Update on COVID-19 ProjectionsScience Advisory and Modelling Consensus Tables

December 19, 2020

Key Findings

• Cases continue to grow and overall case levels are twice the “red” level. Percentpositivity is flattening. Our ability to control case growth is still precarious.• Continuing case growth will increase outbreaks in long-term care homes and

other congregate settings.• Under all scenarios, ICU occupancy will be above 300 beds within 10 days. Worst

case scenarios show occupancy above 1,500 beds by mid-January.• Based on experience in France and Australia, “hard lock-downs” of 4–6 weeks can

reduce case numbers in Ontario to less than 1,000 per day and possibly muchlower with increased testing and support.• With lower case numbers we can maintain safe ICU care for COVID-19 and non-

COVID-19 patients who require it.• As noted in previous briefings, public health restrictions will require more

resources (e.g. testing, isolation/quarantine support) in communities andessential service workplaces where exposure is higher.

2

All Other PHUs, 26

Haldimand-Norfolk, 45

Middlesex-London, 52

Ottawa, 30

Peel, 188

Simcoe Muskoka, 50

Wellington-Dufferin-Guelph, 87

Windsor-Essex, 177

Hamilton, 109

Brant, 64

Halton, 69Niagara, 67

Waterloo, 80Durham, 82

York, 102

Toronto, 128

PROTECT (cases ≥ 10)

RESTRICT (cases ≥ 25)

CONTROL (cases ≥ 40)

Southwestern, 65

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

150

160

170

180

190

200

210

220

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

Wee

kly

new

cae

s per

100

,000

resid

ents

(7-d

ay a

vg.)

Total new cases per 100,000 residents per week across PHUs

Data source: Case and Contact Management System, data up to December 17

Oct 9 Modified

Stage 2 begins in Toronto, Ottawa, and Peel

Sept 17In-person

classes for all major

school boards

Sept 25Restrictions on bars and restaurants

Oct 16 Modified

Stage 2 begins in

York

Nov 7COVID19 RESPONSE

FRAMEWORKDurham, Halton, Eastern

to Protect. Ottawa and York to Restrict. Peel to

Control + local restrictions. Toronto remains in

Modified Stage 2.

Nov 23Toronto and Peel

enter 28x-day lockdown

Dec 14York and Windsor-

Essex enter lockdown

Dec 4Middlesex-

London + T-Bay to Restrict.

Haliburton to Protect

Sept 19Limits on social gatheringsizes

Brant, 2.2%

Halton, 4.0%Hamilton, 4.3%

Middlesex-London, 3.0%Niagara, 2.8%

Peel, 8.1%

Simcoe Muskoka, 1.9%

Wellington-Dufferin-Guelph, 3.3%

Windsor-Essex, 6.6%

Haldimand-Norfolk, 2.6%

Durham, 3.2%

Ottawa, 1.3%

Southwestern, 2.5%

Toronto, 5.1%York, 6.0%

All Other PHUs, 2.6%

PROTECT (positivity ≥ 0.5%)

RESTRICT (positivity ≥ 1.3%)

CONTROL (positivity ≥ 2.5%)

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

13.0

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

% p

ositi

vity

of d

aily

test

ing

episo

des (

7-da

y av

g.)

COVID-19 testing % positivity across PHUs

Data source: Ontario Laboratories Information System (OLIS), data up to December 14

Sept 24Testing guidance update

Oct 6 Assessment Centres move to advance booking

Oct 1School & childcare screening guidance change

Nov 7COVID19 RESPONSE

FRAMEWORKDurham, Halton, Eastern

to Protect. Ottawa and York to Restrict. Peel to

Control + local restrictions. Toronto remains in

Modified Stage 2.

Nov 23Toronto and Peel

enter 28-day lockdown

Brant, 49%

Halton, 70%

Hamilton, 84%

Middlesex-London, 61%

Niagara, 79%Peel, 75%

Simcoe Muskoka, 60%

Wellington-Dufferin-Guelph, 47%

Windsor-Essex, 54%Haldimand-Norfolk, 53%

Durham, 58%

Ottawa, 85%

Southwestern, 61%

Toronto, 88%

York, 83%

All Other PHUs, 74%

0

10

20

30

40

50

60

70

80

90

100

110

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

% o

f tes

ting

episo

des w

ith re

sults

rele

ased

with

in 2

day

s of t

est (

7-da

y av

g.)

