Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

January 28, 2021

Key Findings

• Cases and positivity are down across Public Health Units but testing volumes are also slightly down. Sustained high testing volumes will be important to control of the pandemic.

• Cases are declining across long-term care homes but deaths continue to rise (215 in the last seven days). We are still likely to surpass total deaths from the first wave. Interventions to reduce deaths in long-term care will be critical.

• Hospitalizations are declining but strained ICU capacity continues. COVID-19 has an outsized impact on our health system. This access to care deficit continues to grow and will have short and longer-term negative impacts on health.

• There has been some reduction in mobility. But essential work is still strongly associated with risk of infection. Safe workplaces will be important to control COVID-19.

• The new variant of concern (B.1.1.7) is spreading in Ontario and is a significant threat to control of the Pandemic. However, modelling and international examples suggest that maintaining public health interventions will support continued reductions in cases, even with a return to school.

2

All Other PHUs, 22

Ottawa, 70

Simcoe Muskoka, 76

Brant, 49

Halton, 79

Lambton, 154

Peel, 200Windsor-Essex, 196

York, 127

Huron-Perth, 100

Haldimand-Norfolk, 71

Middlesex-London, 90

Waterloo, 122

Southwestern, 80

Durham, 85

Niagara, 171Toronto, 170

Wellington-Dufferin-Guelph, 121

Chatham-Kent, 85

CONTROL (cases ≥ 40)

RESTRICT (cases ≥ 25)

PROTECT (cases ≥ 10)

0

50

100

150

200

250

300

350

400A

ug

1

Au

g 8

Au

g 1

5

Au

g 2

2

Au

g 2

9

Sep

5

Sep

12

Sep

19

Sep

26

Oct

3

Oct

10

Oct

17

Oct

24

Oct

31

No

v 7

No

v 1

4

No

v 2

1

No

v 2

8

Dec

5

Dec

12

Dec

19

Dec

26

Jan

2

Jan

9

Jan

16

Jan

23

Wee

kly

new

cas

es p

er 1

00

,00

0 r

esid

ents

(7

-day

avg

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

Data source: Case and Contact Management System, data up to January 24

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 7COVID-19 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

Dec 14York and Windsor-Essex enter lockdown

Recent data subject to

change

Dec 4Middlesex-London + T-Bay to Restrict. Haliburton to Protect

Sept 19Limits on social gatheringsizes

Dec 26Province-wide lockdown14 days N. ON28 days S. ON

Jan 18First round LTC vaccinations complete in prioritized PHUs

3

Middlesex-London, 2.4

Hamilton, 3.7

Ottawa, 2.8

Eastern, 2.5

Peel, 9.9

Durham, 4.6

Windsor-Essex, 4.8

Wellington-Dufferin-Guelph, 4.4

All Other PHUs, 2.0

York, 7.8

Southwestern, 3.1

Halton, 4.6

Simcoe Muskoka, 3.2

Lambton, 2.2

Chatham-Kent, 3.1

Waterloo, 4.7

Haldimand-Norfolk, 2.4

Brant, 2.6

Toronto, 7.6

Niagara, 7.6

PROTECT (positivity ≥ 0.5%)

RESTRICT (positivity ≥ 1.3%)

CONTROL (positivity ≥ 2.5%)

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16A

ug

1

Au

g 8

Au

g 1

5

Au

g 2

2

Au

g 2

9

Sep

5

Sep

12

Sep

19

Sep

26

Oct

3

Oct

10

Oct

17

Oct

24

Oct

31

No

v 7

No

v 1

4

No

v 2

1

No

v 2

8

Dec

5

Dec

12

Dec

19

Dec

26

Jan

2

Jan

9

Jan

16

Jan

23

% p

osi

tivi

ty o

f d

aily

tes

tin

g ep

iso

des

(7

-day

avg

.)

Data source: Ontario Laboratories Information System (OLIS), data up to January 24

Sept 24Testing guidance update

Oct 6 Assessment Centres move to advance booking

Oct 1School & childcare screening guidance change

Nov 7COVID-19 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

Dec 14York and Windsor-Essex enter lockdown

Dec 4Middlesex-London + T-Bay to Restrict. Haliburton to Protect

Dec 26Province-wide lockdown14 days N. ON28 days S. ON

COVID-19 testing percent positivity across PHUs

4

Cases and percent positivity have declined across most age groups but testing volumes have also fallen.

