BCCDC Weekly Data Summary 30 April 2021 1 Table of Contents Overall Weekly Summary ……….………………………………………………………………………………………………………………3 Surveillance …………………………………………………………………………………………………………………………………………..4 BC Epidemiology………………………………………………………………………………………………………………….…..4 Labs/Genomics…………………………………………………………………………………………….………………………..22 BC in Canadian and Global Context……………………..………………………….……………………………………...34 Modeling……………………………………………………………………………………………………………………………………..………..42 Additional Resources………………….……..………………………………………………………………………………………………….48 2 Overall Weekly Summary 3 • Case rates remain elevated across BC, but are continuing to decline in each HA; test positivity is stable at 11% for publicly funded tests. • New hospitalizations continue to be elevated, but early signs of slowing; hospital/ critical care census are increasing in FH, VCH, IH; new deaths are stable and low. • Majority of hospitalizations among individuals aged >40 years • Majority of deaths in individuals aged >80 years • The share of VOCs among screened cases in BC is ~78% in epi week 16. VOCs have been detected in all regions of the province. Among sequenced samples provincially based on information for epi week 15, P.1 (~40%) and B.1.1.7 (~60%) remain two dominant VOCs. • Alberta’s case rate is currently the highest in Canada and at similar levels to the Dec peak. Potential for importation into BC. • As of April 29, >39% of adult population in BC has been vaccinated; > 80% of those over 70 years have been vaccinated. • Vaccine coverage varies regionally • The number of outbreaks in LTCFs remains very low. total cases new this week ever hospitalized new this week total deaths new this week removed from isolation new this week Apr 24 to Apr 30: BC COVID-19 Profile 129,482 5,724 6,669 388 1,581 27 119,785 6,646 *Data based on surveillance date (i.e. lab result date, or when not available, date reported to public health) 4 DRAFT Data are by surveillance date for cases and deaths, and admission date for hospitalizations Data to April 30 Case rates are elevated across BC, but continuing to decline in each HA; new hospitalizations continue to be elevated, but stabilizing; new deaths are stable and low. New hospitalizations are elevated and stable, primarily among 40-79 years. The number of hospitalizations among <40 years remain relatively low. Deaths decreasing and mostly in individuals ≥80 years. 6 Data incomplete 7 Hospital and critical care census continues to increase in BC, driven by FH, VCH and IH. 8 9 10 11 12 13 Incidence is elevated in BC, but decreasing (FH, VCH, NH) or stable (IH). Percent positivity remains >10% in FH, VCH and NH. 10.1% 12.6% 3.5% 12.4% 10.3% 3.3% The majority of cases continue to be related to local acquisition through a known case or cluster 14 Likely source of COVID-19 infection by episode date, BC January 15,2020 (week3) to April 17, 2021 (week15) Vaccination progress in BC by age group up to 29 April 2021 15 Hospitalizations Deaths Vaccinations Hospitalizations by admission date, deaths by report date Data sources: hospitalizations and deaths – BCCDC, vaccinations – DARE, PHSA Vaccination progress in BC by HSDA up to 29 April 2021 16 Hospitalizations by admission date, deaths by report date Data sources: hospitalizations and deaths – BCCDC, vaccinations – HSIAR 16 Already eligible or soon to be eligible for mRNA vaccine, age-based rollout Not eligible yet for mRNA vaccine, age￾based rollout Vaccinated priority populations (HCWs, CEVs, outbreaks, etc.) and AstraZeneca recipients Each bar = 100% of population in a given HSDA 17 18 The number of cases among individuals aged ≥70 years and HCWs working in long-term care or assisted living facilities is very low following vaccination roll-out compared with individuals not living or working in these settings. 19 20 21 Note that the two graphs cover different time periods The number of new outbreaks declared remains low, but a handful of new outbreaks declared in acute care and long-term care facilities this week. Lab - Key Messages 1. Percent positivity among publicly funded tests remains elevated for the last epi week (11%) • Testing rates have decreased over the past two weeks (~70,000 total tests April 18 to 24) 2. There are regional differences in percent positivity, which range from 3.3% in VIHA to 12.6% in FH. 3. Incidence and positivity are elevated and declining in individuals aged 5 to 65 years. Incidence is increasing slowly in children 0-4 years is increasing, and is low and stable in individuals >65 years. 4. The provincial weekly median turnaround time (time from specimen collection to lab result) is 17 hours, indicating good testing capacity; only 1 in 4 tests took ≥24 hours to result. 5. Among SARS-COV-2 screened samples, the proportion that were presumptive VOCs for the past epi week 16 was ~78%. 6. VOCs have been detected in all regions of the province. • Among sequenced samples provincially based on information for epi week 15, P.1 and B.1.1.7 remain two dominant VOCs, accounting for roughly 40% and 60% of VOCs respectively. 