Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables January 12, 2021 CONFIDENTIAL - DO NOT CIRCULATE Key Findings • Growth in cases has accelerated and is over 7% on the worst days. • Almost 40% of long-term care homes have active COVID-19 outbreaks. Since January 1st 198 LTC residents and 2 LTC staff have died of COVID-19. Forecasts suggest more deaths in wave 2 in long￾term care than in wave 1. • COVID-19 ICU occupancy is now over 400 beds. Surgeries are being cancelled and the access to care deficit will continue to increase with real consequences for health. • Mobility, and contacts between people have not decreased with the current restrictions. Survey data show that the majority of Ontarians are helping limit spread by following them. However, case numbers will not decline until more of the population follows their example. • A new variant of concern of SARS-CoV-2 (B117) could drive much higher case counts, ICU occupancy and mortality if community transmission occurs. The doubling time for cases could drop by more than 2/3. This new variant is now in Ontario. • Without significant reductions in contacts, the health system will be overwhelmed and mortality will exceed the first wave totals before a vaccine has time to take effect. 2 All Other PHUs, 32 Ottawa, 80 Simcoe Muskoka, 72 Hamilton, 158 Brant, 103 Halton, 115 Lambton, 253 Peel, 232 Windsor-Essex, 323 York, 197 Toronto, 180 PROTECT (cases ≥ 10) Haldimand-Norfolk, 106 Chatham-Kent, 126 Eastern, 142 Durham, 145 Wellington-Dufferin-Guelph, 128 Southwestern, 145 Middlesex-London, 132 Waterloo, 145 RESTRICT (cases ≥ 25) CONTROL (cases ≥ 40) Niagara, 182 0 50 100 150 200 250 300 350 400 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 Dec 12 Dec 19 Dec 26 Jan 2 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 January 8 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 COVID-19 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 14 York and Windsor￾Essex enter lockdown Recent data subject to change Dec 4 Middlesex￾London + T-Bay to Restrict. Haliburton to Protect Sept 19 Limits on social gathering sizes Dec 26 Province-wide lockdown 14 days N. ON 28 days S. ON 3 Middlesex-London, 6% Hamilton, 6% Ottawa, 5% Eastern, 7% Peel, 13% Durham, 8% Windsor-Essex, 14% Wellington-Dufferin-Guelph, 5% All Other PHUs, 4% York, 10% Southwestern, 7% PROTECT (positivity ≥ 0.5%) Halton, 7% RESTRICT (positivity ≥ 1.3%) CONTROL (positivity ≥ 2.5%) Simcoe Muskoka, 3% Lambton, 10% Chatham-Kent, 9% Waterloo, 7% Haldimand-Norfolk, 5% Toronto, 10% Niagara, 6% Brant, 5% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 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 Dec 12 Dec 19 Dec 26 Jan 2 % positivity of daily testing episodes (7-day avg.) COVID-19 testing % positivity across PHUs Data source: Ontario Laboratories Information System (OLIS), data up to January 4 Sept 24 Testing guidance update Oct 6 Assessment Centres move to advance booking Oct 1 School & childcare screening guidance change Nov 7 COVID-19 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 14 York and Windsor￾Essex enter lockdown Dec 4 Middlesex￾London + T-Bay to Restrict. Haliburton to Protect Dec 26 Province-wide lockdown 14 days N. ON 28 days S. ON 4 Halton, 90% Hamilton, 91% Lambton, 63% Haldimand-Norfolk, 84% Durham, 81% Middlesex-London, 86% Wellington-Dufferin-Guelph, 66% All Other PHUs, 77% York, 75% Toronto, 92% Southwestern, 73% Eastern, 85% Peel, 86% Waterloo, 76% Simcoe Muskoka, 71% Windsor-Essex, 72% Brant, 75% Niagara, 84% Chatham-Kent, 84% Ottawa, 84% 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 Dec 5 Dec 12 Dec 19 Dec 26 Jan 2 % of testing episodes with results released within 2 days of test (7-day avg.) Percent of COVID test results returned within 2 days across PHUs Data source: Ontario Laboratories Information System (OLIS), data up to January 4 Sept 