Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

December 10, 2020

CONFIDENTIAL - DO NOT CIRCULATE

Key Findings
• Cases continue to grow while percent positivity appears to be flattening. The
impact of the Pandemic still varies widely across and within public health units.
• Long-term care and overall mortality continue to increase and may exceed 25
deaths per day within a month.
• The reproduction number is fluctuating around 1 which means that we are at a
critical juncture where case rates may change quickly.
• ICU occupancy will continue above 200 beds for the next month and may go
higher, particularly if public health interventions are relaxed. Access to care
deficits will persist.
• For Ontarians with access to suitable housing and employment outside of
essential services, case rates have increased at a slower pace.
• Current lockdown has not had nearly as much impact on mobility (and likely
contacts) as lockdown did in March. Relaxation of public health interventions with
a widening prevention gap will likely lead to even higher case growth.
2
 Total new cases per 100,000 residents per week across PHUs
230
Sept 17 Sept 19 Sept 25 Oct 9 Oct 16 Nov 7 Nov 23 Dec 4
220 In-person Limits on Restrictions Modified Modified COVID19 RESPONSE FRAMEWORK Toronto and Peel Middlesex-
classes for social on bars and Stage 2 Stage 2 Durham, Halton, Eastern to Protect. enter 28-day London + T-Bay
210 all major gathering restaurants begins in begins in Ottawa and York to Restrict. Peel to lockdown to Restrict.
school sizes Toronto, York Control + local restrictions. Toronto Haliburton to
200 boards Ottawa, remains in Modified Stage 2. Protect
and Peel
Peel, 197
190

180
Weekly new cases per 100,000 residents (7-day avg.)

170 Recent data

subject to
160
change
150

140

130

120
Toronto, 118
110
York, 104
100
Windsor-Essex, 94
90
Durham, 82
80 Hamilton, 80
70 Waterloo, 79
WDG, 61
60 Halton, 61
50
CONTROL (cases ≥ 40) Middlesex-London, 42
40 Niagara, 35
30 RESTRICT (cases ≥ 25)
Brant, 33
20
Ottawa, 30
PROTECT (cases ≥ 10) All Other PHUs, 29
10

Nov 7

Nov 14

Nov 21

Nov 28
Aug 1

Aug 8

Aug 15

Aug 22

Aug 29

Sep 5

Sep 12

Sep 19

Sep 26

Dec 5
Oct 3

Oct 10

Oct 17

Oct 24

Oct 31
Data source: Case and Contact Management System, data up to December 8
PHUs are Public Health Units
 New cases with no epidemiological link across PHUs
80

70 Toronto, 70%
Weekly new cases with "no known epi link" (7-day avg.)

60
Recent data
subject to
change

50

40

Peel, 28%
30 WDG, 23%
Waterloo, 21%
Windsor-Essex, 19%
York, 19%
20 Durham, 17%
Hamilton, 14%
Niagara, 14%
All Other PHUs, 13%
10 Brant, 13%
Halton, 10%
Ottawa, 7%
0
Middlesex-London, 6%

Nov 7

Nov 14

Nov 21

Nov 28
Aug 1

Aug 8

Aug 15

Aug 22

Aug 29

Sep 5

Sep 12

Sep 19

Sep 26

Dec 5
Oct 3

Oct 10

Oct 17

Oct 24

Oct 31
Data source: Case and Contact Management System, data up to December 8
 COVID-19 testing % positivity across PHUs
13
Sept 24 Oct 1 Oct 6
Testing School & Assessment
12 guidance child care Centres move
update screening to advance
guidance booking
11 change
Peel, 11%

10
% positivity of daily testing episodes (7-day avg.)

York, 6%
6 Toronto, 6%

5
Durham, 5%
Windsor-Essex, 4%
4 Halton, 4%
Hamilton, 4%
Waterloo, 4%
3 WDG, 3%
CONTROL (positivity ≥ 2.5%)
Brant, 3%
2 All Other PHUs, 2%
RESTRICT (positivity ≥ 1.3%)
Middlesex-London, 2%
Niagara, 2%
1
PROTECT (positivity ≥ 0.5%) Ottawa, 2%

Nov 7

Nov 14

Nov 21

Nov 28
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
Data source: Ontario Laboratories Information System (OLIS), data up to December 4
 Percent of COVID test results returned within 2 days across PHUs
110
Sept 24 Oct 1 Oct 6
Testing School & Assessment
guidance child care Centres move
100 update screening to advance
guidance booking
Middlesex-London, 90%
% of testing episodes with results released within 2 days of test (7-day avg.)

change
90 Toronto, 88%
York, 86%
Ottawa, 83%
80 Hamilton, 79%
Peel, 77%
Windsor-Essex, 77%
70 Halton, 76%
All Other PHUs, 75%
Niagara, 63%
60
Durham, 58%
Waterloo, 56%
WDG, 53%
50

40 Brant, 40%

30

20

10

Nov 7

Nov 14

Nov 21

Nov 28
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
Data source: Ontario Laboratories Information System (OLIS), data up to December 4
Weekly % positivity by age group