5

Ca

ses

pe

r 100

,000

Tests

pe

r 100

,000

Perc

ent p

ositivity

Aug 03 Aug 17 Aug 31 Sep 14 Sep 28 Oct 12 Oct 26 Nov 09 Nov 23 Dec 07 Dec 21 Jan 04 Jan 18

0

5

10

15

20

25

200

400

600

0.0

2.5

5.0

7.5

10.0

Report Date

Age group

Data Source: Ministry of Long Term Care Tracker, Jan 25th extraction based on data reported up to 3:30 pm Jan 24th, 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

256 LTC homes have COVID-19 outbreaks (41% of all homes), 80 outbreaks involve just one case

Since January 1st 596 LTC residents have died of COVID-19 and 3 staff deaths have been reported

The number of resident cases has been decreasing for the past 10 days (peaked on Jan 14th)

6

Cases are dropping but mortality in long-term care continues to increase (215 resident deaths in the last seven days)

0

200

400

600

800

1000

1200

1400

1600

1800

Sep 1 Sep15

Oct 1 Oct15

Nov1

Nov15

Dec1

Dec15

Jan 1 15-Jan

COVID-19 cases and deaths for LTC residents and staff

Daily Active Cases Residents

Daily Active Cases Staff

Cumulative deaths since Sept 1

Public Health Unit

2226 Algoma Public Health Unit

2227 Brant County Health Unit

2230 Durham Region Health Department

2233 Grey Bruce Health Unit

2234 Haldimand-Norfolk Health Unit

2235 Haliburton, Kawartha, Pine Ridge District Health Unit

2236 Halton Region Health Department

2237 Hamilton Public Health Services

2238 Hastings & Prince Edward Counties Health Unit

2240 Chatham-Kent Health Unit

2241 Kingston, Frontenac and Lennox & Addington Health Unit

2242 Lambton Health Unit

2243 Leeds, Grenville & Lanark District Health Unit

2244 Middlesex-London Health Unit

2246 Niagara Region Public Health Department

2247 North Bay Parry Sound District Health Unit

2249 Northwestern Health Unit

2251 Ottawa Public Health

2253 Peel Public Health

2255 Peterborough Public Health

2256 Porcupine Health Unit

2257 Renfrew County & District Health Unit

2258 Eastern Ontario Health Unit

2260 Simcoe Muskoka District Health Unit

2261 Sudbury and District Health Unit

2262 Thunder Bay District Health Unit

2263 Timiskaming Health Unit

2265 Region of Waterloo, Public Health

2266 Wellington-Dufferin-Guelph Health Unit

2268 Windsor-Essex County Health Unit

2270 York Region Public Health

3895 Toronto Public Health

4913 Southwestern Public Health

5183 Huron Perth Health Unit

Long-term Care Outbreaks

January 7, 2021

Size of outbreak (staff and residents)

Public Health Unit

2226 Algoma Public Health Unit

2227 Brant County Health Unit

2230 Durham Region Health Department

2233 Grey Bruce Health Unit

2234 Haldimand-Norfolk Health Unit

2235 Haliburton, Kawartha, Pine Ridge District Health Unit

2236 Halton Region Health Department

2237 Hamilton Public Health Services

2238 Hastings & Prince Edward Counties Health Unit

2240 Chatham-Kent Health Unit

2241 Kingston, Frontenac and Lennox & Addington Health Unit

2242 Lambton Health Unit

2243 Leeds, Grenville & Lanark District Health Unit

2244 Middlesex-London Health Unit

2246 Niagara Region Public Health Department

2247 North Bay Parry Sound District Health Unit

2249 Northwestern Health Unit

2251 Ottawa Public Health

2253 Peel Public Health

2255 Peterborough Public Health

2256 Porcupine Health Unit

2257 Renfrew County & District Health Unit

2258 Eastern Ontario Health Unit

2260 Simcoe Muskoka District Health Unit

2261 Sudbury and District Health Unit

2262 Thunder Bay District Health Unit

2263 Timiskaming Health Unit

2265 Region of Waterloo, Public Health

2266 Wellington-Dufferin-Guelph Health Unit

2268 Windsor-Essex County Health Unit

2270 York Region Public Health

3895 Toronto Public Health

4913 Southwestern Public Health

5183 Huron Perth Health Unit

Long-term Care Outbreaks

January 24, 2021

Size of outbreak (staff and residents)