24 Testing guidance update Oct 6 Assessment Centres move to advance booking Oct 1 School & childcare screening guidance change Nov 7 COVID-19 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 14 York and Windsor￾Essex enter lockdown Dec 4 Middlesex￾London + T-Bay to Restrict. Haliburton to Protect Dec 26 Province-wide lockdown 14 days N. ON 28 days S. ON 5 Weekly % positivity by age group Legend: Data Source: Ontario Laboratory Information System (OLIS), MOH – extracted from SAS VA Jan 10 Note: Includes all data submitted to OLIS up to January 7th 2021. The last six days are considered interim data (week 52) and subject to change Weekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week Weekly % positivity by age group 6 Data Source: Ministry of Long-Term Care Tracker, Dec 19th extraction based on data reported up to 3:30 pm Jan 9th, 2021. 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. 7 Cases and cumulative mortality LTC increasing (198 resident and 2 staff deaths since January 1st) 0 250 500 750 1000 1250 1500 Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov 15 Dec 1 Dec 15 Jan 1 COVID-19 cases and deaths for LTC residents and staff Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Sept 1 Current status 252 LTC homes have COVID-19 outbreaks (40% of all homes) with 105 outbreaks involving resident cases Outbreaks are occurring across almost all public health units, with 91 outbreaks (37%) occurring in priority vaccination areas of Toronto, Peel, York and Windsor-Essex Since January 1st, 198 LTC residents have died of COVID-19 and 2 staff deaths have been reported Forecasts suggest there will be more LTC residents deaths in wave 2 than in wave 1 (1,815 total deaths) 1,119 actual deaths as of Jan 9, 2021 0 500 1,000 1,500 2,000 2,500 3,000 Cumulative LTC resident COVID-19 deaths Date Projected and actual cumulative LTC resident COVID-19 deaths (Sep 1, 2020-Feb 14, 2021) Projected deaths Actual cumulative deaths (MLTC tracker) Last day of forecast: Feb 14, 2021 2,639 projected deaths as of Feb 14, 2021 (worst case) Projections: second wave cumulative LTC resident COVID-19 deaths >2,600 by Feb 14 in worst case scenario 8 Predictions: MOH Capacity Planning and Analytics Division Data: (Cumulative Deaths): MLTC Tracker Tool Public Health Unit 2226 Algoma Public Health Unit 2227 Brant County Health Unit 2230 Durham Region Health Department 2233 Grey Bruce Health Unit 2234 Haldimand -Norfolk Health Unit 2235 Haliburton, Kawartha, Pine Ridge District Health Unit 2236 Halton Region Health Department 2237 Hamilton Public Health Services 2238 Hastings & Prince Edward Counties Health Unit 2240 Chatham -Kent Health Unit 2241 Kingston, Frontenac and Lennox & Addington Health Unit 2242 Lambton Health Unit 2243 Leeds, Grenville & Lanark District Health Unit 2244 Middlesex -London Health Unit 2246 Niagara Region Public Health Department 2247 North Bay Parry Sound District Health Unit 2249 Northwestern Health Unit 2251 Ottawa Public Health 2253 Peel Public Health 2255 Peterborough Public Health 2256 Porcupine Health Unit 2257 Renfrew County & District Health Unit 2258 Eastern Ontario Health Unit 2260 Simcoe Muskoka District Health Unit 2261 Sudbury and District Health Unit 2262 Thunder Bay District Health Unit 2263 Timiskaming Health Unit 2265 Region of Waterloo, Public Health 2266 Wellington -Dufferin -Guelph Health Unit 2268 Windsor -Essex County Health Unit 2270 York Region Public Health 3895 Toronto Public Health 4913 Southwestern Public Health 5183 Huron Perth Health Unit Long -term Care Outbreaks July 1, 2020 Size of outbreak (staff and residents) 9 Public Health Unit 2226 Algoma Public Health Unit 2227 Brant County Health Unit 2230 Durham Region Health Department 2233 Grey Bruce Health Unit 2234 Haldimand -Norfolk Health Unit 2235 Haliburton, Kawartha, Pine Ridge District Health Unit 2236 Halton