Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables February 11, 2021 Key Findings 2 • Public health measures are paying off in declining mobility, cases, positivity, and hospitalizations. • Focussing vaccination on long-term care homes is paying off with declining daily deaths. • ICU occupancy is flat and the access to care deficit continues to grow. • The B.1.1.7 Variant of Concern is spreading. Cases will likely grow again in late February with ICU admissions increasing afterwards. • Aggressive vaccination and sticking with stay-at-home order will help avoid a third wave and a third lockdown. • Some key mental health indicators are unchanged. However, important measures such as emergency department admissions, opioid deaths and care for eating disorders are worsening. Declines in mobility have helped reduce cases 3 Ontario Quebec Alberta Manitoba British Columbia 4 4 5 5 Cases and percent positivity declined across age groups. 6 7 Vaccine dose administrations Data Source: COVax. Data to Jan 22nd extracted from COVax Dose Admin by Day Report. Jan 23rd-Feb 7th: COVax daily reports (Health Data Branch, MOH). Includes Pfizer and Moderna vaccines. Excludes records where status is not known. Current status Since December 15, 2020, 426,834 vaccine dose administrations have been reported in COVax. These administrations include Pfizer and Moderna vaccines. 92% of vaccine administrations have been since Jan 1, 2021. 7 Cumulative COVID-19 vaccine dose administrations (426,834 doses to Feb 10, 2021) 0 50 100 150 200 250 300 350 400 450 15-Dec 17-Dec 19-Dec 21-Dec 23-Dec 25-Dec 27-Dec 29-Dec 31-Dec 02-Jan 04-Jan 06-Jan 08-Jan 10-Jan 12-Jan 14-Jan 16-Jan 18-Jan 20-Jan 22-Jan 24-Jan 26-Jan 28-Jan 30-Jan 01-Feb 03-Feb 05-Feb 07-Feb 09-Feb Doses Administered Thousands Cumulative COVID-19 Vaccinations 2020 2021 Source: COVAX 426,834 The majority of deaths arise from long-term care. Analysis: COVID-19 ModCollab. 8 Data: CCM+ Data Source: Ministry of Long Term Care Tracker, Feb 8th extraction based on data reported up to 3:30 pm Feb 7th, 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 213 LTC homes have COVID-19 outbreaks (34% of all homes) with 90 outbreaks involving resident cases. 25 of 34 PHUs have at least 1 home in outbreak. Since January 1st 900 LTC residents and 3 staff have died of COVID-19. Wave 2 deaths (1,821) now roughly equal to Wave 1 (1,848). 9 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov 15 Dec 1 Dec 15 Jan 1 15- Jan 01- Feb COVID-19 cases and deaths for LTC residents and staff Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Sept 1 Long-term care key indicators improved. 10 Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA February 9, 2021. Does not include patients in alternative health facilities (AHFs) 0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 Confirmed COVID-19 Acute Inpatients (excluding ICU) Confirmed COVID-19 ICU Patients Hospitalizations dropped and ICU occupancy stabilized. The highly transmissible B.1.1.7 variant will soon dominate. • Variants are likely between 5% and 10% of cases now. • To prevent an increase in total cases Re for B.1.1.7 needs to be below 0.7. • Current Re is between 0.8 and 0.9, it has only approached 0.7 once. • Public Health Measures appear to be effective against all variants. • First cases of B.1.351 (detected in South Africa) and P.1 (detected in Brazil) detected in Ontario. 11 Predictions: QueensU To control growth with variants, we must push R to 0.7 12 0 200 400 600 800 1000 1200 1400 1600 1800 15-Dec-20 04-Jan-21 24-Jan-21 13-Feb-21 05-Mar-21 25-Mar-21 14-Apr-21 Daily Counted Cases Toronto Forecast OV R = 0.7 Observed Cases Old Variant (Estimated) New Variant (Estimated) Forecast OV R = 0.7 OV Forecast (R = 0.7) NV Forecast (R = 0.98) Predictions: DLSPH At R=0.9 (just above current) variant triggers exponential growth 13 0 200 400 600 800 1000 1200 1400 1600 1800 15-Dec-20 04-Jan-21 24-Jan-21 13-Feb-21 05-Mar-21 25-Mar-21 14-Apr-21 Daily Counted Cases Toronto Forecast OV R = 0.9 Observed Cases Old Variant (Estimated) New Variant (Estimated) Forecast OV R = 0.9 OV Forecast (R = 0.9) NV Forecast (R = 1.26) Predictions: DLSPH If public health measures are lifted, cases could rise dramatically depending on spread of B.1.1.7. 