Stay-at-home order has reduced overall mobility

9

Stay-at-home order reduced mobility by a small amount

10Analysis: COVID Heterogeneity Research Group

Data: Google

Communities with highest proportion of essential workers continue to have the highest case numbers

11Analysis: COVID Heterogeneity Research Group

Data: iPHIS and StatsCan

Countries that have maintained public health measures are seeing declines in cases despite increased B117 prevalence

12

0

100

200

300

400

500

600

700

800

900

1,000

Daily New Cases per 1 Million People (7-Day Average)

Denmark France Germany Netherlands United Kingdom Ontario

Mean decrease in daily number of cases since most recent peak:• Netherlands: 2%• Germany: 3%• UK: 4%• Denmark: 4%• Ontario: 3%

UK

NL

FR

DK

ON

GER

Cases are decreasing. This is driving decreased hospitalization but not yet decreased ICU occupancy.

13Predictions informed by modeling from COVID-19 ModCollab, Fields Institute, McMasterU, PHO,

QueensU, YorkU; recent growth in new daily cases; reported case trajectories in peer jurisdictionsData (Observed Cases): covid-19.ontario.ca

ON 1%↓

ON 3% ↓

ON 5% ↓ -

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Daily New Cases

ON - Daily ON - 7-Day Mean ON 5%↓ ON 3%↓ ON 1%↓ VOC

VOC ↑

0

50

100

150

200

250

300

350

400

450

500

Observed ON Predicted ON 5%↓ ON 3%↓ ON 1%↓ ON 0%↓ (Constant) VOC ↑ Capacity

Projections: COVID-19 ICU occupancy 150-300 beds end of February

14

ON 0% ↓

ON 1%↓

ON 3% ↓

ON 5% ↓

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

150 beds

VOC ↑

ICU capacity remains strained in most regions with about half of all hospitals with only 1 or 2 beds free

15Analysis: COVID-19 ModCollab. Data: Bed Census

COVID-19 creates a high burden on hospitals

3,500

3,000

2,500

2,000

1,500

1,000

500

0

Nu

mb

er o

f B

eds

Max # of beds 3,513

Max # of beds 1,301

Max # of beds 754

20/0620/0520/04 20/07 20/08 20/09 20/10 20/11 20/12 21/01

Jan Mar May Jul Sep Nov Jan

COVID timelines

Flu timelines

COVID-192018 flu2009 flu

16

Directive #2 LTC Action PlanSurgical Restart

Resume LTC (re)admissions

0

5,000

10,000

15,000

20,000

25,000

30,000

-100%

-50%

0%

50%

100%

150%

2020 2021

We

ekly

Co

nfi

rme

d N

ew

CO

VID

-19

Cas

es

Ch

ange

vs

Pre

vio

us

Ye

ar (

%)

Confirmed COVID Volumes

Diagnostic Imaging (MRI/CT)

Surgery

ALC (Acute)

0% Line (No Change vs Prev Yr)

ER

ER (Projected from triage volumes in eCTAS)

Occupancy Rate

And access to non COVID-19 care continues to decline

Temporary holiday spike in surgical

activity relative to 2019 volumes

Data for most recent week incomplete

17

The Novel SARS-CoV-2 variant B.1.1.7 appears to be much more easily transmitted

• The novel SARS-CoV-2 variant B.1.1.7 emerged in England in November and is spreading in Ontario

• Transmissibility is likely at least 30% higher• UK: Transmissibility is 56% higher (95% credible interval 50-74%) • UK: Secondary Attack Rate is 36% higher• Denmark: Reproduction number (R) is 1.36 compared to other variants (95% CI 1.19; 1.53)

• Current UK evidence summary notes potential for higher mortality “realistic possibility that infection with VOC B.1.1.7 is associated with an increased risk of death compared to infection with non-VOC viruses”

• Vaccines likely still effective

• Other variants of concern: B.1.351, P.1 (both with increased transmissibility, increased risk of re-infection)

• Other variants likely to emerge

18Sources: Public Health England Technical Reports; NERVTAG report; Davies NG et al (LSHTM); Statens Serum Institut Denmark Ekspertrapport af den 15. Januar 2021

With public health measures, cases should decline even with school opening. Infection control will be critical in schools.