22 Weekly Summary of ALL lab tests performed 23 2,463,067 total specimens tested 69,708 new this epi week 132,455 total positive specimens 6,272 new positive this epi week 9.0% positivity 0.4% absolute change from last week 10% relative to last week Weekly Summary of Lab tests paid Publicly 2,030,054 total specimens tested 56,753 new this epi week 131,174 total positive specimens 6,131 new positive this epi week 12% relative to last week 11.0% positivity 0.2% absolute change from last week Data source: PLOVER extract at 10:30am on April 29, 2021. Epi week 16 (April 18 – 24) 17 hr mean turnaround time (TAT) 17 [11-24] Median [Q1 – Q3] TAT 14% TAT relative to last week crpornicoimmenstcovnss nemen rmomogron g Fax BBRA § w ¥igs $f lle 4 \ $x2° R ~ yIA + "Cyptask T ¥=—— sa. tes ae — s 8b: F rgniSpbtere nreiin rove vesmust bex worron rance osmavnon | meer m con — azetm M Mcous | HHE, rom seonecorr canum Moy @ ics | BBR A : . lag Sim 3 Muss rae» .. : F rmisenvcnm Misa ame» weswen A. m rms B »mon & w= ¥, w + [ —— COVID—19 Recent 1 Week Test Positvty by CHSA (Apri 23 o 29, 2021) i= ar SRES" eoctacws Percent positivity among publicly funded tests remains stable compared to the previous epi week and continues to be elevated (11%). The total number of tests resulted has decreased relative to the previous epi week. Data source: PLOVER extract at 10:30am on April 29, 2021. Epi week 16 (April 18 – 24) 26 Incidence and positivity are elevated and declining in individuals aged 5 to 65 years. Incidence in children 0-4 years continues to increase slowly, and is low and stable in individuals >65 years. 23 Incidence remains elevated, but is stable or decreasing across regions; positivity is >10% in health service delivery areas in FH, VCH and NH 28 29 Of all COVID-19 positive test samples in epi week 16 (Apr 18-25) in BC, ~78% were presumptive VOCs. Note that in Northern, the proportion was substantially lower, ~34%. 30 • The proportion of variants sequenced can be interpreted at the population level, given that it includes only samples sequenced from background surveillance and random screening. • Weeks 13 onward include specimens from qPCR SNP screening that resulted as presumptive positive for B.1.1.7 and P.1. 31 • This shows the relative proportion of variants over time. B.1.117 was the most predominant variant in the last two epi weeks, with P.1 being the second most predominant. • Weeks 13 onward include specimens from qPCR SNP screening that resulted as presumptive positive for B.1.1.7 and P.1. 32 Overview of the screening and sequencing process applied to positive COVID -19 tests in BC, April 2021 33 % screened samples that are presumptive VOC changes every week; this is what’s reported as estimated % VOC prevalence in BC COVID-19 Positive test VOC Screening Cluster, outbreaks, hospitalized patients, re-infections, vaccine escape, travellers, and other targeted surveillance Baseline surveillance (random sample) Presumptive VOCs Non-VOCs Sequencing Presumptive B.1.1.7 Emerging VOI Presumptive P.1/B.1.351 Confirmed B.1.1.7 VOI Confirmed P.1 Confirmed B.1.351 5-10% >25% 100% n=600 per week Not all samples from these groups are VOCs Non-VOC Estimate of B.1.1.7 prevalence Estimate of P.1 prevalence Estimate of B.1.351 prevalence Blue arrows highlight most common current pathway Not all presumptive VOCs are sequenced Prevalence estimates of specific VOCs are based on samples from baseline surveillance and screening VOC: Variant of concern VOI: Variant of interest 10-20% Please note the differences in turnaround time for screening and sequencing: screening results usually come back within 1 -2 days, while sequencing results come back after approximately one week, but it could also take longer if there are lab backlogs. 1. Globally, growth in cases in South America, Europe, and North America have declined while it has increased in parts of Asia, driven by recent resurgence in India. 2. Across Canada, cases are trending up in AB and MB. BC, ON, QC and SK have turned the corner. Death rates are trending up in ON; stable in other jurisdictions, overall very low. Hospital census increasing in AB; recent stabilization observed in BC, MB, ON, QC, and SK. 3. Alberta’s case rate is currently the highest in Canada and at similar levels to the Dec peak. Potential for importation into BC. 4. VOCs are now dominant in ON; BC is expected to follow suit by early May. 5. Canadian vaccination update: >50% population vaccinated in the YK and NWT; QC ~35%; BC ~31%; Canada overall ~32%. 6. Global vaccination update: % population that has been vaccinated with at least one dose: Israel ~62%, UK ~50%, US ~43%, Chile ~42%, Europe 20-30%. 