorbidity were classified as having a comorbidity. All other cases
(including cases with unknown and missing information) were classified as not having a comorbidity.
3
Cases with missing or unknown age were excluded from this analysis.
Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System
(CORES) database, The COVID-19 Ottawa Database (The COD).
Time to Significant Medical Events
The temporal progression from earliest symptom onset to hospitalization, ICU admission and death is
described below. Among 1,734 cases who were hospitalized and had a symptom onset date reported,
the median time from symptom onset to hospitalization was 7 days (Table 5). The median time from
symptom onset to ICU admission and death were 9 and 11 days, respectively.
The median time from symptom onset to hospitalization was similar among cases reporting at least one
comorbidity and those reporting no comorbidities (7 and 8 days, respectively), as well as among cases
under 60 years of age and cases over 60 years of age (8 and 7 days, respectively) (Table 6).
Table 5. Time to hospital admission, ICU admission and death among confirmed cases of
COVID-19: Ontario, January 15, 2020 to May 14, 2020
Time to medical events Hospital admission ICU admission (N=633) Death (N=1,825)
(N=2,779)
Number of cases n=1,734 n=469 n=997
Median time from 7 days 9 days 11 days
onset to
Number of cases Blank cell n=602 n=764
Median time from Blank cell 0 days 8 days
onset to
Number of cases Blank cell Blank cell n=221
Median time from Blank cell Blank cell 9 days
onset to
Notes:
1
Cases may report more than one measure of severity. As a result, the sum of the number of hospitalizations, ICU
admission and deaths will not equal the total number of cases.
2
The median number of days from hospital to ICU admission was zero, as a large number of cases were admitted
directly to the ICU.
3
Only cases with valid dates for the events noted are included in the calculations. For example, to calculate time
from symptom onset to hospitalization, an onset and hospital admission date need to be reported for a case.
Data Source: integrated Public Health Information System (iPHIS) database, Coronavirus Rapid Entry System
(CORES) database, The COVID-19 Ottawa Database (The COD).
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 9Table 6. Time from symptom onset to hospital admission, by presence of at least one
comorbid condition and age among confirmed cases of COVID-19: Ontario, January 15, 2020
to May 14, 2020
Blank cell Number of cases with Median number of days from
reported symptom onset symptom onset to hospital
and hospital admission admission
dates
At least 1
1,170 7 days
comorbidity
No comorbidities 615 8 daysunderreporting due to a variety of factors, such as disease awareness and medical care seeking
behaviours, which may depend on severity of illness, clinical practice, changes in laboratory
testing, and reporting behaviours.
Lags in iPHIS and Local Systems data entry due to reduced holiday and weekend staffing may
result in lower case counts recorded over holidays and weekends than would otherwise be
recorded.
Only cases meeting the confirmed case classification as outlined in the MOH COVID-19 case
definition are included in this report.
The episode date is an estimate of symptom onset in a case. It is calculated hierarchically based
on either the date of symptom onset, specimen collection/test date, or the date reported to
public health.
Case counts for the recent days should be interpreted with caution due to reporting lags.
The data only represent cases reported to public health and recorded in iPHIS and Local
Systems. As a result, the number of reported cases as well as case details (e.g. comorbidities)
are subject to underreporting owing to factors such as illness awareness, illness severity,
medical care seeking behaviour, clinical practice, laboratory testing algorithms and reporting
practices.
Data on hospital admissions, ICU admissions and deaths are likely under-reported as these
events may occur after the completion of public health follow up of cases. Cases that were
admitted to hospital or died after follow-up was completed may not be captured in iPHIS or
Local Systems.
Cases may report one or more of the three measures of illness severity included in this report
except as noted below for Figure 1.
For Figure 1, cases were classified based on the most severe outcome reported using the
following hierarchy: death > ICU > hospitalization. For example, a hospitalized case that was also
treated in an ICU would be assigned to the illness severity measure of ICU. Since only the most
severe outcome reported is counted for a case, the sum of the cases reporting severe outcomes
and those not reporting severe outcome equals the total number of cases.
Cases with unknown or missing ages were excluded from age-specific analyses.
Cumulative hospitalizations, ICU admissions, and deaths are shown throughout the report,
unless otherwise specified (e.g. Figure 1). The counts do not necessarily represent cases that are
currently hospitalized or in the ICU, as cases may be discharged over time.
Cases with information indicating they had at least one comorbidity were classified as having a
comorbidity. All other cases (including cases with unknown and missing information) were
classified as not having a comorbidity.
Cases may report multiple comorbid conditions.
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 11 For time to significant medical events calculations, only cases with valid dates for the relevant
events are included in the calculations. For example, only cases with reported symptom onset
and hospital admission dates are included in the time from symptom onset to hospitalization
calculation.
COVID-19 in Ontario: January 15, 2020 to May 14, 2020 12Disclaimer This document was developed by Public Health Ontario (PHO). PHO provides scientific and technical advice to Ontario’s government, public health organizations and health care providers. PHO’s work is guided by the current best available evidence at the time of publication. The application and use of this document is the responsibility of the user. PHO assumes no liability resulting from any such application or use. This document may be reproduced without permission for non-commercial purposes only and provided that appropriate credit is given to PHO. No changes and/or modifications may be made to this document without express written permission from PHO. Citation Ontario Agency for Health Protection and Promotion (Public Health Ontario). Weekly Epidemiologic summary: COVID-19 and Severe Outcomes in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2020. For Further Information For more information, email cd@oahpp.ca. Public Health Ontario Public Health Ontario is an agency of the Government of Ontario dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. For more information about PHO, visit publichealthontario.ca. COVID-19 in Ontario: January 15, 2020 to May 14, 2020 13
You can also read