19Predictions: COVID-19 ModCollab.

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

01/01 01/08 01/15 01/22 01/29 02/05 02/12 02/19 02/26

New

dai

ly C

OV

ID-1

9 c

ases

Effect of school operating status with VOC present starting from 1% on 9 Dec, 2020

Reported Cases Schools open Schools closed

Data Source: COVax. Data extracted 8:00pm nightly (Health Data Branch, MOH). Includes Pfizer and Moderna vaccines. Excludes records where dose administration status is not known.

Current status

Since December 15, 2020, 295,816 vaccine doses have been administrated in Ontario.

These administrations include Pfizer and Moderna vaccines.

90% of vaccine administrations have been since Jan 1 2021.

20

Cumulative COVID-19 vaccine dose administrations (295,816 doses to January 25th, 2021)

0

200

400

600

800

1000

1200

1400

1600

1800

Sep1

Sep15

Oct 1 Oct15

Nov1

Nov15

Dec1

Dec15

Jan 1 15-Jan

COVID-19 cases and deaths for LTC residents and staff

Daily Active Cases Residents

Daily Active Cases Staff

Cumulative deaths since Sept 1

0

50

100

150

200

250

300

350

15

-Dec

16

-Dec

17

-Dec

18

-Dec

19

-Dec

20

-Dec

21

-Dec

22

-Dec

23

-Dec

24

-Dec

25

-Dec

26

-Dec

27

-Dec

28

-Dec

29

-Dec

30

-Dec

31

-Dec

1-J

an

2-J

an

3-J

an

4-J

an

5-J

an

6-J

an

7-J

an

8-J

an

9-J

an

10

-Jan

11

-Jan

12

-Jan

13

-Jan

14

-Jan

15

-Jan

16

-Jan

17

-Jan

18

-Jan

19

-Jan

20

-Jan

21

-Jan

22

-Jan

23

-Jan

24

-Jan

25

-Jan

Do

ses

Ad

min

iste

red

Tho

usa

nd

s

Cumulative COVID-19 Vaccinations

2020 2021 Source: COVAX

295,816

Key Findings

• Cases and positivity are down across Public Health Units but testing volumes are also slightly down. Sustained high testing volumes will be important to control of the pandemic.

• Cases are declining across long-term care homes but deaths continue to rise (215 in the last seven days). We are still likely to surpass total deaths from the first wave. Interventions to reduce deaths in long-term care will be critical.

• Hospitalizations are declining but strained ICU capacity continues. COVID-19 has an outsized impact on our health system. This access to care deficit continues to grow and will have short and longer-term negative impacts on health.

• There has been some reduction in mobility. But essential work is still strongly associated with risk of infection. Safe workplaces will be important to control COVID-19.

• The new variant of concern (B.1.1.7) is spreading in Ontario and is a significant threat to control of the Pandemic. However, modelling and international examples suggest that maintaining public health interventions will support continued reductions in cases, even with a return to school.

21

Contributors

• COVID Heterogeneity Research Group: Rafal Kustra, Huiting Ma, Siyi Wang, Gary Moloney, Kristy Yiu, Beate Sander, Jeff Kwong, Stefan Baral, Sharmistha Mishra

• COVID-19 Modeling Collaborative: Kali Barrett, Stephen Mac, David Naimark, AysegulErman, Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander

• DLSPH: Ashleigh Tuite, David Fisman

• Fields Institute: Taha Jaffer, Alik Sokolov, Yichao Chen, Luis Seco, Kumar Murty

• QueensU: Troy Day

• 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

• PHO: Sarah Buchan, Kevin Brown

22

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, 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

23