update on covid-19 projections · 2020. 12. 21. · weekly new caes per 100,000 residents (7-day...
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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