Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

December 19, 2020

CONFIDENTIAL - DO NOT CIRCULATE

Key Findings

• Cases continue to grow and overall case levels are twice the “red” level. Percent
positivity 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 much
lower 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 and
essential service workplaces where exposure is higher.
2
 Total new cases per 100,000 residents per week across PHUs
Sept 17 Sept 25 Oct 16 Nov 7 Nov 23 Dec 4 Dec 14
In-person Restrictions Modified COVID19 RESPONSE Toronto and Peel Middlesex- York and
classes for on bars and Stage 2 FRAMEWORK enter 28x-day London + T-Bay Windsor-
all major restaurants begins in Durham, Halton, Eastern lockdown to Restrict. Essex enter
220 school York to Protect. Ottawa and Haliburton to lockdown
boards York to Restrict. Peel to Protect
210 Oct 9
Sept 19 Control + local restrictions.
200 Limits on Modified Toronto remains in
social Stage 2 Modified Stage 2.
190 gathering begins in
sizes Toronto, Peel, 188
180 Ottawa,
and Peel
Windsor-Essex, 177
170
Weekly new caes per 100,000 residents (7-day avg.)

160
150
140
130
Toronto, 128
120
110 Hamilton, 109
York, 102
100 Wellington-Dufferin-Guelph, 87
90 Durham, 82
Waterloo, 80
80 Halton, 69
70 Niagara, 67
Southwestern, 65
60 Brant, 64
50 Middlesex-London, 52
CONTROL (cases ≥ 40) Simcoe Muskoka, 50
40 Haldimand-Norfolk, 45
30 RESTRICT (cases ≥ 25) Ottawa, 30
20
All Other PHUs, 26
PROTECT (cases ≥ 10)
10
0

Nov 7

Dec 5
Aug 15

Aug 22

Aug 29

Oct 3
Sep 12

Sep 19

Sep 26
Aug 1

Aug 8

Sep 5

Nov 14

Nov 21

Nov 28

Dec 12
Oct 10

Oct 17

Oct 24

Oct 31
Data source: Case and Contact Management System, data up to December 17
 COVID-19 testing % positivity across PHUs
Sept 24 Oct 6 Nov 7 Nov 23
Testing Assessment COVID19 RESPONSE Toronto and Peel
guidance Centres move FRAMEWORK enter 28-day
update to advance Durham, Halton, Eastern lockdown
13.0 to Protect. Ottawa and
booking
York to Restrict. Peel to
Control + local restrictions.
12.0 Toronto remains in
Oct 1 Modified Stage 2.
School & childcare
11.0 screening guidance
change
10.0
% positivity of daily testing episodes (7-day avg.)

9.0

8.0 Peel, 8.1%

7.0
Windsor-Essex, 6.6%
6.0 York, 6.0%
Toronto, 5.1%
5.0 Hamilton, 4.3%
Halton, 4.0%
4.0 Wellington-Dufferin-Guelph, 3.3%
Durham, 3.2%
Middlesex-London, 3.0%
3.0 Niagara, 2.8%
CONTROL (positivity ≥ 2.5%)
All Other PHUs, 2.6%
Haldimand-Norfolk, 2.6%
2.0 Southwestern, 2.5%
RESTRICT (positivity ≥ 1.3%) Brant, 2.2%
Simcoe Muskoka, 1.9%
1.0 Ottawa, 1.3%
PROTECT (positivity ≥ 0.5%)

0.0

Nov 7

Dec 5
Aug 15

Aug 22

Aug 29

Oct 3
Sep 12

Sep 19

Sep 26
Aug 1

Aug 8

Sep 5

Nov 14

Nov 21

Nov 28

Dec 12
Oct 10

Oct 17

Oct 24

Oct 31

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

 Percent of COVID test results returned within 2 days across PHUs
Sept 24 Oct 6 Nov 7 Nov 23
Testing Assessment COVID19 RESPONSE Toronto and Peel
guidance Centres move FRAMEWORK enter 28-day
update to advance Durham, Halton, Eastern lockdown
110
booking to Protect. Ottawa and
York to Restrict. Peel to
Oct 1 Control + local restrictions.
100 Toronto remains in
School & childcare
% of testing episodes with results released within 2 days of test (7-day avg.)

Modified Stage 2.
screening guidance Toronto, 88%
change
90 Ottawa, 85%
Hamilton, 84%
York, 83%
80 Niagara, 79%
Peel, 75%
All Other PHUs, 74%
70 Halton, 70%
Middlesex-London, 61%
Southwestern, 61%
60 Simcoe Muskoka, 60%
Durham, 58%
Windsor-Essex, 54%
50 Haldimand-Norfolk, 53%
Brant, 49%
Wellington-Dufferin-Guelph, 47%
40

