Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables January 28, 2021 CONFIDENTIAL - DO NOT CIRCULATE Key Findings • Cases and positivity are down across Public Health Units but testing volumes are also slightly down. Sustained high testing volumes will be important to control of the pandemic. • Cases are declining across long-term care homes but deaths continue to rise (215 in the last seven days). We are still likely to surpass total deaths from the first wave. Interventions to reduce deaths in long-term care will be critical. • Hospitalizations are declining but strained ICU capacity continues. COVID-19 has an outsized impact on our health system. This access to care deficit continues to grow and will have short and longer-term negative impacts on health. • There has been some reduction in mobility. But essential work is still strongly associated with risk of infection. Safe workplaces will be important to control COVID-19. • The new variant of concern (B.1.1.7) is spreading in Ontario and is a significant threat to control of the Pandemic. However, modelling and international examples suggest that maintaining public health interventions will support continued reductions in cases, even with a return to school. 2 All Other PHUs, 22 Ottawa, 70 Simcoe Muskoka, 76 Brant, 49 Halton, 79 Lambton, 154 Peel, 200 Windsor-Essex, 196 York, 127 Huron-Perth, 100 Haldimand-Norfolk, 71 Middlesex-London, 90 Waterloo, 122 Southwestern, 80 Durham, 85 Niagara, 171 Toronto, 170 Wellington-Dufferin-Guelph, 121 Chatham-Kent, 85 CONTROL (cases ≥ 40) RESTRICT (cases ≥ 25) PROTECT (cases ≥ 10) 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 Jan 9 Jan 16 Jan 23 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 24 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 Jan 18 First round LTC vaccinations complete in prioritized PHUs 3 Middlesex-London, 2.4 Hamilton, 3.7 Ottawa, 2.8 Eastern, 2.5 Peel, 9.9 Durham, 4.6 Windsor-Essex, 4.8 Wellington-Dufferin-Guelph, 4.4 All Other PHUs, 2.0 York, 7.8 Southwestern, 3.1 Halton, 4.6 Simcoe Muskoka, 3.2 Lambton, 2.2 Chatham-Kent, 3.1 Waterloo, 4.7 Haldimand-Norfolk, 2.4 Brant, 2.6 Toronto, 7.6 Niagara, 7.6 PROTECT (positivity ≥ 0.5%) RESTRICT (positivity ≥ 1.3%) CONTROL (positivity ≥ 2.5%) 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 Jan 9 Jan 16 Jan 23 % positivity of daily testing episodes (7-day avg.) Data source: Ontario Laboratories Information System (OLIS), data up to January 24 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 COVID-19 testing percent positivity across PHUs 4 Cases and percent positivity have declined across most age groups but testing volumes have also fallen. 5 Analysis: DLSPH Data: OLIS Data Source: Ministry of Long Term Care Tracker, Jan 25th extraction based on data reported up to 3:30 pm Jan 24th, 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. Current status 256 LTC homes have COVID-19 outbreaks (41% of all homes), 80 outbreaks involve just one case Since January 1st 596 LTC residents have died of COVID-19 and 3 staff deaths have been reported The number of resident cases has been decreasing for the past 10 days (peaked on Jan 14th) 6 Cases are dropping but mortality in long-term care continues to increase (215 resident deaths in the last seven days) 0 200 400 600 800 1000 1200 1400 1600 1800 Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov 15 Dec 1 Dec 15 Jan 1 15- Jan COVID-19 cases and deaths for LTC residents and staff Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Sept 1 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) 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 24, 2021 Size of outbreak (staff and residents) Stay-at-home order has reduced overall mobility 9 Stay-at-home order reduced mobility by a small amount 10 Analysis: COVID Heterogeneity Research Group Data: Google Communities with highest proportion of essential workers continue to have the highest case numbers 11 Analysis: COVID Heterogeneity Research Group Data: iPHIS and StatsCan Countries that have maintained public health measures are seeing declines in cases despite increased B117 prevalence 12 0 100 200 300 400 500 600 700 800 900 1,000 Daily New Cases per 1 Million People (7-Day Average) Denmark France Germany Netherlands United Kingdom Ontario Mean decrease in daily number of cases since most recent peak: • Netherlands: 2% • Germany: 3% • UK: 4% • Denmark: 4% • Ontario: 3% UK NL FR DK ON GER Cases are decreasing. This is driving decreased hospitalization but not yet decreased ICU occupancy. 13 Predictions informed by modeling from COVID-19 ModCollab, Fields Institute, McMasterU, PHO, QueensU, YorkU; recent growth in new daily cases; reported case trajectories in peer jurisdictions Data (Observed Cases): covid-19.ontario.ca ON 1%↓ ON 3% ↓ ON 5% ↓ - 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 Daily New Cases ON - Daily ON - 7-Day Mean ON 5%↓ ON 3%↓ ON 1%↓ VOC VOC ↑ 0 50 100 150 200 250 300 350 400 450 500 Observed ON Predicted ON 5%↓ ON 3%↓ ON 1%↓ ON 0%↓ (Constant) VOC ↑ Capacity Projections: COVID-19 ICU occupancy 150-300 beds end of February 14 ON 0% ↓ ON 1%↓ ON 3% ↓ ON 5% ↓ Predictions: COVID-19 ModCollab. Data (Observed ICU Occupancy): CCSO 150 beds VOC ↑ ICU capacity remains strained in most regions with about half of all hospitals with only 1 or 2 beds free Analysis: COVID-19 ModCollab. 