14 Predictions informed by modeling from COVID-19 ModCollab, McMasterU, QueensU, YorkU; recent decrease in new daily cases Data (Observed Cases): covid-19.ontario.ca - 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 01-01 01-03 01-05 01-07 01-09 01-11 01-13 01-15 01-17 01-19 01-21 01-23 01-25 01-27 01-29 01-31 02-02 02-04 02-06 02-08 02-10 02-12 02-14 02-16 02-18 02-20 02-22 02-24 02-26 02-28 03-02 03-04 03-06 03-08 03-10 03-12 03-14 03-16 03-18 03-20 03-22 03-24 03-26 03-28 03-30 Daily Cases ON - Daily ON - 7-Day Mean ON 5%↓ Low Medium High The majority of ICU admissions arise outside of long-term care homes. Analysis: COVID-19 ModCollab. 15 Data: CCM+ ICU Occupancy will follow changes in case rates by two weeks. Growth could start as early as the second week in March. Predictions: COVID-19 ModCollab. 16 Data (Observed ICU Occupancy): CCSO 0 100 200 300 400 500 600 700 01-01 01-03 01-05 01-07 01-09 01-11 01-13 01-15 01-17 01-19 01-21 01-23 01-25 01-27 01-29 01-31 02-02 02-04 02-06 02-08 02-10 02-12 02-14 02-16 02-18 02-20 02-22 02-24 02-26 02-28 03-02 03-04 03-06 03-08 03-10 03-12 03-14 03-16 03-18 03-20 03-22 03-24 03-26 03-28 03-30 ICU Occupancy ON Observed ON Predicted Low High Medium Capacity Threshold The impact of the Pandemic has been inequitable and will continue to be inequitable Analysis: COVID Heterogeneity Research Group Data: ICES 17 Mental health medication dispensing has been stable Analysis: ODPRN Data: ICES data is updated quarterly, with up to a 3 month reporting lag Individuals dispensed benzodiazepines (per 1,000 population) [ICES data] WHO pandemic declaration 18 Emergency department visits for mental health and addictions care have declined -43% -2% -15% -38% 6% -17% -50% -40% -30% -20% -10% 0% 10% 20% 30% 2020-02-23 2020-03-23 2020-04-23 2020-05-23 2020-06-23 2020-07-23 2020-08-23 2020-09-23 2020-10-23 2020-11-23 2020-12-23 2021-01-23 Percent Mental Health-related ED visits Substance Use-related ED visits WHO pandemic declaration Analysis: OH MHA Centre of Excellence Data: Electronic Canadian Triage and Acuity Scale (eCTAS) 19 Overdose deaths have continued to climb Notes: Data provided by the office of the Chief Coroner of Ontario (OCC); Suspect drug-related deaths are identified based on preliminary information reported by the investigating coroners to the office of the Chief Coroner of Ontario. It takes several months for these investigations to be completed and acute drug toxicity deaths to be confirmed; Opioid￾related deaths includes confirmed and probable, and are considered preliminary; Once investigations are complete, acute opioid toxicity is typically deemed to be at least one of the substances directly contributing to about 65%-80% of suspected-drug related deaths (depending on the time period) WHO pandemic declaration Analysis: ODPRN Data: Chief Coroner of Ontario 20 Eating disorder visits and admissions have increased. 21 0 0.5 1 1.5 2 2.5 3 3.5 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Crude rate per 100,000 population 4-week average Hospitalizations and emergency department visits* for eating disorders among children and adolescents (3 to 17 years) in Ontario by 4-week average, Jan 2017 to Sept 2020 Emergency department visits Hospitalizations Analysis: OH MHA Centre of Excellence Data: ICES) Key Findings 22 • Public health measures are paying off in declining mobility, cases, positivity, and hospitalizations. • Focussing vaccination on long-term care homes is paying off with declining daily deaths. • ICU occupancy is flat and the access to care deficit continues to grow. • The B.1.1.7 Variant of Concern is spreading. Cases will likely grow again in late February with ICU admissions increasing afterwards. • Aggressive vaccination and sticking with stay-at-home order will help avoid a third wave and a third lockdown. • Some key mental health indicators are unchanged. However, important measures such as emergency department admissions, opioid deaths and care for eating disorders are worsening. 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, Michelle Rossi, Paul Kurdyak (also DLSPH and CAMH) • ODPRN: Tara Gomes • PHO: Sarah Buchan, Kevin Brown 23 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, Rob Reid, 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 24