Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables December 10, 2020 CONFIDENTIAL - DO NOT CIRCULATE Key Findings • Cases continue to grow while percent positivity appears to be flattening. The impact of the Pandemic still varies widely across and within public health units. • Long-term care and overall mortality continue to increase and may exceed 25 deaths per day within a month. • The reproduction number is fluctuating around 1 which means that we are at a critical juncture where case rates may change quickly. • ICU occupancy will continue above 200 beds for the next month and may go higher, particularly if public health interventions are relaxed. Access to care deficits will persist. • For Ontarians with access to suitable housing and employment outside of essential services, case rates have increased at a slower pace. • Current lockdown has not had nearly as much impact on mobility (and likely contacts) as lockdown did in March. Relaxation of public health interventions with a widening prevention gap will likely lead to even higher case growth. 2 All Other PHUs, 29 Brant, 33 Durham, 82 Halton, 61 Hamilton, 80 Middlesex-London, 42 Niagara, 35 Ottawa, 30 Peel, 197 Waterloo, 79 WDG, 61 Windsor-Essex, 94 York, 104 Toronto, 118 PROTECT (cases ≥ 10) RESTRICT (cases ≥ 25) CONTROL (cases ≥ 40) 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29 Sep 5 Sep 12 Sep 19 Sep 26 Oct 3 Oct 10 Oct 17 Oct 24 Oct 31 Nov 7 Nov 14 Nov 21 Nov 28 Dec 5 Weekly new cases per 100,000 residents (7-day avg.) Total new cases per 100,000 residents per week across PHUs Data source: Case and Contact Management System, data up to December 8 Sept 19 Limits on social gathering sizes Oct 9 Modified Stage 2 begins in Toronto, Ottawa, and Peel Sept 17 In-person classes for all major school boards Sept 25 Restrictions on bars and restaurants Oct 16 Modified Stage 2 begins in York Nov 7 COVID19 RESPONSE FRAMEWORK Durham, Halton, Eastern to Protect. Ottawa and York to Restrict. Peel to Control + local restrictions. Toronto remains in Modified Stage 2. Nov 23 Toronto and Peel enter 28-day lockdown Dec 4 Middlesex￾London + T-Bay to Restrict. Haliburton to Protect Recent data subject to change PHUs are Public Health Units All Other PHUs, 13% Brant, 13% Durham, 17% Halton, 10% Hamilton, 14% Middlesex-London, 6% Niagara, 14% Ottawa, 7% Peel, 28% Waterloo, 21% WDG, 23% Windsor-Essex, 19% York, 19% Toronto, 70% 0 10 20 30 40 50 60 70 80 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29 Sep 5 Sep 12 Sep 19 Sep 26 Oct 3 Oct 10 Oct 17 Oct 24 Oct 31 Nov 7 Nov 14 Nov 21 Nov 28 Dec 5 Weekly new cases with "no known epi link" (7-day avg.) New cases with no epidemiological link across PHUs Data source: Case and Contact Management System, data up to December 8 Recent data subject to change COVID -19 testing % positivity across PHUs Data source: Ontario Laboratories Information System (OLIS), data up to December 4 All Other PHUs, 2 % Brant, 3 % Durham, 5 % Hamilton, 4 % Middlesex -London, 2 % Niagara, 2 % Ottawa, 2 % Waterloo, 4 % WDG, 3 % Windsor -Essex, 4 % York, 6 % Toronto, 6 % Peel, 11 % Halton, 4 % PROTECT (positivity ≥ 0.5%) RESTRICT (positivity ≥ 1.3%) CONTROL (positivity ≥ 2.5%) 0123456789 10 11 12 13 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29 Sep 5 Sep 12 Sep 19 Sep 26 Oct 3 Oct 10 Oct 17 Oct 24 Oct 31 Nov 7 Nov 14 Nov 21 Nov 28 % positivity of daily testing episodes (7-day avg.) Sept 24 Testing guidance update Oct 1 School & child care screening guidance change Oct 6 Assessment Centres move to advance booking Percent of COVID test results returned within 2 days across PHUs Data source: Ontario Laboratories Information System (OLIS), data up to December 4 All Other PHUs, 75% Brant, 40% Durham, 58% Hamilton, 79% Middlesex-London, 90% Niagara, 63% Ottawa, 83% Waterloo, 56% WDG, 53% York, 86% Toronto, 88% Peel, 77% Halton, 76% Windsor-Essex, 77% 0 10 20 30 40 50 60 70 80 90 100 110 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29 Sep 5 Sep 12 Sep 19 Sep 26 Oct 3 Oct 10 Oct 17 Oct 24 Oct 31 Nov 7 Nov 14 Nov 21 Nov 28 % of testing episodes with results released within 2 days of test (7-day avg.) Sept 24 Testing guidance update Oct 1 School & child care screening guidance change Oct 6 Assessment Centres move to advance booking Weekly % positivity by age group Data: OLIS LTC Home cases and outbreaks 8 Cases in LTC flattening, while deaths remain high (102 deaths in the past 7 days) Data Source: Ministry of Long Term Care Tracker. Data are self-reported by the long-term care homes to the Ministry of Long-Term Care. Daily case and death figures may not immediately match the numbers posted by the local public health units (i.e. iPHIS database) due to lags in reporting time. Current status (Dec 8) • 115 homes currently in outbreak, with 1194 confirmed cases currently in these homes • There have been 496 resident deaths since Aug 1st (493 since Sept 1st) 102 of which have been in the past 7 days • 37 of the 115 homes in outbreak are based on 1 staff case 0 100 200 300 400 500 600 700 800 Aug 1 Aug 15 Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov 15 Dec 1 COVID-19 cases and deaths for LTC residents and staff Daily Deaths, Residents Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Aug 1 Daily mortality is increasing and based on forecasting will continue to increase Forecasting: McMasterU. 