Data: OLIS
 Cases in LTC flattening, while deaths remain high (102
deaths in the past 7 days)
LTC Home cases and outbreaks
800
COVID-19 cases and deaths for LTC residents and staff
Current status (Dec 8)
700 Daily Deaths, Residents Daily Active Cases Residents
• 115 homes currently in outbreak,
with 1194 confirmed cases 600
Daily Active Cases Staff Cumulative deaths since Aug 1
currently in these homes 500

• There have been 496 resident 400

deaths since Aug 1st (493 since 300
Sept 1st) 102 of which have been
in the past 7 days 200

• 37 of the 115 homes in outbreak 100

are based on 1 staff case 0

Aug 1 Aug Sep 1 Sep Oct 1 Oct Nov 1 Nov Dec 1
15 15 15 15

Data Source: Ministry of Long Term Care Tracker. 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 8
posted by the local public health units (i.e. iPHIS database) due to lags in reporting time.
Daily mortality is increasing and based on forecasting will
continue to increase

Number of Deaths

95% confidence band

maximum likelihood estimate

5% confidence band

• Reported Number of Deaths - Predicted Number of Deaths

Forecasting: McMasterU. 9
Data (Observed Deaths): CCM+
Ontario is following case growth of peer countries

Projected Ontario cases at 0, 1, 3 and 5% increases per day mapped to progression in peer countries starting at
12/100,000 cases/day
Michigan
10,000
ON 5%↑
9,000
Netherlands
8,000

7,000

6,000
Cases / Day

ON 3%↑
5,000 UK
France
4,000
Germany
3,000
ON 1%↑
2,000 ON 0%↑
1,000

ON 2nd wave - 7-Day Average ON 2nd wave - Daily ON 0%↑ (Constant) ON 1%↑
ON 3%↑ ON 5%↑ France Germany
Netherlands UK Michigan

Predictions informed by modeling from McMasterU, COVID-19 ModCollab, PHO; recent growth in
Note: Ontario reached 12/100,000 cases between 1.5 new daily cases; reported cases in peer jurisdictions 10
and 3 months after these countries Data (Observed Cases): covid-19.ontario.ca; https://ourworldindata.org; covidtracking.com
 COVID-19 hospitalizations and ICU admissions continue to rise
900

91.6% increase in COVID19

800 hospitalizations over most
Confirmed COVID19 Acute Inpatients (excluding ICU) recent 4 weeks
Confirmed COVID19 ICU Patients 165.9% increase in COVID19
700
patients in ICU

600

500

400

300

200

100

0
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
11
Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA December 8
Projections: ICU Occupancy > 200 beds under all
scenarios for at least a month
600
UK
Netherlands
Michigan
500 ON 5%↑
COVID-19 Patients in ICU / Day

400 Germany
ON 3%↑
France

300
ON 1%↑

ON 0%↑

200

100

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

France Germany Netherlands UK Michigan

COVID-19 ModCollab. 12
Data (Observed ICU Occupancy): CCSO
 Access to care continues well below 2019 volumes
80% 14,000
Surgical Resume LTC
Directive #2 LTC Action Plan Restart (re)admissions
60%
12,000

40%
10,000
20%

Active cases of COVID-19

2020 vs 2019 (%)

8,000
0%

-20% 6,000
COVID Volumes
Diagnostic Imaging (MRI/CT)
-40% Surgery
ALC (Acute) 4,000
0% Line (No Change vs 2019)
-60%
ER
ER (Projected from triage volumes in eCTAS) 2,000
-80% Occupancy Rate

-100% 0
Communities with access to suitable housing have
lower case growth but all rates are increasing

City of Toronto, excluding

LTCH residents, up to
Dec 2, 2020 : 7-day
rolling average
University of Toronto, St. Michael’s Hospital, and ICES.
Data: iPHIS and StatsCan
Communities with more multi-generational housing
have higher case growth but all rates are increasing

City of Toronto, excluding

LTCH residents, up to
Dec 2, 2020 : 7-day
rolling average
University of Toronto, St. Michael’s Hospital, and ICES.
Data: iPHIS and StatsCan
Communities with more non-health care essential work
have higher case growth but all rates are increasing

City of Toronto, excluding

LTCH residents, up to
Dec 2, 2020 : 7-day
rolling average
University of Toronto, St. Michael’s Hospital, and ICES.
Data: iPHIS and StatsCan
Current restrictions have had less effect on mobility than
in the Spring

* Weighted by device count.

University of Toronto, St. Michael’s Hospital, ICES, and Bluedot 17

Data: Bluedot
Key Findings
• Cases continue to grow while percent positivity appears to be flattening. The
impact of the Pandemic still varies widely across and within public health units.
• Long-term care and overall mortality continue to increase and may exceed 25
deaths per day within a month.
• The reproduction number is fluctuating around 1 which means that we are at a
critical juncture where case rates (and other impacts) may change quickly.
• ICU occupancy will continue above 200 beds for the next month and may go
higher, particularly if public health interventions are relaxed. Access to care
deficits will persist.
• For Ontarians with access to suitable housing and employment outside of
essential services, case rates have increased at a slower pace.
• Current lockdown has not had nearly as much impact on mobility (and likely
contacts) as lockdown did in March. Relaxation of public health interventions with
a widening prevention gap will likely lead to even higher case growth.
18