Toronto Public Health says it needs $5 million more for respiratory illness ahead of winter that could see 'high level' of virus activity

Toronto Public Health is seeking an additional $5 million to help combat respiratory illnesses as the city heads into a potentially challenging season.

"This season, epidemiological data suggests that Toronto will experience a high level of respiratory virus activity," Medical Officer of Health Dr. Eileen de Villa said in her report, which is set to be tabled at a meeting of the Toronto Public Health Board next week.

The report outlines the city's preparedness for the upcoming respiratory illness season. It notes that vaccination remains the most effective way to prevent infection, and recommends that people get all shots that they are eligible for as soon as they become available. It also says that measures such as masking, hand washing, and physical distancing can also play a role.

Last winter hospitals were overwhelmed by a so-called "triple whammy" of COVID-19, influenza and RSV which stretched health resources thin.

De Villa said this year could see an early start as well.

"There is the potential for an early start to the respiratory season, and a surge of COVID-19, influenza, and RSV activity, along with the circulation of other respiratory viruses," de Villa wrote.

"These predictions are based on respiratory virus activity during the 2022-2023 season which started earlier and was busier than previous seasons due to the combined effect of COVID-19, influenza, RSV, and other agents. At that time, case severity was highest in the fall and winter, and in outbreaks among long-term care/retirement home residents and hospital patients (collectively known as institutional settings).

The number of people in hospital with COVID-19 in Ontario has been rising sharply since August, while influenza cases have remained mostly flat so far, according to data from Public Health Ontario.

For the week of Oct. 1-7, there were 1,135 people in Ontario hospitals with active COVID-19 cases, while 168 people were hospitalized because of COVID-19. That compares with 203 active COVID-19 cases in Ontario hospitals and 57 hospitalizations due to COVID-19 in the first week of July.

De Villa is recommending that the TPH Board ask Ontario's Ministry of Health for an additional $5.1 million in annual funding for "Infection Prevention and Control (IPAC) hubs" to prevent and mitigate the impacts of outbreaks, particularly in long-term care and retirement homes, and other congregate settings such as shelters and group homes.

MONEY NEEDED TO MAINTAIN INFECTION PREVENTION HUBS

As part of a plan to prepare for future waves of COVID-19 in 2020, the province established local networks of Infection Prevention and Control (IPAC) hubs.

The model sees hospitals and public health units work with partners in the local health system who have infection prevention and control expertise to provide support to congregate settings, such as long-term care homes, retirement homes, shelters and group homes.

"IPAC Hubs help build knowledge and expertise, support development of IPAC programs, enhance capacity to respond, provide advanced IPAC and clinical advice, and help ensure these institutions can better respond to respiratory virus outbreaks," de Villa wrote. "IPAC Hubs are an important new support for outbreak response and for capacity building in institutions."

She said the $5.1 million is needed so that IPAC hubs "can continue to provide these important services at the high-level that has been achieved."

In an email, a spokesperson for Health Minister Sylvia Jones said the province has been putting money into the hubs for the past few years.

“Since 2020-21 our government has invested over $100 million for IPAC hubs to support over 5,000 congregate living settings across the province,” Jones’ office said.

However they said they could not yet confirm whether additional funding might be committed.

IPAC hubs in Toronto are currently run out of hospitals, but agencies like TPH and Public Health Ontario (PHO) are key partners.

“In addition to contributing to IPAC Hubs as experts in prevention and outbreak response, the local public health unit retains the responsibility to declare, support the management of, and close outbreaks in health care settings like long-term care homes and retirement homes,” TPH said in an email. “The IPAC hubs extend the reach and depth of knowledge exchange with facilities and enable the TPH team to provide collaborative outreach to prevent outbreaks and to provide focused outbreak management to settings at the highest risk.”

The health unit said the hubs have been a “welcome addition” during the pandemic and have helped create strong partnerships with the facilities they work with. A loss of funding would mean a loss of quick access to expertise for the facilities, TPH said.

“While TPH would continue to provide support for outbreak response and management to long-term care and retirement homes as it did before the COVID-19 pandemic all partners would lose access to the site-specific expertise that has been built in these hubs, through access to medical IPAC experts,” the health unit wrote.

“With stable and permanent funding, the IPAC hubs can plan and retain that expertise to deliver on their mandate for training and education just as with stable and secure funding TPH can provide high quality outbreak management supports and guidance to vulnerable people in our community.”

ONGOING FUNDING CONCERNS

Aside from the $5.1 million, TPH has expressed concerns recently about stable ongoing funding for its work.

Coun. Chris Moise, who chairs the TPH Board, told CP24 that TPH is currently short around $21.5 million in its overall budget in the latest funding formula with the province, which was revealed in August, and that he has sent a letter to the ministry asking them to make up the shortfall. Moise said sustained funding is key, especially given the health unit’s expanded role in vaccine rollout.

“The Board of Health now is responsible for distribution of vaccines. That was not the case (previously),” Moise said.

He said while the province and the ministry are on the same page in terms of working toward infection prevention and control, it’s not clear whether any new money will be flowing to the health unit now that they have the added responsibility for vaccinations.

“We're wondering, you know, are we going to be absorbing the cost of administering this. So that was something that was not clear,” he said.

Free COVID-19 and flu vaccines will become available to the general public starting Oct. 30 through the city's four city-run immunization clinics, as well as mobile clinics and pharmacies.

Those 60 and up in long-term care homes, Elder Care Lodges, and some retirement homes will also be able to access the RSV vaccine.

Other measure that are part of the health unit's plan to combat respiratory illness this season include letters home to families of school kids on reducing the spread of respiratory viruses in school settings, continuing to monitor disease levels through wastewater and testing, and communicating with the public.

"During this fall and winter, and the respiratory seasons to come, TPH, the Ministry of Health, Ontario Health, Ontario Health Teams, and other partners have a unique opportunity to leverage lessons learned from the pandemic to continue to strengthen our collective seasonal response," de Villa wrote.

She recommended that TPH staff provide an update back to the board on the respiratory illness season if warranted in January.