update on covid-19 projections · 2021. 1. 12. · update on covid-19 projections science advisory...

Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

January 12, 2021

Key Findings

• Growth in cases has accelerated and is over 7% on the worst days.

• Almost 40% of long-term care homes have active COVID-19 outbreaks. Since January 1st 198 LTC residents and 2 LTC staff have died of COVID-19. Forecasts suggest more deaths in wave 2 in long-term care than in wave 1.

• COVID-19 ICU occupancy is now over 400 beds. Surgeries are being cancelled and the access to care deficit will continue to increase with real consequences for health.

• Mobility, and contacts between people have not decreased with the current restrictions. Survey data show that the majority of Ontarians are helping limit spread by following them. However, case numbers will not decline until more of the population follows their example.

• A new variant of concern of SARS-CoV-2 (B117) could drive much higher case counts, ICU occupancy and mortality if community transmission occurs. The doubling time for cases could drop by more than 2/3. This new variant is now in Ontario.

• Without significant reductions in contacts, the health system will be overwhelmed and mortality will exceed the first wave totals before a vaccine has time to take effect.

2

All Other PHUs, 32

Ottawa, 80Simcoe Muskoka, 72

Hamilton, 158

Brant, 103

Halton, 115

Lambton, 253

Peel, 232

Windsor-Essex, 323

York, 197

Toronto, 180

PROTECT (cases ≥ 10)

Haldimand-Norfolk, 106

Chatham-Kent, 126

Eastern, 142

Durham, 145

Wellington-Dufferin-Guelph, 128

Southwestern, 145

Middlesex-London, 132

Waterloo, 145

RESTRICT (cases ≥ 25)

CONTROL (cases ≥ 40)

Niagara, 182

0

50

100

150

200

250

300

350

400

Au

g 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

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 8

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

3

Middlesex-London, 6%Hamilton, 6%

Ottawa, 5%

Eastern, 7%

Peel, 13%

Durham, 8%

Windsor-Essex, 14%

Wellington-Dufferin-Guelph, 5%

All Other PHUs, 4%

York, 10%

Southwestern, 7%

PROTECT (positivity ≥ 0.5%)

Halton, 7%

RESTRICT (positivity ≥ 1.3%)

CONTROL (positivity ≥ 2.5%)Simcoe Muskoka, 3%

Lambton, 10%

Chatham-Kent, 9%

Waterloo, 7%

Haldimand-Norfolk, 5%

Toronto, 10%

Niagara, 6%Brant, 5%

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Au

g 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

% p

osi

tivi

ty o

f d

aily

tes

tin

g ep

iso

des

(7

-day

avg

.)COVID-19 testing % positivity across PHUs

Data source: Ontario Laboratories Information System (OLIS), data up to January 4

Sept 24Testing guidance update

Oct 6 Assessment Centres move to advance booking

Oct 1School & childcare screening guidance change





Modified Stage 2.

Nov 23Toronto and Peel

enter 28-day lockdown




4

Halton, 90%Hamilton, 91%

Lambton, 63%

Haldimand-Norfolk, 84%Durham, 81%

Middlesex-London, 86%

Wellington-Dufferin-Guelph, 66%

All Other PHUs, 77%

York, 75%

Toronto, 92%

Southwestern, 73%

Eastern, 85%

Peel, 86%

Waterloo, 76%

Simcoe Muskoka, 71%Windsor-Essex, 72%

Brant, 75%

Niagara, 84%

Chatham-Kent, 84%Ottawa, 84%

0

10

20

30

40

50

60

70

80

90

100

110

Au

g 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

% o

f te

stin

g ep

iso

des

wit

h r

esu

lts

rele

ased

wit

hin

2 d

ays

of

test

(7

-day

avg

.)Percent of COVID test results returned within 2 days across PHUs

Data source: Ontario Laboratories Information System (OLIS), data up to January 4

Sept 24Testing guidance update

Oct 6 Assessment Centres move to advance booking

Oct 1School & childcare screening guidance change





Modified Stage 2.

Nov 23Toronto and Peel

enter 28-day lockdown




5

Weekly % positivity by age group

Legend:

Data Source: Ontario Laboratory Information System (OLIS), MOH – extracted from SAS VA Jan 10Note: Includes all data submitted to OLIS up to January 7th 2021. The last six days are considered interim data (week 52) and subject to change

Weekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week

Weekly % positivity by age group

6

Data Source: Ministry of Long-Term Care Tracker, Dec 19th extraction based on data reported up to 3:30 pm Jan 9th, 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.

