Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables February 25, 2021 Key Findings 2 • Declines in cases, hospitalization and ICU occupancy are slowing. Public health measures have decreased transmission and slowed spread of variants of concern. • Variants of concern such as B.1.1.7 continue to spread across Ontario. Cases, hospitalizations, and ICU admissions will likely soon increase. • Evidence-based approaches to key public health measures, such as focusing vaccination where it has the biggest impact on deaths and hospitalizations, are key to controlling the impact of the pandemic. • The next few weeks are critical to understanding the impact of the variants. There is a period of remaining risk before the pandemic likely recedes in the summer. • We can keep the gains we have made by watching spread very closely and by loosening public health measures only carefully. We must be nimble in applying public health measures to extinguish flare ups quickly. PROTECT (cases ≥ 10) Province-wide lockdown RESTRICT (cases ≥ 25) First dose vaccination Completed in prioritized PHUs CONTROL (cases ≥ 40) Northwestern, 105 weekly cases Thunder Bay, 105 weekly cases Peel, 84 weekly cases Toronto, 71 weekly cases York, 67 weekly cases Ontario, 49 weekly cases 0 40 80 120 160 200 240 280 320 360 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 Jan 30 Feb 6 Feb 13 Feb 20 (7-day avg.) Weekly new cases per 100,000 residents Data source: Case and Contact Management System (CCM), data up to February 22 Total new cases per 100,000 per week across Public Health Units 3 Porcupine, 448 Thunder Bay, 444 Ottawa, 175 Halton, 169 Ontario, 247 0 50 100 150 200 250 300 350 400 450 500 550 600 650 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 Jan 30 Feb 6 Feb 13 Feb 20 (7-day avg.) Testing episodes per 100,000 Data source: Ontario Laboratory Information System (OLIS), data up to February 22 Testing episodes per 100K across Public Health Units 4 PROTECT (positivity ≥ 0.5%) RESTRICT (positivity ≥ 1.3%) First dose vaccination completed in prioritized PHUs CONTROL (positivity ≥ 2.5%) Peel, 7.1% Toronto, 5.6% York, 5.3% Thunder Bay, 4.6% Northwestern, 3.1% Ontario, 3.1% 0 2 4 6 8 10 12 14 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 Jan 30 Feb 6 Feb 13 Feb 20 (7-day avg.) % positivity of daily testing episodes Data source: Ontario Laboratory Information System (OLIS), data up to February 22 COVID-19 testing % positivity across Public Health Units Province-wide lockdown 5 Data Source: Ministry of Long Term Care Tracker, Feb 21st extraction based on data reported up to 3:30 pm Feb 22, 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 129 LTC homes have COVID-19 outbreaks (20% of all homes); 46 involve residents (Feb 21). Outbreaks still occurring across most Public Health Units. Second wave mortality (1,886 deaths) has now surpassed the first wave (1,848 deaths). Daily death rates have dropped sharply. 6 Case and death rates in long-term care homes continue to improve (20 resident deaths in the last 7 days) 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 14- Feb COVID-19 cases and deaths for LTC residents and staff Daily Active Cases Residents Daily Active Cases Staff Cumulative deaths since Sept 1 Focused LTC vaccination, together with lockdowns, have rapidly reduced infections and deaths in LTC 7 A key to disease control, mobility has been flat but new variants will start to increase case numbers 8 Variants of Concern (VOC) continue to spread quickly in Ontario (likely 40% of cases in second week of March) Data: PHO 9 Weekly growth in Variants of Concern in Ontario matches other countries. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 % VOC by week (Countries aligned at VOC > 10%) Ontario Germany Netherlands Denmark Switzerland UK Data: PHO (Ontario), Robert Koch Institute (RKI), Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Danish Covid-19 Consortium, SARS-CoV-2 Variants of Concern in Switzerland, Public Health England 10 Future case growth depends heavily on our control of the variants of concern. Predictions informed by modeling from COVID-19 ModCollab, McMasterU, PHO, YorkU 11 Data (Observed Cases): covid-19.ontario.ca - 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 1-1-21 1-3-21 1-5-21 1-7-21 1-9-21 1-11-21 1-13-21 1-15-21 1-17-21 1-19-21 1-21-21 1-23-21 1-25-21 1-27-21 1-29-21 1-31-21 2-2-21 2-4-21 2-6-21 2-8-21 2-10-21 2-12-21 2-14-21 2-16-21 2-18-21 2-20-21 2-22-21 2-24-21 2-26-21 2-28-21 3-2-21 3-4-21 3-6-21 3-8-21 3-10-21 3-12-21 3-14-21 3-16-21 3-18-21 3-20-21 3-22-21 3-24-21 3-26-21 3-28-21 3-30-21 Daily Cases ON - Daily ON - 7-Day Mean ON 5%↓ High Medium Low 0 200 400 600 800 1000 1200 1400 1600 1800 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 09-Jan 16-Jan 23-Jan 30-Jan 06-Feb 13-Feb 20-Feb Patients in Inpatient Beds with COVID19… Patients in ICU with COVID-Related Critical Illness Data Sources: MOH COVID Inpatient Census and Critical Care Information System, data up to February 21 COVID-19 hospitalization and ICU occupancy decreases have started to level off. 12 ICU occupancy is likely to remain challenged. Predictions: COVID-19 ModCollab. 