34 BC in Canadian and Global Context - Key Messages Globally, growth in cases in South America, Europe, and North America have declined while it has increased in parts of Asia, driven by recent resurgence in India Source Source 35 Across Canada, cases are trending up in AB and MB. BC, ON, QC and SK have turned the corner. Death rates are trending up in ON; stable in other jurisdictions, overall very low. DRAFT Data to 27 April Alberta’s case rate is currently the highest in Canada and at similar levels to the Dec peak. Potential for importation into BC. 37 Data to 27 April 38 Hospital census increasing in AB; recent stabilization observed in BC, MB, ON, QC, and SK VOCs are now dominant in ON; BC is expected to follow suit by early May 39 Gray lines = European countries for which data are available. Their trajectories have consistently shown that it takes ~2 months for B.1.1.7 to become a dominant strain, regardless if COVID cases were stable or increasing. DRAFT - NOT FOR FURTHER DISTRIBUTION Please note that these are approximate estimates only and may not be accurate. Data across jurisdictions are not directly comparable due to different sampling methodologies. There were likely changes in methodology over time within the same jurisdiction, especially during the early part of the curve. Some data points were extrapolated/approximated to complete the visualization. NB: Across the EU, B.1.1.7 is the predominant VOC by far; B.1.351 also contributes to a small proportion of cases, depending on the country (0.1-5%); P.1. is rare Canadian vaccination update, 29 April: >50% population vaccinated in the YK and NWT; QC ~35%; BC ~31%; Canada overall ~32%. Source 40 Global vaccination update, April 28 41 Source Jurisdictions are aligned at day 0 when % population vaccinated reached 5% Israel UK Chile US Serbia Denmark Norway Germany Canada Source Finland Hungary Canada is in the top 10 most vaccinated countries worldwide Note the differences in the speed of vaccine rollout between countries that have delayed administration of second dose have vs those that haven’t Fraser (1.08 → 0.92) Vancouver (0.78 → 0.69) Coastal Our model shows that Rt is below 1 in all regions of BC. Whenever Rt > 1, there is a risk that the number of new cases will grow. Dynamic compartmental modeling: recent trends Interior (0.98 ≈ 0.93) Vancouver (0.73 ≈ 0.68) Island Northern (0.84 → 0.74) Solid black line: median Rt , data up to Apr 28, 2021; Grey band: 5%-95% credible interval; Purple bars: all reported cases. Due to lag from symptom onset to reporting, most recent cases are not shown. Recent trend shown comparing 7 day average Rt from (last week → this week). BC (0.97 → 0.86) Scenarios of trajectory in cases, hospitalizations, and deaths in BC based on infectious contact Fitting period: March 1, 2020 – April 25, 2021 43 44 Scenarios of trajectories in cases based on infectious contact, by HA Case Report Date Fitting period: March 1, 2020 – April 25, 2021 45 Scenarios of trajectories in hospitalizations incidence based on infectious contact, by HA Case Report Date Fitting period: March 1, 2020 – April 25, 2021 Rt modelling methods • A dynamic compartmental model was fit to COVID-19 data for BC using a Bayesian framework (Anderson et al. 2020. PLoS Comp. Biol. 16(12): e1008274) • Results are presented as provincial and regional time-varying estimates of average daily transmission rate (Rt ) • The following caveats apply to these results • the model does not consider importation of cases, hence all transmission is assumed to arise from local cases • the model does not distinguish cases arising from variants of concern (VoCs) versus ‘wild-type’ COVID-19, hence model estimates represent average rates of transmission 46 Model notes and assumptions • Levels of infectious contact characterized by historic estimated rates: • 40% would be similar to what was observed after the 8th September, 2020 announcement • 50% would be similar to changes observed after 7th November 2020 announcement • 60% would be similar rate of contact observed at beginning of 2021. • Current BC Vaccination schedule incorporated into model fitting and projections incorporating variable rates of contact and susceptibility by age. Note vaccination of higher contact workers not explicitly included, which may under-estimate total impact of vaccination. • Vaccination was modeled using the current proposed one dose schedule by age group, with all eligible age groups vaccinated by end of June, adjusting for age-dependent impact on transmission. Further assumed a 15% hesitancy of all age groups. • Establishment of VoC varied by region and estimated from sequencing of cases. Estimates used were: Fraser: 20th January, Vancouver Coastal: 7th February, Interior: 15th March, and 25th March Vancouver Island and Northern. • Dominance of VoC assumed to be 7 weeks in line with other jurisdictions. 50% increased transmission and disease severity selected to reflect experienced changes in other jurisdictions. DRAFT - NOT FOR FURTHER DISTRIBUTION 47 Additional Resources • *NEW* BCCDC COVID-19 Epidemiology app (public) has been updated with provincial and international vaccination data. • *NEW* CHSA Case/Vaccine Dashboard - Internal HA use only – needs a Tableau license. If you would like access, please contact rose.jose@bccdc.ca • LHA Trends Dashboard – Internal HA use only – needs a Tableau license. If you would like access, please contact rose.jose@bccdc.ca • More BC COVID-19 data, including the latest Situation Report, maps, and BC COVID-19 public dashboard, can be found here (public) • COVID SPEAK Survey results (public) • PHAC’s COVID-19 Epidemiology update can be found here (public) • For the most up to date BC, Canadian and global mobility data and to compare jurisdictions of interest to you, please visit BCCDC Mobility app (note: not for public release)