Region Health Department 2237 Hamilton Public Health Services 2238 Hastings & Prince Edward Counties Health Unit 2240 Chatham -Kent Health Unit 2241 Kingston, Frontenac and Lennox & Addington Health Unit 2242 Lambton Health Unit 2243 Leeds, Grenville & Lanark District Health Unit 2244 Middlesex -London Health Unit 2246 Niagara Region Public Health Department 2247 North Bay Parry Sound District Health Unit 2249 Northwestern Health Unit 2251 Ottawa Public Health 2253 Peel Public Health 2255 Peterborough Public Health 2256 Porcupine Health Unit 2257 Renfrew County & District Health Unit 2258 Eastern Ontario Health Unit 2260 Simcoe Muskoka District Health Unit 2261 Sudbury and District Health Unit 2262 Thunder Bay District Health Unit 2263 Timiskaming Health Unit 2265 Region of Waterloo, Public Health 2266 Wellington -Dufferin -Guelph Health Unit 2268 Windsor -Essex County Health Unit 2270 York Region Public Health 3895 Toronto Public Health 4913 Southwestern Public Health 5183 Huron Perth Health Unit Long -term Care Outbreaks October 1, 2020 Size of outbreak (staff and residents) 10 Public Health Unit 2226 Algoma Public Health Unit 2227 Brant County Health Unit 2230 Durham Region Health Department 2233 Grey Bruce Health Unit 2234 Haldimand -Norfolk Health Unit 2235 Haliburton, Kawartha, Pine Ridge District Health Unit 2236 Halton Region Health Department 2237 Hamilton Public Health Services 2238 Hastings & Prince Edward Counties Health Unit 2240 Chatham -Kent Health Unit 2241 Kingston, Frontenac and Lennox & Addington Health Unit 2242 Lambton Health Unit 2243 Leeds, Grenville & Lanark District Health Unit 2244 Middlesex -London Health Unit 2246 Niagara Region Public Health Department 2247 North Bay Parry Sound District Health Unit 2249 Northwestern Health Unit 2251 Ottawa Public Health 2253 Peel Public Health 2255 Peterborough Public Health 2256 Porcupine Health Unit 2257 Renfrew County & District Health Unit 2258 Eastern Ontario Health Unit 2260 Simcoe Muskoka District Health Unit 2261 Sudbury and District Health Unit 2262 Thunder Bay District Health Unit 2263 Timiskaming Health Unit 2265 Region of Waterloo, Public Health 2266 Wellington -Dufferin -Guelph Health Unit 2268 Windsor -Essex County Health Unit 2270 York Region Public Health 3895 Toronto Public Health 4913 Southwestern Public Health 5183 Huron Perth Health Unit Long -term Care Outbreaks January 7, 2021 Size of outbreak (staff and residents) 11 Despite some reduced mobility from “Grey Zone” restrictions, there was a pre-holiday spike 12 Analysis: UofT, St. Michael’s Hospital, ICES Data: Google % change relative to January 2020 “Grey Zone” restrictions did not affect the proportion of people working from home; holiday decreases are not likely to persist 13 Analysis: UofT, St. Michael’s Hospital, ICES Data: Google % change relative to January 2020 With current restrictions, almost 2/3 of the population are acting in a way that will decrease COVID-19 spread • Are people in your neighbourhood physically distancing? • In the last 4 weeks, how many people outside your household visited your house (meal, celebration, stay over)? • And if so, did you observe restrictions? 14 3 or more 1-2 None Didn’t observe restrictions Observed restrictions Survey: Fields Institute Occasionally or never Most of the time/sometimes All the time - 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 12-21 12-28 01-04 01-11 01-18 01-25 02-01 02-08 Daily New Cases (Other Countries Aligned at 230/1M Population/Day) ON - Daily ON - 7-Day Mean ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ ON 7%↑ FRA GER NLD UK As happened in other jurisdictions, case growth continues under current levels of restrictions 15 ON 3%↑ ON 1%↑ ON 0%↑ ON 7%↑ Predictions informed by modeling from McMasterU, Fields Institute, 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 Note: Ontario reached 