Percent of COVID test results returned within 2 days across PHUs

Data source: Ontario Laboratories Information System (OLIS), data up to December 14

Sept 24Testing guidance update

Oct 6 Assessment Centres move to advance booking

Oct 1School & childcare screening guidance change

Nov 7COVID19 RESPONSE

FRAMEWORKDurham, Halton, Eastern

to Protect. Ottawa and York to Restrict. Peel to

Control + local restrictions. Toronto remains in

Modified Stage 2.

Nov 23Toronto and Peel

enter 28-day lockdown

Weekly % positivity by age group

Legend:

Data Source: Ontario Laboratory Information System (OLIS), MOH – extracted from SAS VA December 19.Note: Includes all data submitted to OLIS up to December 16, 2020. The last six days are considered interim data (week 49) and subject to changeWeekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week

Weekly % positivity by age group

0

5,000

10,000

15,000

20,000

25,000

30,000

11-09

11-11

11-13

11-15

11-17

11-19

11-21

11-23

11-25

11-27

11-29

12-01

12-03

12-05

12-07

12-09

12-11

12-13

12-15

12-17

12-19

12-21

12-23

12-25

12-27

12-29

12-31

01-02

01-04

01-06

01-08

01-10

01-12

01-14

01-16

01-18

01-20

01-22

01-24

Number of Cases per Day (other countries aligned at 13/100,000/day)

ON 2nd wave - Daily ON 2nd wave - 7-Day Average ON 0%↑ (Constant) ON 1%↑

ON 3%↑ ON 5%↑ ON 7%↑ France

Germany Netherlands UK Michigan

As in other jurisdictions, case growth continues despite soft restrictions

7

ON 3%↑

ON 1%↑

ON 0%↑

ON 7%↑

Predictions informed by modeling from McMasterU, COVID-19 ModCollab, PHO; recent growth in new daily cases; reported cases in peer jurisdictions

Data (Observed Cases): covid-19.ontario.ca; https://ourworldindata.org; covidtracking.comNote: Ontario reached 13/100,000 cases between 1.5 and 3 months after these countries

ON 5%↑

0

100

200

300

400

500

600

700

800

900

1000

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

Patients in Inpatient Beds with COVID19 (excluding ICU)Patients in ICU with COVID-Related Critical Illness

8Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA December 18.

Over the past 4 weeks:69.3% increase in hospitalizations

83.1% increase in ICU patients

COVID-19 hospitalizations and ICU admissions continue to climb

0

300

600

900

1,200

1,500

1,800

11-09

11-11

11-13

11-15

11-17

11-19

11-21

11-23

11-25

11-27

11-29

12-01

12-03

12-05

12-07

12-09

12-11

12-13

12-15

12-17

12-19

12-21

12-23

12-25

12-27

12-29

12-31

01-02

01-04

01-06

01-08

01-10

01-12

01-14

01-16

01-18

01-20

01-22

COVI

D-19

Pat

ient

s in

ICU

/ D

ay

ON Observed ON Predicted ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ ON 7%↑

Projections: ICU occupancy > 300 beds end of Dec, > 1,500 mid Jan in more severe scenarios

9

ON 0%↑

ON 1%↑

ON 3%↑

ON 5%↑

ON 7%↑

Predictions: COVID-19 ModCollab. Data (Observed ICU Occupancy): CCSO

150 beds

High ICU occupancy threatens quality of care

• High occupancy→ Threatens timely access for all patients needing admission→ Delayed access ↑ mortality (Gabler 2013, Harris 2018)

• Acceptable occupancy threshold varies by ICU size (Green 2002)