7

Cases and cumulative mortality LTC increasing (198 resident and 2 staff deaths since January 1st)

0

250

500

750

1000

1250

1500

Sep 1 Sep15

Oct 1 Oct15

Nov1

Nov15

Dec 1 Dec15

Jan 1

COVID-19 cases and deaths for LTC residents and staff

Daily Active Cases Residents

Daily Active Cases Staff

Cumulative deaths since Sept 1

Current status

252 LTC homes have COVID-19 outbreaks (40% of all homes) with 105 outbreaks involving resident cases

Outbreaks are occurring across almost all public health units, with 91 outbreaks (37%) occurring in priority vaccination areas of Toronto, Peel, York and Windsor-Essex

Since January 1st, 198 LTC residents have died of COVID-19 and 2 staff deaths have been reported

Forecasts suggest there will be more LTC residents deaths in wave 2 than in wave 1 (1,815 total deaths)

1,119 actual deaths as of Jan 9, 2021

0

500

1,000

1,500

2,000

2,500

3,000

Cu

mu

lati

ve L

TC r

esid

ent

CO

VID

-19

dea

ths

Date

Projected and actual cumulative LTC resident COVID-19 deaths (Sep 1, 2020-Feb 14, 2021)

Projected deaths

Actual cumulative deaths (MLTC tracker)

Last

day

of

fore

cast

:Feb

14

, 20

21

2,639 projected deaths as of Feb 14, 2021 (worst case)

Projections: second wave cumulative LTC resident COVID-19 deaths >2,600 by Feb 14 in worst case scenario

8Predictions: MOH Capacity Planning and Analytics Division Data: (Cumulative Deaths): MLTC Tracker Tool

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

July 1, 2020

Size of outbreak (staff and residents)

9

Public Health Unit




































October 1, 2020


10

Public Health Unit




































January 7, 2021


11

Despite some reduced mobility from “Grey Zone” restrictions, there was a pre-holiday spike

12Analysis: UofT, St. Michael’s Hospital, ICES

Data: Google% change relative to January 2020

“Grey Zone” restrictions did not affect the proportion of people working from home; holiday decreases are not likely to persist

13Analysis: UofT, St. Michael’s Hospital, ICES

Data: Google% change relative to January 2020

• Are people in your neighbourhood physically distancing?

• In the last 4 weeks, how many people outside your household visited your house (meal, celebration, stay over)?

• And if so, did you observe restrictions?

With current restrictions, almost 2/3 of the population are acting in a way that will decrease COVID-19 spread

14Didn’t observe restrictions Observed restrictions

Survey: Fields Institute

Occasionally or never Most of the time/sometimes All the time

3 or more 1-2 None

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

12/21 12/28 01/04 01/11 01/18 01/25 02/01 02/08

Daily New Cases (Other Countries Aligned at 230/1M Population/Day)

ON - Daily ON - 7-Day Mean ON 0%↑ (Constant) ON 1%↑ ON 3%↑ ON 5%↑

ON 7%↑ FRA GER NLD UK

As happened in other jurisdictions, case growth continues under current levels of restrictions

15

ON 3%↑

ON 1%↑

ON 0%↑

ON 7%↑

Predictions informed by modeling from McMasterU, Fields Institute, 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

Note: Ontario reached 23/100,000 cases between 1.5 and 3 months after these countries

ON 5%↑

https://ourworldindata.org/

0

500

1,000

1,500

2,000

2,500

3,000

3,500

ICU

Bed

s O

ccu

pie

d w

ith

CO

VID

-19

Pat

ien

ts (

per

Day

)

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

Projections: COVID-19 ICU occupancy around 500 beds in mid-January, potentially over 1,000 beds in February in more severe, but realistic scenarios

16

ON 0%↑

ON 1%↑

ON 3%↑

ON 5%↑

ON 7%↑

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

150 beds

At 9% growth rate (not shown): >2,000 occupancy Feb 5

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

1500

1-Aug 8-Aug 15-Aug 22-Aug 29-Aug 5-Sep 12-Sep 19-Sep 26-Sep 3-Oct 10-Oct 17-Oct 24-Oct 31-Oct 7-Nov 14-Nov 21-Nov 28-Nov 5-Dec 12-Dec 19-Dec 26-Dec 2-Jan