30

20

10

Nov 7

Dec 5
Aug 15

Aug 22

Aug 29

Oct 3
Sep 12

Sep 19

Sep 26
Aug 1

Aug 8

Sep 5

Nov 14

Nov 21

Nov 28

Dec 12
Oct 10

Oct 17

Oct 24

Oct 31

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

Weekly % positivity by age group
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 change
Weekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week
As in other jurisdictions, case growth continues despite
soft restrictions
Number of Cases per Day (other countries aligned at 13/100,000/day)
30,000 ON 7%↑

25,000

20,000

15,000
ON 5%↑

10,000

ON 3%↑
5,000
ON 1%↑
ON 0%↑
0
9

4
-0

-1

-1

-1

-1

-1

-2

-2

-2

-2

-2

-0

-0

-0

-0

-0

-1

-1

-1

-1

-1

-2

-2

-2

-2

-2

-3

-0

-0

-0

-0

-1

-1

-1

-1

-1

-2

-2

-2
11

11

11

11

11

11

11

11

11

11

11

12

12

12

12

12

12

12

12

12

12

12

12

12

12

12

12

01

01

01

01

01

01

01

01

01

01

01

01
ON 2nd wave - Daily ON 2nd wave - 7-Day Av erage ON 0%↑ (Constant) ON 1%↑
ON 3%↑ ON 5%↑ ON 7%↑ France
Germany Netherlands UK Michigan

Predictions informed by modeling from McMasterU, COVID-19 ModCollab, PHO; recent growth in
Note: Ontario reached 13/100,000 cases between 1.5 new daily cases; reported cases in peer jurisdictions 7
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 climb
1000

900
Patients in Inpatient Beds with COVID19 (excluding ICU) Over the past 4 weeks:
Patients in ICU with COVID-Related Critical Illness 69.3% increase in hospitalizations
800
83.1% increase in ICU patients

700

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 12-Dec 8
Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA December 18.
Projections: ICU occupancy > 300 beds end of Dec, >
1,500 mid Jan in more severe scenarios
1,800

ON 7%↑
1,500
COVID-19 Patients in ICU / Day

1,200

ON 5%↑
900

600 ON 3%↑

ON 1%↑

300 ON 0%↑

150 beds
0
9

2
-0

-1

-1

-1

-1

-1

-2

-2

-2

-2

-2

-0

-0

-0

-0

-0

-1

-1

-1

-1

-1

-2

-2

-2

-2

-2

-3

-0

-0

-0

-0

-1

-1

-1

-1

-1

-2

-2
11

11

11

11

11

11

11

11

11

11

11

12

12

12

12

12

12

12

12

12

12

12

12

12

12

12

12

01

01

01

01

01

01

01

01

01

01

01
ON Observed ON Predicted ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑ ON 7%↑

Predictions: COVID-19 ModCollab. 9

Data (Observed ICU Occupancy): CCSO
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

Elective 15% of total

Non-Elective 85% of total

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

ICU Bed Days Distribution, Ontario, FY 2018/19 pD = probability of delayed admission to hospital bed
10
Data: ICES; https://doi.org/10.5034/inquiryjrnl_39.4.400
 Access to care continues to decline below 2019 levels
80% 14,000
Surgical Resume LTC
Directive #2 LTC Action Plan Restart (re)admissions
60%
12,000

40%

10,000
20%

COVID-19 Active Cases

2020 vs 2019 (%)

8,000
0%

-20%
6,000
COVID Volumes

-40% Diagnostic Imaging (MRI/CT)

Surgery 4,000
ALC (Acute)
-60%
0% Line (No Change vs 2019)
ER 2,000
-80%
ER (Projected from triage volumes in eCTAS)
Occupancy Rate
-100% 0
5 2 9 6 2 9 16 23 r 1 r 8 15 22 29 r 5 1 2 19 26 y 3 10 17 24 31 n 7 14 21 28 ul 5 l 12 l 19 l 26 g 2 g 9 1 6 2 3 3 0 p 6 13 20 27 ct 4 11 18 25 v 1 v 8 15 22 29 c 6 13
Jan n 1 n 1 n 2 eb eb b b a a ar ar ar p pr pr pr a ay ay ay ay u n n n J u u u u u g g g e p p p ct ct ct o o v v v e ec
0 t o t o J a t o J a t o J a7 t o F 3 to F to F e to F e to M t o Mt o M t o M t o M 0 t o A t o A t o A t o A t o Mt o M t o M t o M t o M 1 to J to J u to J u to J u29 to t o J t o J t o J t o A t o A t o A u t o A u t o A u1 t o S to S e to S e to S e 8 to O t o O t o O t o O t o N to N to N o to N o to N o0 to D t o D
c 3 n 6 13 20 n 2 eb 10 17 24 ar 2 r 9 16 23 r 3 r 6 13 20 r 27 4 11 18 25 un n 8 15 22 un ul 6 l 13 l 20 l 27 ug 3 10 17 24 g 3 p 7 14 21 p 2 t 5 12 19 t 26 v 2 9 16 23 v 3 c 7
De J a J an J an J a F eb eb F eb M Ma ar ar Ma A p A pr A pr A p y J J u un un J J J u J u J u A ug ug ug A u S e ep ep S e Oc c t c t Oc No ov ov ov
F F M M Ma May May May J J A A A S S O O N N N No De
Community spread drives outbreaks in LTC homes

