Modelling April 3, 2020 COVID-19 Update: Today’s Presentation • The information provided in this presentation was developed by several experts at Ontario Health, Public Health Ontario and researchers at Ontario universities, led by the COVID-19 Command Table. • The objective of today’s presentation is to share the modelling and projection data that the Command Table has been using to inform our work, and advising government on their response to COVID-19. • We feel is it important to be transparent with the public about the challenges we are facing, and the important work we all need to do to flatten the curve. • How this outbreak unfolds is in the hands of the public, in all of your hands – we can change the outcomes by how we all stay at home and physically distance ourselves. • Recognizing that we get new information about this outbreak on a daily basis, we will continue to refine our models. • Our public health measures so far have made a significant difference and we need everyone to stay focused on these in the weeks ahead: stay home, stop the spread, stay safe. 2 COVID-19: Cases and Deaths by Age Group (January 15 to April 2, 2020) Age Group Cases Deaths Case Fatality Ratio (%) 19 and under 82 0 0 20-39 945 0 0 40-59 1,178 7 0.6 60-79 821 24 2.9 80 and over 226 36 15.9 3 0 0 3,255 67 2.1 Unknown Total Data Source: integrated Public Health Information System (iPHIS). Data extracted April 2, 2020 at 4pm 4 COVID-19: Cases in Ontario and Other Jurisdictions Source: Johns Hopkins University, Centre for System Science and Engineering. Accessed April 1, 2020 5 COVID-19: Deaths in Ontario and Other Jurisdictions Source: Johns Hopkins University, Centre for System Science and Engineering. Accessed April 1, 2020 6 COVID-19: Key Public Health Measures Timeline March 30 – Early April Enhance capacity for contact tracing Jan 24 Minister’s Order made novel coronavirus a reportable disease March 13 Essential visitors only in LTC and other congregate care settings Jan 25 February Rapid testing ramp-up Stop cycling of intermittent inmates and personal visits in correctional facilities Aggressive case and contact management of all confirmed cases March 12 Closure of public schools Prohibit gatherings over 250 people March 16 Practice physical distancing Ontario confirms first case of COVID-19 7 Limit outings to essentials needs Self-isolate for 14 days if travelled outside Canada Prohibit gatherings over 50 people March 17 Make virtual work arrangements where possible Closure of public gathering places and establishments Third Week of March Second Week of March Jan 25 Closure of parks and outdoor recreational amenities March 17 Ontario reports Emergency first COVID-19 Declaration death (from March 11) March 21 Work deployment for health services providers March 23 Closure of non-essential workplaces March 24 Work deployment for LTC homes Fourth Week of March March 24 Ontario reports first deaths (2) in LTC homes March 25 Prohibit gatherings greater than 5 people Self-isolation for individuals over 70, compromised immune systems or underlying medical conditions Extended school closure Last Week of March / Early April COVID-19: Using Models to Inform Ontario’s Planning • Models are used to help plan for what could happen. • As with any model, the farther out predicted, the more uncertainty there is in the predictions. • There is more confidence in the projections for the next 30 days than in the longer term projections. • Assumptions were used to inform the model. • Experts modelled how the disease spreads based on observed data and what is known from other countries. • Any benefit seen in the model from improved public health measures assumes people follow those measures. • If there are people with COVID-19 infections moving between health care facilities, there could be larger outbreaks. 9 Cumulative Confirmed COVID-19 Cases, Number of Days since the 100th Case 98,000 Data from: Dong, E., Du, H., & Gardner, L. (2020). An interactive web-based dashboard to track COVID-19 in real time. The Lancet Infectious Diseases, as of April 2, 2020. Data compiled by Johns Hopkins University from the following sources: WHO, CDC, ECDC, NHC, DXY, 1point3acres, Worldometers.info, BNO, state and national government health department, and local media reports. 10 Projected Ontario Cases by April 30, 2020 400,000 300,000 300,000 200,000 220,000 cases prevented by current action 100,000 80,000 12,500 0 R0 2.5,No little control (baseline) Intervention Current projection Current Intervention Scenario 11 Improved today Full Futurecontrol Intervention Projected Ontario Deaths by April 30, 2020 7000 6,000 6000 5000 4000 4,400 deaths prevented by current action 3000 2000 1,600 1000 200 0 R0 2.5, little control (baseline) No Intervention Current projection Current Intervention Scenario 12 Improved control today Full Future Intervention Projected Ontario Deaths over Course of Pandemic 120,000 100,000 100,000 80,000 60,000 40,000 3,000 to 15,000 20,000 0 Without Public Health Measures With Public Health Measures Projected Deaths Note: Range depends on implementation of maximum public health measures 13 Ontario ICU Capacity for COVID-19 3800 3600 3400 3200 3000 2800 2600 2400 2200 2000 1800 1600 1400 Known expansion capacity 900 additional planned ICU beds for COVID19 patients 1200 1000 Current available capacity 800 410 available ICU beds for COVID19 patients in addition to beds currently filled with COVID19 patients 600 400 200 14 Ontario confirmed COVID19 ICU cases Expected Best Case Worst case 30-Apr 29-Apr 28-Apr 27-Apr 26-Apr 25-Apr 24-Apr 23-Apr 22-Apr 21-Apr 20-Apr 19-Apr 18-Apr 17-Apr 16-Apr 15-Apr 14-Apr 13-Apr 12-Apr 11-Apr 10-Apr 09-Apr 08-Apr 07-Apr 06-Apr 05-Apr 04-Apr 03-Apr 02-Apr 01-Apr 31-Mar 30-Mar 29-Mar 28-Mar 27-Mar 26-Mar 25-Mar 24-Mar 23-Mar 22-Mar 21-Mar 20-Mar 19-Mar 0 COVID-19: Slowing the Spread • We need you to help us change the outcomes for Ontarians by staying at home and physically distancing. • Our public health measures so far have made a difference and we need everyone to stay focused on these: stay home, stop the spread, stay safe. • We need everyone to help stop the spread so we all must continue to fully adhere to the public health measures that have been put in place. We want to avoid the health care system being overwhelmed and the consequences to Ontarians, as we have seen in other jurisdictions in Europe and in the United States. 16 COVID-19: Additional Public Health Measures Immediate Focus • Enhanced capacity for case and contact tracing is underway. • Increased testing for COVID-19, with a focus on long-term care, retirement homes and other congregate settings. Future Measures • Reduce the number and types of essential workplaces. • Enhance focus on enforcement and fines for non-compliance. • Expand direction/guidance on physical distancing, including retail settings. • Enhanced support for elderly, homeless and other vulnerable populations and communities. • Consider entry restrictions in some communities including First Nations. • Human resource management (movement of health care workers between settings). • Use of technology to reinforce self-isolation (alerts). • Additional public education and communication (shelter in place with limited exceptions). 17