Confirmed COVID19 Acute Inpatients (excluding ICU)

Confirmed COVID19 ICU Patients

17Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System, extracted January 9

Over the past 4 weeks:72.2% increase in hospitalizations

61.2% increase in ICU patients

COVID-19 hospitalizations and ICU admissions continue to climb

One quarter of hospitals have no ICU beds free, another quarter have only 1 or 2 beds free

18

0%

20%

40%

60%

80%

100%

120%

140%

160%C

orn

wal

l Co

mm

un

ity

Ho

spit

al n

= 1

1

Ham

ilto

n H

eal

th S

cie

nce

s G

ene

ral

n =

31

Hu

mb

er R

iver

Wils

on

n =

46

Mar

kham

Sto

uff

ville

n =

15

Mic

hae

l Gar

ron

Ho

spit

al n

= 1

7

Nia

gara

He

alth

Sys

tem

St.

Cat

har

ines

n =

14

Oak

ville

Tra

falg

ar M

em

ori

al H

osp

ital

n =

21

Qu

inte

He

alth

care

Bel

levi

lle n

= 1

8

Scar

bo

rou

gh C

ente

nar

y n

= 2

0

St. T

ho

mas

-Elg

in G

ener

al H

osp

ital

n =

8

Stra

tfo

rd G

en

eral

Ho

spit

al n

= 6

Sun

nyb

roo

k H

eal

th S

cie

nce

s C

entr

e n

= 5

2

Trill

ium

Cre

dit

Val

ley

Ho

spit

al n

= 2

4

Will

iam

Osl

er E

tob

ico

ke C

amp

us

n =

14

Win

dso

r R

egi

on

al M

etro

po

litan

Cam

pu

s n

= 1

9

Ch

ath

am-K

ent

n =

10

Geo

rgia

n B

ay G

ener

al H

osp

ital

n =

6

Mac

ken

zie

Hea

lth

n =

30

Ori

llia

Sold

iers

Mem

ori

al H

osp

ital

n =

8

Sou

thla

ke R

egio

nal

Hea

lth

Ce

ntr

e n

= 1

8

Un

ity

Hea

lth

St.

Mic

hae

l's n

= 2

9

Blu

ewat

er H

ealt

h S

arn

ia G

ener

al H

osp

ital

n =

14

Cam

bri

dge

Mem

ori

al H

osp

ital

n =

12

Gre

y B

ruce

Hea

lth

Ser

vice

s O

wen

So

un

d n

= 6

Gu

elp

h G

ener

al H

osp

ital

n =

10

Ham

ilto

n H

eal

th S

cie

nce

s Ju

ravi

nsk

i Ho

spit

al n

= 2

3

Kin

gsto

n H

ealt

h S

cien

ces

Cen

tre

n =

33

Qu

een

sway

- C

arle

ton

Ho

spit

al n

= 1

2

Ro

yal V

icto

ria

Re

gio

nal

Hea

lth

Cen

tre

n =

15

Scar

bo

rou

gh B

irch

mo

un

t n

= 1

5

St. M

ary'

s G

ene

ral H

osp

ital

n =

13

The

Ott

awa

Ho

spit

al C

ivic

Cam

pu

s n

= 2

9

UH

N T

oro

nto

We

ster

n H

osp

ital

n =

33

Un

ity

Hea

lth

St.

Jo

sep

h's

n =

18

Bra

ntf

ord

Gen

eral

Ho

spit

al n

= 1

5

Bro

ckvi

lle G

en

earl

Ch

arle

s St

n =

10

Gra

nd

Riv

er K

itch

ener

Wat

erlo

o n

= 2

0

Hal

ton

Hea

lth

care

Milt

on

Dis

tric

t H

osp

ital

n =

8

Hea

lth

Sci

ence

s N

ort

h n

= 1

4

Ho

pit

al M

on

tfo

rt n

= 1

2

Jose

ph

Bra

nt

Ho

spit

al n

= 2

4

Lake

rid

ge H

ealt

h A

jax

n =

13

Lake

rid

ge H

ealt

h O

shaw

a n

= 3

2

LHSC

Un

iver

sity

Cam

pu

s n

= 2

5

LHSC

Vic

tori

a C

amp

us

n =

31

Mo

un

t Si

nai

Ho

spit

al n

= 2

1

Nia

gara

He

alth

Sys

tem

Gre

ater

Nia

gara

n =

15

No

rth

Bay

Reg

ion

al H

eal

th C

entr

e n

= 1

6

No

rth

Yo

rk G

ene

ral H

osp

ital

n =

23

Pe

mb

roke

Reg

ion

al H

osp

ital

Inc.