15 Data: Bed Census COVID-19 creates a high burden on hospitals 3,500 3,000 2,500 2,000 1,500 1,000 500 0 Number of Beds Max # of beds 3,513 Max # of beds 1,301 Max # of beds 754 20/04 20/05 20/06 20/07 20/08 20/09 20/10 20/11 20/12 21/01 Jan Mar May Jul Sep Nov Jan COVID timelines Flu timelines COVID-19 2018 flu 2009 flu 16 Directive #2 LTC Action Plan Surgical Restart Resume LTC (re)admissions 0 5,000 10,000 15,000 20,000 25,000 30,000 -100% -50% 0% 50% 100% 150% 2020 2021 Weekly Confirmed New COVID-19 Cases Change vs Previous Year (%) Confirmed COVID Volumes Diagnostic Imaging (MRI/CT) Surgery ALC (Acute) 0% Line (No Change vs Prev Yr) ER ER (Projected from triage volumes in eCTAS) Occupancy Rate And access to non COVID-19 care continues to decline Temporary holiday spike in surgical activity relative to 2019 volumes Data for most recent week incomplete 17 The Novel SARS-CoV-2 variant B.1.1.7 appears to be much more easily transmitted • The novel SARS-CoV-2 variant B.1.1.7 emerged in England in November and is spreading in Ontario • Transmissibility is likely at least 30% higher • UK: Transmissibility is 56% higher (95% credible interval 50-74%) • UK: Secondary Attack Rate is 36% higher • Denmark: Reproduction number (R) is 1.36 compared to other variants (95% CI 1.19; 1.53) • Current UK evidence summary notes potential for higher mortality “realistic possibility that infection with VOC B.1.1.7 is associated with an increased risk of death compared to infection with non-VOC viruses” • Vaccines likely still effective • Other variants of concern: B.1.351, P.1 (both with increased transmissibility, increased risk of re-infection) • Other variants likely to emerge Sources: Public Health England Technical Reports; NERVTAG report; Davies NG et al (LSHTM); Statens Serum Institut Denmark Ekspertrapport af den 15. Januar 2021 18 With public health measures, cases should decline even with school opening. Infection control will be critical in schools. Predictions: COVID-19 ModCollab. 19 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 01-01 01-08 01-15 01-22 01-29 02-05 02-12 02-19 02-26 New daily COVID-19 cases Effect of school operating status with VOC present starting from 1% on 9 Dec, 2020 Reported Cases Schools open Schools closed Data Source: COVax. Data extracted 8:00pm nightly (Health Data Branch, MOH). Includes Pfizer and Moderna vaccines. Excludes records where dose administration status is not known. Current status Since December 15, 2020, 295,816 vaccine doses have been administrated in Ontario. These administrations include Pfizer and Moderna vaccines. 90% of vaccine administrations have been since Jan 1 2021. 20 Cumulative COVID-19 vaccine dose administrations (295,816 doses to January 25th, 2021) 0 200 400 600 800 1000 1200 1400 1600 1800 Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov 15 Dec 1 Dec 15 Jan 1 15- Jan COVID-19 cases and deaths for LTC residents and staff Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Sept 1 0 50 100 150 200 250 300 350 15-Dec 16-Dec 17-Dec 18-Dec 19-Dec 20-Dec 21-Dec 22-Dec 23-Dec 24-Dec 25-Dec 26-Dec 27-Dec 28-Dec 29-Dec 30-Dec 31-Dec 01-Jan 02-Jan 03-Jan 04-Jan 05-Jan 06-Jan 07-Jan 08-Jan 09-Jan 10-Jan 11-Jan 12-Jan 13-Jan 14-Jan 15-Jan 16-Jan 17-Jan 18-Jan 19-Jan 20-Jan 21-Jan 22-Jan 23-Jan 24-Jan 25-Jan Doses Administered Thousands Cumulative COVID-19 Vaccinations 2020 2021 Source: COVAX 295,816 Key Findings • Cases and positivity are down across Public Health Units but testing volumes are also slightly down. Sustained high testing volumes will be important to control of the pandemic. • Cases are declining across long-term care homes but deaths continue to rise (215 in the last seven days). We are still likely to surpass total deaths from the first wave. Interventions to reduce deaths in long-term care will be critical. • Hospitalizations are declining but strained ICU capacity continues. COVID-19 has an outsized impact on our health system. This access to care deficit continues to grow and will have short and longer-term negative impacts on health. • There has been some reduction in mobility. But essential work is still strongly associated with risk of infection. Safe workplaces will be important to control COVID-19. • The new variant of concern (B.1.1.7) is spreading in Ontario and is a significant threat to control of the Pandemic. However, modelling and international examples suggest that maintaining public health interventions will support continued reductions in cases, even with a return to school. 21 Contributors • COVID Heterogeneity Research Group: Rafal Kustra, Huiting Ma, Siyi Wang, Gary Moloney, Kristy Yiu, Beate Sander, Jeff Kwong, Stefan Baral, Sharmistha Mishra • COVID-19 Modeling Collaborative: Kali Barrett, Stephen Mac, David Naimark, Aysegul Erman, Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander • DLSPH: Ashleigh Tuite, David Fisman • Fields Institute: Kumar Murty • QueensU: Troy Day • McMasterU: Michael Li, Irena Papst, Ben Bolker, Jonathan Dushoff, David Earn • YorkU: Jianhong Wu, Francesca Scarabel, Bushra Majeed • MOHLTC: Michael Hillmer, Kamil Malenvov, Qing Huang, Jagadish Rangrej, Nam Bains, Jennifer Bridge • OH: Erik Hellsten, Stephen Petersen, Anna Lambrinos, Chris Lau, Access to Care Team • PHO: Sarah Buchan, Kevin Brown 22 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 23