Update on COVID-19 Projections Science Advisory and Modelling Consensus Tables May 20, 2021 Key Findings 2 • Cases, positivity and hospitalization rates are decreasing. Control of the pandemic is improving due to current public health measures and the efforts of Ontarians. • The access to care deficit continues but high-priority surgeries are being performed at higher rates. • Maintaining progress on vaccinations and maintaining some public health measures until mid-June can help ensure a good summer: • School re-opening will create an increase in cases, but this may be manageable. • Outdoor activities are much safer than indoor activities and should be encouraged. Cases are decreasing in most Public Health Units, with the greatest progress made in hotspot areas 0 50 100 150 200 250 300 350 400 Weekly new cases per 100,000 residents Porcupine Huron Perth Lambton Peterborough Haliburton KPR Renfrew KFLA North Bay Parry Sound Peel Toronto Durham York Hamilton Niagara Halton Middlesex-London Brant Haldimand-Norfolk Wellington-Dufferin-Guelph Waterloo Ottawa Windsor-Essex Simcoe Muskoka Southwestern Eastern Northwestern Hastings & PEC Chatham-Kent Grey Bruce Sudbury Thunder Bay Timiskaming Leeds Grenville Lanark Algoma Data source: CCM Data note: Data for the most recent day have been censored to account for reporting delays Average weekly cases on: May 2 May 15 Increasing Decreasing 3 Dec 26 Province-wide lockdown 14-days for N. Ontario 28-days for S. Ontario Jan 18 First dose vaccination complete in LTC Home residents Apr 3 Province-wide emergency brake Apr 17 Enhanced public health measures and enforcement Peel, 12.1% Toronto, 9.5% Porcupine, 9.0% Durham, 8.3% Hamilton, 8.2% Ontario, 7.1% 0 2 4 6 8 10 12 14 16 18 Aug 1 Aug 15 Aug 29 Sep 12 Sep 26 Oct 10 Oct 24 Nov 7 Nov 21 Dec 5 Dec 19 Jan 2 Jan 16 Jan 30 Feb 13 Feb 27 Mar 13 Mar 27 Apr 10 Apr 24 May 8 Specimen Date (7-day avg.) % positivity of daily testing episodes Data source:Ontario Laboratory Information System (OLIS), data up to May 14 % positivity is declining across Ontario 4 5 Higher vaccination coverage is starting to control hospitalizations in older age groups Data Sources: MOH COVID Inpatient Census and Critical Care Information System 0 500 1000 1500 2000 2500 Patients in Inpatient Beds with COVID19 Patients in ICU with COVID-Related Critical Illness Hospitalization rates are down, ICU occupancy has dropped slightly 6 - 1,000 2,000 3,000 4,000 5,000 6,000 Daily Cases ON - Daily ON - 7-Day Average Partial reopening June 2, 130k/day Partial reopening June 16, 130k/day Mean of case trajectories observed globally Continued efforts to control spread of COVID-19 can help limit the impact of all variants of the virus 7 Figure shows predictions based on 5 models. • Partial reopening June 2 or 16 • Vaccinating 100k￾150k/day • New VOC not explicitly considered Not shown: 2 models looked at school opening June 2: School opening associated with a 6-11% increase in new daily cases Predictions informed by modeling from COVID-19 ModCollab, Fields Institute, McMasterU, PHO, YorkU Data (Observed Cases): covid-19.ontario.ca Range from last briefing - 100 200 300 400 500 600 700 800 900 1,000 ICU Occupancy ON - Daily ON - 7-Day Average Predicted Mean of case trajectories observed globally Partial reopening June 2, 130k/day Partial reopening June 16, 130k/day ICU occupancy continues to decrease slowly, with potentially fewer than 500 patients with COVID-19 in ICUs by mid-June Predictions: COVID-19 ModCollab. 8 Data (Observed ICU Occupancy): CCSO 500/day 300/day Range from last briefing Higher priority procedures were more likely to be completed throughout the pandemic Data for most recent week incomplete † As of the week of March 8, 2021, the comparator year was rolled back to 2019 to ensure the baseline for comparison continues to be pre-pandemic data Higher Urgency Surgery (P2) Lower Urgency Surgery (P3-4) Surgical Restart Directive #2 -100% -50% 0% 50% 100% 150% Apr 2020 May Jun Jul Aug Sep Oct Nov Dec Jan 2021 Feb Mar Apr May Change vs Previous Year† (%) 9 Data Sources: GTA IMS Transport Tracking, Ontario Health 0 100 200 300 400 500 600 20-Nov 27-Nov 04-Dec 11-Dec 18-Dec 25-Dec 01-Jan 08-Jan 15-Jan 22-Jan 29-Jan 05-Feb 12-Feb 19-Feb 26-Feb 05-Mar 12-Mar 19-Mar 26-Mar 02-Apr 09-Apr 16-Apr 23-Apr 03-May 10-May Weekly Patient Transfers Date beginning week Post-Acute / Alternate Level of Care Acute to Acute ICU to ICU While the situation is improving, a high volume of patient transfers continues due to system capacity pressures 10 * Note that this is just Pending Appointments. Anyone that has made an appointment