• 30 bed ICU: < 75% occupancy level• 15 bed ICU: < 65% occupancy level

10Data: ICES; https://doi.org/10.5034/inquiryjrnl_39.4.400

pD = probability of delayed admission to hospital bed

0 100,000 200,000 300,000 400,000 500,000 600,000

Non-Elective

Elective

85% of total

15% of total

ICU Bed Days Distribution, Ontario, FY 2018/19

Directive #2 LTC Action Plan SurgicalRestart

Resume LTC (re)admissions

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

-100%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

Dec 30 to Jan 5

Jan 6 to Jan

12

Jan 13 to Jan

19

Jan 20 to Jan

26

Jan 27 to Feb 2

Feb 3 to Feb 9

Feb 10 to Feb 16

Feb 17 to Feb 23

Feb 24 to Mar 1

Mar 2 to Mar 8

Mar 9 to Mar 15

Mar 16 to Mar 22

Mar 23 to Mar 29

Mar 30 to Apr 5

Apr 6 to Apr 12

Apr 13 to Apr 19

Apr 20 to Apr 26

Apr 27 to May 3

May 4 to May 10

May 11 to May 17

May 18 to May 24

May 25 to May 31

Jun 1 to Jun 7

Jun 8 to Jun 14

Jun 15 to Jun 21

Jun 22 to Jun 28

Jun 29 to Jul 5

Jul 6 to Jul 12

Jul 13 to Jul 19

Jul 20 to Jul 26

Jul 27 to Aug 2

Aug 3 to Aug 9

Aug 10 to Aug 16

Aug 17 to Aug 23

Aug 24 to Aug 30

Aug 31 to Sep 6

Sep 7 to Sep 13

Sep 14 to Sep 20

Sep 21 to Sep 27

Sep 28 to Oct 4

Oct 5 to Oct 11

Oct 12 to Oct 18

Oct 19 to Oct 25

Oct 26 to Nov 1

Nov 2 to Nov 8

Nov 9 to Nov 15

Nov 16 to Nov 22

Nov 23 to Nov 29

Nov 30 to Dec 6

Dec 7 to Dec 13

COVI

D-19

Act

ive

Case

s

2020

vs 2

019

(%)

COVID Volumes

Diagnostic Imaging (MRI/CT)

Surgery

ALC (Acute)

0% Line (No Change vs 2019)

ER

ER (Projected from triage volumes in eCTAS)

Occupancy Rate

Access to care continues to decline below 2019 levels

Community spread drives outbreaks in LTC homes

12

LTC Home cases and outbreaks

Data Source: Ministry of Long Term Care Tracker, Dec 19th extraction based on data reported up to 3:30 pm Dec 18th, 2020. 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 145 Long term care (LTC) homes currently in outbreak, with 1,639 active confirmed cases in these homes

795 resident, 902 staff active cases in total

2,481 cumulative resident deaths, 8 cumulative staff deaths as of Dec 18th

83% of resident deaths in wave 2 have occurred since Nov 1

49 of the 145 homes in outbreak are based on 1 staff case

There have been 633 resident deaths since Sept 1st , 100 of which have been in the past 7 days

13

Cases and cumulative mortality LTC increasing (100 deaths in the past 7 days)

0

100

200

300

400

500

600

700

800

900

Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov15

Dec 1 Dec15

COVID-19 cases and deaths for LTC residents and staff

Daily Active Cases Residents

Daily Active Cases Staff

Cumulative deaths since Sept 1

Daily mortality is increasing and based on forecasting will continue to increase

14Forecasting: McMasterU. Data (Observed Deaths): CCM+

maximum likelihood estimate

5% confidence band

95% confidence bandN

umbe

r of D

eath

s

• Reported Number of Deaths - Predicted Number of Deaths

Other jurisdictions are 1 ½ - 3 months ahead of us Most have used some form of hard lockdown

15

130 / 1 MillionON currently (~133 cases/1M/Day

Data: https://ourworldindata.org

Peer Jurisdictions with “Hard Lockdowns” see dramatic reductions in case numbers

Victoria, Australia France

16

-

100

200

300

400

500

600

700

800

900

1,000

2020-0

6-01

2020-0

7-01

2020-0

8-01

2020-0

9-01

2020-1

0-01

2020-1

1-01

2020-1

2-01

Case

s / 1

M P

opul

atio

n / D

ay

Cases/1M population/Day (7-day Average)

Victoria

-

100

200

300

400

500

600

700

800

900

1,000

2020-0

6-01

2020-0

7-01

2020-0

8-01

2020-0

9-01

2020-1

0-01

2020-1

1-01

2020-1

2-01

Case

s / 1

M P

opul

atio

n / D

ay

Cases/1M population/Day (7-day Average)

France

Hard Lockdown (~12-16 Weeks) Hard Lockdown (~7 Weeks)

