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Implementation of a population-based COVID-19 vaccine strategy, with a tailored approach to reduce inequities in 2-dose coverage, by a mid-sized local public health agency in southeastern Ontario, Canada.Coverage maps and crude and age-standardized coverage rates by material and social deprivation, urban/rural status, and sex were calculated biweekly and reviewed by local public health planners. In collaboration with community partners, the results guided targeted strategies to enhance uptake for marginalized populations.The largest gaps in vaccine coverage were for those living in more materially deprived areas and rural residents-coverage was lower by 10.9% (95% confidence interval: -11.8 to -10.0) and 9.3% (95% confidence interval: -10.4 to -8.1) for these groups compared with living in less deprived areas and urban residents, respectively. The gaps for all health equity indicators decreased statistically significantly over time. Targeted strategies included expanding clinic operating hours and availability of walk-in appointments, mobile clinics targeted to marginalized populations, leveraging primary care partners to provide pop-up clinics in rural and materially and socially deprived areas, and collaborating with multiple partners to coordinate communication efforts, especially in rural areas.The scale and scope of monitoring and improving local vaccine uptake are unprecedented. Regular review of health equity indicators provided critical situational awareness for decision makers, allowing partners to align and tailor strategies locally and in collaboration with one another. Health care providers and pharmacies/pharmacists are key partners who require innovative support to increase uptake in marginalized groups. Continued engagement of other community partners such as schools, municipalities, and local service groups is also crucial. A "hyper local" approach is needed along with commitment from partners in all sectors and at all levels to reduce barriers to vaccination that lie further upstream for marginalized groups.

Contexte : Pendant la pandémie de maladie à coronavirus 2019 (COVID-19), l’Ontario a créé un plan de réouverture de l’économie en trois phases. Des éclosions étaient attendues à chaque phase. Une semaine après la phase deux de réouverture dans la région de l’administration provinciale de santé publique de de Kingston, Frontenac, Lennox et Addington, un cas positif a été signalé après trois semaines sans nouveau cas de COVID-19. L’objectif de ce rapport est de décrire cette éclosion de la COVID-19, déclarée dans un établissement de services personnels, et l’intervention de la santé publique pour contenir cette éclosion. Méthodes : L’enquête sur l’éclosion a porté sur tous les cas de COVID-19 survenus dans la région de Kingston, Frontenac, Lennox et Addington entre le 20 juin 2020 et le 3 juillet 2020. Des inspecteurs et des infirmières en Santé publique ont été rapidement déployés pour inspecter l’ESP. Une approche multimodale des dépistages à haut volume a impliqué des centres d’évaluation fixes, des capacités de dépistage au volant et des dépistages ciblés sur le site de l’éclosion. Les tests de dépistage ont été effectués par une amplification en chaîne par polymérase en temps réel au laboratoire local de Santé publique Ontario. Résultats : Trente-sept cas ont été liés à cette éclosion : 38 % par exposition directe à l’ESP; 32 % par contact familial; et 30 % par contact social et professionnel. Un événement de supercontamination a contribué à 38 % du total des cas. La majorité des cas se situaient dans les quintiles inférieurs ou moyens lorsque l’on analysait la difficulté matérielle. Les taux de dépistage ont été multipliés par quatre par rapport aux semaines de référence précédentes en réponse aux messages médiatiques et aux messages de Santé publique, ce qui a entraîné un faible pourcentage de positivité. Conclusion : L’interaction entre les dépistages intensifs et accessibles, la rapidité d’exécution en laboratoire, la recherche des contacts dans les 24 heures suivant l’obtention de résultats de laboratoire positifs conformément aux normes provinciales, une communication publique fréquente, les inspections rapides, l’auto-isolement et le port obligatoire du masque ont permis de stopper l’éclosion. Des inspections ou des autovérifications doivent être exigées dans tous les ESP avant la réouverture et les responsables de la gestion des éclosions doivent travailler avec les ESP pour réduire la possibilité d’événements de supercontamination.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, Ontario created a three-phase reopening framework for the economy. Outbreaks were expected at each phase. One week after Phase Two of reopening in the provincial public health administration region of Kingston, Frontenac, Lennox and Addington (KFL&A), a positive case was reported after three weeks of zero new COVID-19 cases. The objective of this report is to describe this COVID-19 outbreak, linked to a personal service setting (PSS), and the public health response to contain the outbreak. Methods: The outbreak investigation included all COVID-19 cases in KFL&A between June 20, 2020 and July 3, 2020. Public health inspectors and nurses were rapidly deployed to inspect the PSS. A multimodal approach to high-volume testing involved fixed assessment centres, drive-through testing capacity and targeted testing at the outbreak site. Testing was conducted through a real-time polymerase chain reaction assay at the local Public Health Ontario laboratory. Results: Thirty-seven cases were associated with the outbreak: 38% through direct PSS exposure; 32% through household contact; and 30% through social and workplace contact. A superspreading event contributed to 38% of total cases. The majority of cases were in the low to mid-quintiles when analyzed for material deprivation. Testing rates increased four-fold compared to the prior baseline weeks in response to media attention and public health messaging, resulting in a low percent positivity. Conclusion: The interplay of aggressive accessible testing, quick lab turnaround time, contact tracing within 24 hours of positive laboratory results as per provincial standards, frequent public communication, rapid inspections, mandatory self-isolation and face coverings were measures successful in halting the outbreak. Inspections or self-audits should be required at all PSSs prior to reopening and outbreak management must work with PSSs to reduce the possibility of superspreading events.

The emergence and rapid global spread of SARS-CoV-2 demonstrates the importance of infectious disease surveillance, particularly during the early stages. Viral genomes can provide key insights into transmission chains and pathogenicity. Nasopharyngeal swabs were obtained from thirty-two of the first SARS-CoV-2 positive cases (March 18–30) in Kingston Ontario, Canada. Viral genomes were sequenced using Ion Torrent (n = 24) and MinION (n = 27) sequencing platforms. SARS-CoV-2 genomes carried forty-six polymorphic sites including two missense and three synonymous variants in the spike protein gene. The D614G point mutation was the predominate viral strain in our cohort (92.6%). A heterozygous variant (C9994A) was detected by both sequencing platforms but filtered by the ARTIC network bioinformatic pipeline suggesting that heterozygous variants may be underreported in the SARS-CoV-2 literature. Phylogenetic analysis with 87,738 genomes in the GISAID database identified global origins and transmission events including multiple, international introductions as well as community spread. Reported travel history validated viral introduction and transmission inferred by phylogenetic analysis. Molecular epidemiology and evolutionary phylogenetics may complement contact tracing and help reconstruct transmission chains of emerging diseases. Earlier detection and screening in this way could improve the effectiveness of regional public health interventions to limit future pandemics.