and received a vaccine will be counted under “Individuals with at least one dose”. Data for Appointments reflect 21 PHUs that are captured through the provincial booking system. Appointments made through other systems (e.g., local PHU booking systems, pharmacies, primary care) are not included. Age is based on year of birth. Age <40 includes those age 18-39. Figure for age <40 is shown separately because of the difference in scale of the overall population size. Data Sources MOF 2020 Population Projections COVAX analytical file, extracted, 8:00 pm May 18 2021, CPAD, MOH COVAX Skedulo, extracted 6:00pm May 18 2021 Vaccination coverage continues to increase 11 The hotspot strategy is working. Continued efforts are key to a good summer. Figure excludes long-term care vaccination – at least 1 dose as of May 17, 2021 Source: ICES 12 2m = = + + 2m Outdoors + Distance = No Masks Needed Outdoors + No Distance = Masks Needed Marr L, Virginia Tech 2021 Two-out-of-three rule for outdoor activities Outdoor activities can be much safer Byproducts to avoid when engaging in outdoor activities Always wear masks and distance indoors Dining indoors, dining with others, sharing food or drinks Crowding and going to crowded places Carpooling with others Locker rooms and shared amenities Sharing overnight accommodation with others Travel between regions 13 Select examples of safer outdoor activities Camping • Local camping with your own household is safer • Camping elsewhere with your own household is not safer • Camping with people outside your household is not safer Basketball • Basketball with masks is safer Tennis • Single tennis is safer • Doubles tennis with masks is safer Singing and playing music • Singing outside where there is social distancing is safer Note: Indoor facilities associated with outdoor recreation (e.g., change rooms and clubhouses) present a greater risk and should remain closed at this time 14 Key Findings 15 • Cases, positivity and hospitalization rates are decreasing. Control of the pandemic is improving due to current public health measures and the efforts of Ontarians. • The access to care deficit continues but high-priority surgeries are being performed at higher rates. • Maintaining progress on vaccinations and maintaining some public health measures until mid-June can help ensure a good summer: • School re-opening will create an increase in cases, but this may be manageable. • Outdoor activities are much safer than indoor activities and should be encouraged. Contributors • COVID-19 Modeling Collaborative: Kali Barrett, Stephen Mac, David Naimark, Aysegul Erman, Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander • Fields Institute: Taha Jaffar, Kumar Murty • ICES: Jeff Kwong, Hannah Chung, Kinwah Fung, Michael Paterson, Susan Bronskill, Laura Rosella, Astrid Guttmann, Charles Victor, Michael Schull, and Marian Vermeulen • McMasterU: Michael Li, Irena Papst, Ben Bolker, Jonathan Dushoff, David Earn • YorkU: Jianhong Wu, Yanyu Xiao, Zack McCarthy • MOHLTC: Michael Hillmer, Kamil Malikov, Qing Huang, Jagadish Rangrej, Nam Bains, Jennifer Bridge • OH: Erik Hellsten, Stephen Petersen, Anna Lambrinos, Chris Lau, Access to Care Team • PHO: Kevin Brown • UofT: Ashleigh Tuite • Science Advisory Table: Peter Juni, Antonina Maltsev, Bruno da Costa 16 Content provided by Modelling Consensus and Scientific Advisory Table members and secretariat Beate Sander,* Peter Juni, Brian Schwartz,* Kumar Murty,* Upton Allen, Vanessa Allen, Kali Barrett, Nicholas Bodmer, Isaac Bogoch, Kevin Brown, Sarah Buchan, Yoojin Choi, Troy Day, Laura Desveaux, David Earn, Gerald Evans, David Fisman, Jennifer Gibson, Anna Greenberg, Anne Hayes,* Michael Hillmer, Jessica Hopkins, Jeff Kwong, Fiona Kouyoumdjian, Audrey Laporte, John Lavis, Gerald Lebovic, Brian Lewis, Linda Mah, Kamil Malikov, Antonina Maltsev, Doug Manuel, Roisin McElroy, Allison McGeer, David McKeown, John McLaughlin, Sharmistha Mishra, Justin Morgenstern, Andrew Morris, Samira Mubareka, Laveena Munshi, Christopher Mushquash, Ayodele Odutayo, Shahla Oskooei, Menaka Pai, Samir Patel, Anna Perkhun, Bill Praamsma, Justin Presseau, Fahad Razak, Rob Reid,* Paula Rochon, Laura Rosella, Michael Schull, Arjumand Siddiqi, Chris Simpson, Arthur Slutsky, Janet Smylie, Nathan Stall, Robert Steiner, Ashleigh Tuite, Jennifer Walker, Tania Watts, Ashini Weerasinghe, Scott Weese, Xiaolin Wei, Jianhong Wu, Diana Yan, Emre Yurga * Chairs of Scientific Advisory, Evidence Synthesis, and Modelling Consensus Tables For table membership and profiles, please visit the About and Partners pages on the Science Advisory Table website. 17