13 Data (Observed ICU Occupancy): CCSO 0 50 100 150 200 250 300 350 400 450 500 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 High Medium Low Capacity Threshold • Reporting in COVax began on December 15, 2020. At this time, only first doses were administered. • Starting the first week of January 2021, second doses began being administered. 14 More Ontarians are getting vaccinated, focusing coverage on areas where impact is greatest will be important. Source: COVax-ON data February 23, 2021 - 10:10 AM - Data for Time Given between 12/15/2020 to 02/22/2021 - Dose 1 Administered was determined based on the first Time Given for each client. - Dose 2 Administered was determined based on the last Time Given for each client where there is more than 1 dose administered 0 50000 100000 150000 200000 250000 300000 350000 400000 2020-12-15 2020-12-16 2020-12-17 2020-12-18 2020-12-19 2020-12-20 2020-12-21 2020-12-22 2020-12-23 2020-12-24 2020-12-25 2020-12-26 2020-12-27 2020-12-28 2020-12-29 2020-12-30 2020-12-31 2021-01-01 2021-01-02 2021-01-03 2021-01-04 2021-01-05 2021-01-06 2021-01-07 2021-01-08 2021-01-09 2021-01-10 2021-01-11 2021-01-12 2021-01-13 2021-01-14 2021-01-15 2021-01-16 2021-01-17 2021-01-18 2021-01-19 2021-01-20 2021-01-21 2021-01-22 2021-01-23 2021-01-24 2021-01-25 2021-01-26 2021-01-27 2021-01-28 2021-01-29 2021-01-30 2021-01-31 2021-02-01 2021-02-02 2021-02-03 2021-02-04 2021-02-05 2021-02-06 2021-02-07 2021-02-08 2021-02-09 2021-02-10 2021-02-11 2021-02-12 2021-02-13 2021-02-14 2021-02-15 2021-02-16 2021-02-17 2021-02-18 2021-02-19 2021-02-20 2021-02-21 2021-02-22 Cumulative # of Doses Individuals who have received first dose Individuals that have recieved at least 1 dose Individuals that have been fully vaccinated (2 doses) Individuals who have been fully vaccinated The next few months are key to maintaining our gains and a declining pandemic in the summer • A combination of vaccination and public health measures should help reduce transmission • Strong public health measures brought cases down and slowed spread of new variants of concern • Vaccination in long-term care has helped bring down deaths and cases • Vaccination of older age groups and high-risk communities will drive hospitalizations and deaths down further • A changing environment for COVID-19 will help decrease transmission • Warmer weather will increase time outdoors and decrease time in crowded or closed-in places • Increasing vaccination should confer immunity more reliably and safer than historical models (1918 Influenza pandemic) that had to rely on the spread of infection alone • The major challenge becomes how to protect the health system over the next few months and closely monitor the spread of all types of cases while accelerating vaccination • We should expect flares in communities and settings where risk factors make people vulnerable 15 Key Findings 16 • Declines in cases, hospitalization and ICU occupancy are slowing. Public health measures have decreased transmission and slowed spread of variants of concern. • Variants of concern such as B.1.1.7 continue to spread across Ontario. Cases, hospitalizations, and ICU admissions will likely soon increase. • Evidence-based approaches to key public health measures, such as focusing vaccination where it has the biggest impact on deaths and hospitalizations, are key to controlling the impact of the pandemic. • The next few weeks are critical to understanding the impact of the variants. There is a period of remaining risk before the pandemic likely recedes in the summer. • We can keep the gains we have made by watching spread very closely and by loosening public health measures only carefully. We must be nimble in applying public health measures to extinguish flare ups quickly. Contributors • COVID-19 Modeling Collaborative: Kali Barrett, Stephen Mac, David Naimark, Aysegul Erman, Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander • Fields Institute: Kumar Murty • 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) • PHO: Sarah Buchan, Kevin Brown, Vanessa Allen 17 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 18