23/100,000 cases between 1.5 and 3 months after these countries ON 5%↑ 0 500 1,000 1,500 2,000 2,500 3,000 3,500 ICU Beds Occupied with COVID-19 Patients (per Day) ON Observed ON Predicted ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ ON 7%↑ Projections: COVID-19 ICU occupancy around 500 beds in mid￾January, potentially over 1,000 beds in February in more severe, but realistic scenarios 16 ON 0%↑ ON 1%↑ ON 3%↑ ON 5%↑ ON 7%↑ Predictions: COVID-19 ModCollab. Data (Observed ICU Occupancy): CCSO 150 beds At 9% growth rate (not shown): >2,000 occupancy Feb 5 0 100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 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 12-Dec 19-Dec 26-Dec 02-Jan Confirmed COVID19 Acute Inpatients (excluding ICU) Confirmed COVID19 ICU Patients 17 Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System, extracted January 9 Over the past 4 weeks: 72.2% increase in hospitalizations 61.2% increase in ICU patients COVID-19 hospitalizations and ICU admissions continue to climb One quarter of hospitals have no ICU beds free, another quarter have only 1 or 2 beds free 18 0% 20% 40% 60% 80% 100% 120% 140% 160% Cornwall Community Hospital n = 11 Hamilton Health Sciences General n = 31 Humber River Wilson n = 46 Markham Stouffville n = 15 Michael Garron Hospital n = 17 Niagara Health System St. Catharines n = 14 Oakville Trafalgar Memorial Hospital n = 21 Quinte Healthcare Belleville n = 18 Scarborough Centenary n = 20 St. Thomas-Elgin General Hospital n = 8 Stratford General Hospital n = 6 Sunnybrook Health Sciences Centre n = 52 Trillium Credit Valley Hospital n = 24 William Osler Etobicoke Campus n = 14 Windsor Regional Metropolitan Campus n = 19 Chatham-Kent n = 10 Georgian Bay General Hospital n = 6 Mackenzie Health n = 30 Orillia Soldiers Memorial Hospital n = 8 Southlake Regional Health Centre n = 18 Unity Health St. Michael's n = 29 Bluewater Health Sarnia General Hospital n = 14 Cambridge Memorial Hospital n = 12 Grey Bruce Health Services Owen Sound n = 6 Guelph General Hospital n = 10 Hamilton Health Sciences Juravinski Hospital n = 23 Kingston Health Sciences Centre n = 33 Queensway - Carleton Hospital n = 12 Royal Victoria Regional Health Centre n = 15 Scarborough Birchmount n = 15 St. Mary's General Hospital n = 13 The Ottawa Hospital Civic Campus n = 29 UHN Toronto Western Hospital n = 33 Unity Health St. Joseph's n = 18 Brantford General Hospital n = 15 Brockville Genearl Charles St n = 10 Grand River Kitchener Waterloo n = 20 Halton Healthcare Milton District Hospital n = 8 Health Sciences North n = 14 Hopital Montfort n = 12 Joseph Brant Hospital n = 24 Lakeridge Health Ajax n = 13 Lakeridge Health Oshawa n = 32 LHSC University Campus n = 25 LHSC Victoria Campus n = 31 Mount Sinai Hospital n = 21 Niagara Health System Greater Niagara n = 15 North Bay Regional Health Centre n = 16 North York General Hospital n = 23 Pembroke Regional Hospital Inc. n = 9 Peterborough Regional Hospital Drive n = 28 Ross Memorial Hospital n - 9 Sault Area Hospital n = 13 Scarborough General n = 29 St Joseph's Healthcare System Charlton n = 27 The Ottawa Hospital General Campus n = 29 Thunder Bay Regional Health Sciences Centre n = 22 Trillium Mississauga Hospital n = 37 UHN Toronto General Hospital n = 38 William Osler Brampton Campus n = 24 Windsor Regional Ouellette Campus n = 20 Woodstock General Hospital n = 12 0 Free Beds 1 Free Bed 2 Free Beds 3+ Free Beds Percentage of L3 MSICU Beds Occupied Percentage of Ontario L3 Medical Surgical ICU Beds Occupied on January 8, 2021, by Number of Available Beds Other ICU Patients Patients with COVID-19 = 100% Occupancy 85% Occupancy Access to care continues to decline below 2019 levels Dec. 21 to 27 holiday fluctuation in surgical volumes 19 Daily mortality is increasing under current restrictions, doubling from 50 to 100 deaths per day between now and end of February Forecasting: McMasterU. 