9 Data (Observed Deaths): CCM+ maximum likelihood estimate 5% confidence band 95% confidence band Number of Deaths • Reported Number of Deaths - Predicted Number of Deaths 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 Cases / Day Projected Ontario cases at 0, 1, 3 and 5% increases per day mapped to progression in peer countries starting at 12/100,000 cases/day ON 2nd wave - 7-Day Average ON 2nd wave - Daily ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ France Germany Netherlands UK Michigan Ontario is following case growth of peer countries 10 France ON 3%↑ UK Netherlands Michigan ON 1%↑ ON 0%↑ ON 5%↑ Germany Predictions informed by modeling from McMasterU, COVID-19 ModCollab, PHO; recent growth in new daily cases; reported cases in peer jurisdictions Data (Observed Cases): covid-19.ontario.ca; https://ourworldindata.org; covidtracking.com Note: Ontario reached 12/100,000 cases between 1.5 and 3 months after these countries 0 100 200 300 400 500 600 700 800 900 01-Aug 08-Aug 15-Aug 22-Aug 29-Aug 05-Sep 12-Sep 19-Sep 26-Sep 03-Oct 10-Oct 17-Oct 24-Oct 31-Oct 07-Nov 14-Nov 21-Nov 28-Nov 05-Dec Confirmed COVID19 Acute Inpatients (excluding ICU) Confirmed COVID19 ICU Patients 11 Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA December 8 91.6% increase in COVID19 hospitalizations over most recent 4 weeks 165.9% increase in COVID19 patients in ICU COVID-19 hospitalizations and ICU admissions continue to rise 0 100 200 300 400 500 600 COVID-19 Patients in ICU / Day ON Observed ON Predicted ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ France Germany Netherlands UK Michigan Projections: ICU Occupancy > 200 beds under all scenarios for at least a month 12 France ON 3%↑ UK Netherlands Michigan ON 1%↑ ON 0%↑ ON 5%↑ Germany COVID-19 ModCollab. Data (Observed ICU Occupancy): CCSO Directive #2 LTC Action Plan Surgical Restart Resume LTC (re)admissions 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 -100% -80% -60% -40% -20% 0% 20% 40% 60% 80% Active cases of COVID-19 2020 vs 2019 (%) COVID Volumes Diagnostic Imaging (MRI/CT) Surgery ALC (Acute) 0% Line (No Change vs 2019) ER ER (Projected from triage volumes in eCTAS) Occupancy Rate Access to care continues well below 2019 volumes City of Toronto, excluding LTCH residents, up to Dec 2, 2020 : 7-day rolling average Communities with access to suitable housing have lower case growth but all rates are increasing University of Toronto, St. Michael’s Hospital, and ICES. Data: iPHIS and StatsCan City of Toronto, excluding LTCH residents, up to Dec 2, 2020 : 7-day rolling average Communities with more multi-generational housing have higher case growth but all rates are increasing University of Toronto, St. Michael’s Hospital, and ICES. Data: iPHIS and StatsCan Communities with more non-health care essential work have higher case growth but all rates are increasing City of Toronto, excluding LTCH residents, up to Dec 2, 2020 : 7-day rolling average University of Toronto, St. Michael’s Hospital, and ICES. Data: iPHIS and StatsCan Current restrictions have had less effect on mobility than in the Spring University of Toronto, St. Michael’s Hospital, ICES, and Bluedot 17 Data: Bluedot * Weighted by device count. Key Findings • Cases continue to grow while percent positivity appears to be flattening. The impact of the Pandemic still varies widely across and within public health units. • Long-term care and overall mortality continue to increase and may exceed 25 deaths per day within a month. • The reproduction number is fluctuating around 1 which means that we are at a critical juncture where case rates (and other impacts) may change quickly. • ICU occupancy will continue above 200 beds for the next month and may go higher, particularly if public health interventions are relaxed. Access to care deficits will persist. • For Ontarians with access to suitable housing and employment outside of essential services, case rates have increased at a slower pace. • Current lockdown has not had nearly as much impact on mobility (and likely contacts) as lockdown did in March. Relaxation of public health interventions with a widening prevention gap will likely lead to even higher case growth. 18