50% ↓ Cases : ~ 3 Weeks 75% ↓ Cases: ~ 4.5-6 Weeks 90% ↓ Cases: ~ 7 Weeks (Victoria)

Data: https://ourworldindata.org

-

1,000

2,000

3,000

4,000

5,000

6,000

2020-1

2-28

2021-0

1-04

2021-0

1-11

2021-0

1-18

2021-0

1-25

2021-0

2-01

2021-0

2-08

2021-0

2-15

2021-0

2-22

2021-0

3-01

2021-0

3-08

2021-0

3-15

2021-0

3-22

2021-0

3-29

2021-0

4-05

2021-0

4-12

2021-0

4-19

2021-0

4-26

2021-0

5-03

2021-0

5-10

2021-0

5-17

2021-0

5-24

2021-0

5-31

2021-0

6-07

2021-0

6-14

2021-0

6-21

Case

s / D

ay

Predicted Number of Cases / Day

ON 0%↑ ON 3%↑ ON 5%↑

ON Predictions: The effect of lockdowns varies with the starting case numbers and length of lockdown

17

4-Week Hard Lockdown

6-Week Hard Lockdown

Predictions: COVID-19 ModCollab.

Threshold ON 0%↑ ON 3%↑ ON 5%↑

< 1,000 Cases / Day Jan 15 Jan 26 Feb 5

< 500 Cases / Day Jan 29 Feb 12 Feb 24

< 100 Cases / Day Mar 22 Apr 19 May 8

Manitoba’s lockdown was the most stringent and had the biggest impact on mobility

• The mobility index is the estimated proportion of time spent outside of home – 100 represents January2020 levels.

Manitoba has had a strict lockdown since November 12

Data from: https://www.google.com/covid19/mobility/

Earlier lockdowns will reduce cases

19

-

500

1,000

1,500

2,000

2,500

3,000

3,500

2020

-12-

21

2020

-12-

23

2020

-12-

25

2020

-12-

27

2020

-12-

29

2020

-12-

31

2021

-01-

02

2021

-01-

04

2021

-01-

06

2021

-01-

08

2021

-01-

10

2021

-01-

12

2021

-01-

14

2021

-01-

16

2021

-01-

18

2021

-01-

20

2021

-01-

22

2021

-01-

24

2021

-01-

26

2021

-01-

28

2021

-01-

30

2021

-02-

01

2021

-02-

03

2021

-02-

05

2021

-02-

07

2021

-02-

09

2021

-02-

11

2021

-02-

13

2021

-02-

15

2021

-02-

17

2021

-02-

19

2021

-02-

21

2021

-02-

23

2021

-02-

25

2021

-02-

27

2021

-03-

01

2021

-03-

03

2021

-03-

05

2021

-03-

07

2021

-03-

09

2021

-03-

11

2021

-03-

13

2021

-03-

15

2021

-03-

17

2021

-03-

19

2021

-03-

21

2021

-03-

23

2021

-03-

25

2021

-03-

27

2021

-03-

29

2021

-03-

31

Case

s / D

ay P

reve

nted

Daily Number of Cases Prevented by Starting Hard Lockdown Dec 21 vs. Dec 28

ON 0%↑ ON 3%↑ ON 5%↑

ON 0%↑ ON 3%↑ ON 5%↑

Dec 21 - Dec 31, 2020 801 1,658 2,601

Dec 21 - Jan 31, 2021 11,260 26,709 45,147

Total Number of Cases Prevented

Predictions: COVID-19 ModCollab.

Key Findings

• Cases continue to grow and overall case levels are twice the “red” level. Percentpositivity is flattening. Our ability to control case growth is still precarious.• Continuing case growth will increase outbreaks in long-term care homes and

other congregate settings.• Under all scenarios, ICU occupancy will be above 300 beds within 10 days. Worst

case scenarios show occupancy above 1,500 beds by mid-January.• Based on experience in France and Australia, “hard lock-downs” of 4–6 weeks can

reduce case numbers in Ontario to less than 1,000 per day and possibly muchlower with increased testing and support.• With lower case numbers we can maintain safe ICU care for COVID-19 and non-

COVID-19 patients who require it.• As noted in previous briefings, public health restrictions will require more

resources (e.g. testing, isolation/quarantine support) in communities andessential service workplaces where exposure is higher.

20