Why are northern Ontario's COVID numbers so low? 'Part of it has to do with a little bit of luck'

Three months into the second wave of COVID-19 and northeastern Ontario continues to have some of the lowest case numbers in the country. 

And before cases in the northwest spiked up over 100 in recent weeks, northern Ontario as a whole was largely untouched by the second wave of the pandemic.

There are currently about 130 active cases in the region and some 920 have tested positive since COVID-19 first hit nine months ago.

The infection rate is about 10 times less than southern Ontario and much lower than pretty much every province, except for those in Atlantic Canada. Although with recent spikes in New Brunswick and Nova Scotia, their numbers are quite comparable now to northern Ontario.

Even the northern parts of other provinces have far more COVID-19 spread, despite having fewer people than northern Ontario. In northern Saskatchewan, the infection rate is 20 times what it is in northern Ontario. 

Northern Manitoba has roughly the same population as Sault Ste. Marie and has over 1,000 cases since the start of the pandemic compared to just 60 for the Algoma district. 

"Part of it has to do with a little bit of luck," says Dr. Lucas Castellani, medical director of infection prevention and control at Sault Area Hospital.

"It makes you wonder how much it has to do with geography and transit between the areas."

He also gives credit to northern Ontario public health officials for clear messaging that has kept people from getting complacent as the pandemic has dragged on month after month.

Castellani also said we won't really know if northern Ontario has dodged the second wave until the numbers flatten out in southern Ontario and elsewhere in Canada.

"I think it's a little bit tricky to make those comparisons. It's always nice to have a goal that's lofty, because that's how you achieve success," he said. 

"I think there's room to use those comparisons to think about how we can do a better job, but is it healthy? If you're comparing it all the time, it's apples to oranges."

Dr. Ronald St. John, the former director general at the federal centre for emergency preparedness and response at the Public Health Agency of Canada, says the regional comparisons are often not very helpful.

He said physical distancing is a lot easier to do in a place like northern Ontario than a larger urban centre.

"If you have to go to work, let's say in Toronto on the subway, it's pretty hard to keep your social distance on the subway," St. John said. 

"Sometimes the behaviours are more difficult to follow in one place than another."

St. John said when he was making emergency plans in his old job the big concern for a place like northern Ontario  was the lack of access to hospitals and doctors. 

He said an outbreak of a deadlier form of coronavirus, such as the Middle East Respiratory Syndrome, which is 35 per cent fatal compared with about 1 per cent for COVID-19, would likely have hit rural areas harder than big cities. 

"I think it's a question of good fortune or I should say good fortune so far," infection control epidemiologist and University of Toronto professor Colin Furness says of northern Ontario's numbers. 

He points out that luck can change very suddenly. In the U.S., COVID hit the big cities first and then after a super spreader motorcycle rally, the virus is now growing faster in small cities and towns. 

"So, there's a bit of lesson there. COVID will go to urban areas first. It will go to rural areas if you propagate it," Furness said.

He said it is possible that there is a higher degree of immunity in northern Ontario because of long-term exposure to benign forms of coronavirus such as the common cold.

Furness said this is why it's thought that COVID-19 has spread less among young people and has had less of an impact in Africa.

"So we could say that northern Ontario might be experiencing something like Africa," he said. 

"That's possible. The fact of the matter is we would need to do some pretty sophisticated measurement to answer that question."

Furness said obviously right now the focus is on developing a vaccine. 

But he hopes that governments will also invest in some of that measuring to find out how COVID-19 has spread, why areas like northern Ontario have been so "lucky" and how we can better prepare for the next pandemic. 

"We've been caught flat-footed by COVID," Furness said, "It's outsmarted us all and I'd really like to turn the tide."