Flags across the Niagara region are flying at half-mast during February — not because of one death, but because of hundreds.
Between the start of the pandemic and December, 87 people died after being infected by COVID-19. One month later, the number of deaths nearly doubled to 142. As of Friday, Feb. 5, there are 336 lives lost.
That's more than double in one month, and almost four times the number of deaths in December.
The pocket deep in southern Ontario has become one of the hardest hit areas during the pandemic, but has never been declared a hot spot by the Ford government. The province also, at one point, deferred vaccines from the region.
Those decisions, along with other factors, led to more deaths, says Dr. Mustafa Hirji, Niagara's acting medical officer of health.
What factors led to the spikes in death?
There isn't a way to pinpoint exactly what triggered the higher levels of infection and death, but leading experts in Niagara have some idea.
Dr. Karim Ali, infectious diseases lead at Niagara Health, says you have to go all the way back to the summer.
"Back in June and July, we started seeing a shift in terms of the numbers, where younger people were becoming more and more infected ... I'm talking about 20- to 40-year-olds. Not to blame them, but this is the population that's more mobile and working," he said.
"It's only a matter of time before it starts spilling over into vulnerable populations."
"We were definitely seeing a lot of spread within households and gatherings where people met with close friends and extended family," he said. "Likely what happened is some proportion of these people either worked in a long-term care home or had a loved one in a long-term care home. When they went to work or went visiting, it unfortunately meant they brought infection with them."
Niagara has 32 long-term care and retirement homes, and their residents are among the most vulnerable during the pandemic. Hirji says Niagara has a disproportionate number of such homes compared to the rest of Ontario.
And unsurprisingly, Hijiri and Ali both say Niagara has one of the province's highest proportion of seniors.
"For lack of a better analogy, everything aligns here for the worst in terms of death," Ali said.
"It breaks your heart."
Alarm bells began ringing in December
Alarm bells started ringing in the final weeks of 2020. Hirji says that's when COVID-19 began infecting more people.
"It was around the 22nd, 23rd, we started to see the pace of deaths unfortunately pick up, and that's because a week or two earlier our cases had started to go up."
Death is a lagging metric. Hirji says usually when people get COVID-19, they don't die immediately. They suffer severe symptoms that worsen over two to three weeks. When deaths begin to rise, it means the problem already started two to four weeks ago.
Outbreaks began spreading in congregate settings and hospitals. Some of the outbreaks in long-term care homes were rampant enough to have Niagara Health take over management.
Hirji says workers who helped local long-term care homes fight outbreaks in the past couldn't help when the virus returned because they had been busy helping quell the spread in the Greater Toronto Area.
"That meant outbreaks weren't managed as well, infection spread more, perhaps some residents weren't getting as much attention as they would have otherwise, and all of that, I think, has led to some of the increase in deaths," he said.
Passing the peak
"Our health-care system was completely overwhelmed by the time our cases went up."
But the COVID-19 vaccine rollout wasn't as efficient as it could have been, and the province was dealing with supply constraints. Niagara was also never labelled a hot spot, despite being among the five hardest-hit regions in Ontario.
"The core error here was vaccine, province-wide, wasn't prioritized to get to long-term care and retirement home residents who, as a group, are at a greater risk of passing away," he said. "I think we should have taken that initial vaccine that came and really sent it to every part of the province with that group as the first priority to get vaccinated."
"I think that's where the province is at now. But unfortunately, a few weeks were lost when the first doses of vaccine were coming and ... I think had that happened earlier, that could have saved lives in Niagara, but really all across the province."
With 5,374 vaccines being put into arms to date, and cases beginning to slow down because of the provincial stay-at-home order, Hirji said the region may have passed its peak.
Numbers improving, but still too high
While there were 61 new cases reported Friday, that's a far cry from some of the numbers earlier this year. Hirji said it's still far too high.
"Even in early December, we were still in the 20s in terms of the number of cases we had," he said.
"It's really important everyone continues to stay home and limit their contact with the outside world because that's what's driving COVID-19 and its ability to spread."
And if anyone needs to be reminded of that, Hirji points to the flags blowing in the wind at half-mast.
"People really do die from COVID-19 when it starts to spread," he said. "Hopefully by remembering their death, we'll remember and have the motivation to continue doing what we need to do."