20 Data (Observed Deaths): CCM+ Assumption: continue current restrictions. 0 100 200 300 400 500 600 700 800 900 1000 2-1-20 3-1-20 4-1-20 5-1-20 6-1-20 7-1-20 8-1-20 9-1-20 10-1-20 11-1-20 12-1-20 1-1-21 Daily New Cases per 1 Million People (7-Day Average) France Germany Netherlands United Kingdom Ontario The Novel SARS-CoV-2 variant: B.1.1.7 appears to be much more easily transmitted • Novel SARS-CoV-2 variant, B.1.1.7, emerged in southeast England in November • Transmissibility: 56% ↑ (95% credible interval 50-74%) • No increase in disease severity, vaccines likely still effective 21 800 Cases/1M Pop ~ 12,000 cases/Day for ON Population Sources: Public Health England Technical Reports; Davies NG et al (LSHTM) Sources: https://ourworldindata.org; CCM+ UK NLD GER FRA ON If the SARS-CoV-2 variant B.1.1.7 spreads in the community, doubling time for cases could drop to 10 days in March Predictions: QueensU Assumptions: 1 case infected with B.1.1.7. from the UK entering Ontario mid-Oct, transmissibility of variant 56% ↑ than other circulating variants (based on UK data), continue current restrictions. 22 Key components of hard lockdowns in peer jurisdictions Victoria, Australia France (Fall) UK* Germany* Netherlands* Strict stay-at-home order / movement restrictions ✓ ✓ ✓ ✓ ✓ Non-essential retail closed ✓ ✓ ✓ ✓ ✓ Bars, restaurants , gyms etc. closed ✓ ✓ ✓ ✓ ✓ Most workplaces closed ✓ ✓ ✓ ✓ ✓ Schools closed ✓ ✕ ✓ ✓ ✓ Mandatory masking outdoors ✓ ✓ ✕ ✕ ✕ Testing blitz in high risk areas ✓ ✕ ✕ ✕ ✕ Curfew ✓ ✓ ✕ ✓ ✕ Enforcement ✓ ✓ ✓ ✓ ✓ 23 ✓ = fully imposed, ✓ = partially imposed, ✕ = not imposed, *Currently in lockdown Key Findings • Growth in cases has accelerated and is over 7% on the worst days. • Almost 40% of long-term care homes have active COVID-19 outbreaks. Since January 1st 198 LTC residents and 2 LTC staff have died of COVID-19. Forecasts suggest more deaths in wave 2 in long-term care than in wave 1. • COVID-19 ICU occupancy is now over 400 beds. Surgeries are being cancelled and the access to care deficit will continue to increase with real consequences for health. • Mobility, and contacts between people have not decreased with the current restrictions. Survey data show that the majority of Ontarians are helping limit spread by following them. However, case numbers will not decline until more of the population follows their example. • A new variant of concern of SARS-CoV-2 (B117) could drive much higher case counts, ICU occupancy and mortality if community transmission occurs. The doubling time for cases could drop by more than 2/3. This new variant is now in Ontario. • Without significant reductions in contacts, the health system will be overwhelmed and mortality will exceed the first wave totals before a vaccine has time to take effect. 24 Content provided by Modelling Consensus and Scientific Advisory Table members and secretariat Beate Sander,* Peter Juni, Brian Schwartz,* Kumar Murty,* Upton Allen, Vanessa Allen, Nicholas Bodmer, Isaac Bogoch, Kevin Brown, Sarah Buchan, Yoojin Choi, Troy Day, David Earn, Gerald Evans, David Fisman, Jennifer Gibson, Anna Greenberg, Anne Hayes, Michael Hillmer, Jessica Hopkins, Jeff Kwong, Audrey Laporte, John Lavis, Gerald Lebovic, Brian Lewis, Linda Mah, Kamil Malikov, Antonina Maltsev, Doug Manuel, Allison McGeer, David McKeown, John McLaughlin, Sharmistha Mishra, Justin Morgenstern, Samira Mubareka, Laveena Munshi, Christopher Mushquash, Ayodele Odutayo, Shahla Oskooei, Samir Patel, Bill Praamsma, Justin Presseau, Fahad Razak, Paula Rochon, Laura Rosella, Arjumand Siddiqi, Chris Simpson, Arthur Slutsky, Janet Smylie, Nathan Stall, Ashleigh Tuite, Jennifer Walker, Tania Watts, Ashini Weerasinghe, Scott Weese, Xiaolin Wei, Jianhong Wu, Diana Yan, Emre Yurga * Chairs of Scientific Advisory or Modelling Consensus Tables 25