12
 Cases and cumulative mortality LTC increasing (100
deaths in the past 7 days)
LTC Home cases and outbreaks
COVID-19 cases and deaths for LTC residents and staff
Current status 900

145 Long term care (LTC) homes currently 800 Daily Active Cases Residents
in outbreak, with 1,639 active confirmed
700 Daily Active Cases Staff
cases in these homes
600 Cumulative deaths since Sept 1
795 resident, 902 staff active cases in total
500
2,481 cumulative resident deaths, 8
cumulative staff deaths as of Dec 18th 400

83% of resident deaths in wave 2 have 300

occurred since Nov 1
200
49 of the 145 homes in outbreak are based 100
on 1 staff case
0
There have been 633 resident deaths since Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov Dec 1 Dec
15 15
Sept 1st , 100 of which have been in the
past 7 days

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
13
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.
Daily mortality is increasing and based on forecasting
will continue to increase

95% confidence band

Number of Deaths

maximum likelihood estimate

5% confidence band

• Reported Number of Deaths - Predicted Number of Deaths

Forecasting: McMasterU. 14
Data (Observed Deaths): CCM+
Other jurisdictions are 1 ½ - 3 months ahead of us
Most have used some form of hard lockdown

ON currently (~133 130

cases/1M/Day
/ 1 Million

15
Data: https://ourworldindata.org
Peer Jurisdictions with “Hard Lockdowns” see dramatic
reductions in case numbers

Victoria, Australia France

Cases/1M population/Day (7-day Average) Cases/1M population/Day (7-day Average)
1,000 1,000
Hard Lockdown (~12-16 Weeks) Hard Lockdown
900 900 (~7 Weeks)

800 800
Cases / 1M Population / Day

Cases / 1M Population / Day

700 700

600 600

500 500

400 400

300 300

200 200

100 100

- -
01

01

01

01

01

01

01

01

01

01

01

01

01

01
6-

7-

8-

9-

0-

1-

2-

6-

7-

8-

9-

0-

1-

2-
-0

-0

-0

-0

-1

-1

-1

-0

-0

-0

-0

-1

-1

-1
20

20

20

20

20

20

20

20

20

20

20

20

20

20
20

20

20

20

20

20

20

20

20

20

20

20

20

20
Victoria France

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

Data: https://ourworldindata.org 16
ON Predictions: The effect of lockdowns varies with the
starting case numbers and length of lockdown
Predicted Number of Cases / Day
6,000 4-Week Hard Lockdown

5,000 Threshold ON 0%↑ ON 3%↑ ON 5%↑

< 1,000 Cases / Day Jan 15 Jan 26 Feb 5
4,000
< 500 Cases / Day Jan 29 Feb 12 Feb 24
6-Week Hard Lockdown
Cases / Day

< 100 Cases / Day Mar 22 Apr 19 May 8

3,000

2,000

1,000

-
28

04

11

18

25

01

08

15

22

01

08

15

22

29

05

12

19

26

03

10

17

24

31

07

14

21
2-

1-

1-

1-

1-

2-

2-

2-

2-

3-

3-

3-

3-

3-

4-

4-

4-

4-

5-

5-

5-

5-

5-

6-

6-

6-
-1

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0

-0
20

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21

21
20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20

20
ON 0%↑ ON 3%↑ ON 5%↑

17
Predictions: COVID-19 ModCollab.
 Manitoba’s lockdown was the most stringent and had
the biggest impact on mobility

Manitoba has had a strict

lockdown since November 12

• The mobility index is the estimated proportion of time spent outside of home – 100 represents January
2020 levels.
Data from: https://www.google.com/covid19/mobility/
 Cases / Day Prevented

-
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

ON 0%↑
2021-02-01
2021-02-03
2021-02-05
2021-02-07
ON 3%↑

2021-02-09
2021-02-11
2021-02-13
2021-02-15
ON 5%↑

2021-02-17
Earlier lockdowns will reduce cases

2021-02-19
2021
2020

2021-02-21
2021-02-23
Dec 21 - Jan 31,

2021-02-25
Dec 21 - Dec 31,

2021-02-27
2021-03-01
2021-03-03
Total Number of Cases Prevented

2021-03-05
Daily Number of Cases Prevented by Starting Hard Lockdown Dec 21 vs. Dec 28

2021-03-07
801

2021-03-09
11,260
ON 0%↑

2021-03-11
2021-03-13
2021-03-15
2021-03-17
2021-03-19
1,658

2021-03-21
26,709
ON 3%↑

2021-03-23
2021-03-25
2021-03-27
2021-03-29
2021-03-31
Predictions: COVID-19 ModCollab.
2,601

45,147
ON 5%↑

19
Key Findings

• Cases continue to grow and overall case levels are twice the “red” level. Percent
positivity 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 much
lower 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 and
essential service workplaces where exposure is higher.
20