n =

9

Pe

terb

oro

ugh

Reg

ion

al H

osp

ital

Dri

ve n

= 2

8

Ro

ss M

emo

rial

Ho

spit

al n

- 9

Sau

lt A

rea

Ho

spit

al n

= 1

3

Scar

bo

rou

gh G

ene

ral n

= 2

9

St J

ose

ph

's H

ealt

hca

re S

yste

m C

har

lto

n n

= 2

7

The

Ott

awa

Ho

spit

al G

ener

al C

amp

us

n =

29

Thu

nd

er B

ay R

egio

nal

Hea

lth

Sci

ence

s C

entr

e n

= 2

2

Trill

ium

Mis

siss

auga

Ho

spit

al n

= 3

7

UH

N T

oro

nto

Gen

era

l Ho

spit

al n

= 3

8

Will

iam

Osl

er B

ram

pto

n C

amp

us

n =

24

Win

dso

r R

egi

on

al O

uel

lett

e C

amp

us

n =

20

Wo

od

sto

ck G

ener

al H

osp

ital

n =

12

0 Free Beds 1 Free Bed 2 Free Beds 3+ Free Beds

Per

cen

tage

of

L3 M

SIC

U B

eds

Occ

up

ied

Percentage of Ontario L3 Medical Surgical ICU Beds Occupied on January 8, 2021, by Number of Available Beds

Other ICU Patients Patients with COVID-19

=

100% Occupancy85% Occupancy

Access to care continues to decline below 2019 levels

Dec. 21 to 27 holiday fluctuation in surgical volumes

19

Daily mortality is increasing under current restrictions, doubling from 50 to 100 deaths per day between now and end of February

20Forecasting: McMasterU. Data (Observed Deaths): CCM+

Assumption: continue current restrictions.

0

100

200

300

400

500

600

700

800

900

1000

2/1/20 3/1/20 4/1/20 5/1/20 6/1/20 7/1/20 8/1/20 9/1/20 10/1/20 11/1/20 12/1/20 1/1/21

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

France Germany Netherlands United Kingdom Ontario

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

• Novel SARS-CoV-2 variant, B.1.1.7, emerged in southeast England in November

• Transmissibility: 56% ↑ (95% credible interval 50-74%)

• No increase in disease severity, vaccines likely still effective

21

800 Cases/1M Pop ~ 12,000 cases/Day for ON Population

Sources: https://ourworldindata.org; CCM+Sources: Public Health England Technical Reports; Davies NG et al (LSHTM)

UK

NLD

GER

FRA

ON

https://ourworldindata.org/

If the SARS-CoV-2 variant B.1.1.7 spreads in the community, doubling time for cases could drop to 10 days in March

Predictions: QueensU

Assumptions: 1 case infected with B.1.1.7. from the UK entering Ontario mid-Oct, transmissibility of variant 56% ↑ than other circulating variants (based on UK data), continue current restrictions.

22

Key components of hard lockdowns in peer jurisdictions

Victoria, Australia

France (Fall) UK* Germany* Netherlands*

Strict stay-at-home order / movement restrictions

✓ ✓ ✓ ✓ ✓

Non-essential retail closed ✓ ✓ ✓ ✓ ✓

Bars, restaurants , gyms etc. closed ✓ ✓ ✓ ✓ ✓

Most workplaces closed ✓ ✓ ✓ ✓ ✓

Schools closed ✓ ✕ ✓ ✓ ✓

Mandatory masking outdoors ✓ ✓ ✕ ✕ ✕

Testing blitz in high risk areas ✓ ✕ ✕ ✕ ✕

Curfew ✓ ✓ ✕ ✓ ✕

Enforcement ✓ ✓ ✓ ✓ ✓

23

✓ = fully imposed, ✓ = partially imposed, ✕ = not imposed, *Currently in lockdown

Key Findings

• Growth in cases has accelerated and is over 7% on the worst days.

• Almost 40% of long-term care homes have active COVID-19 outbreaks. Since January 1st

198 LTC residents and 2 LTC staff have died of COVID-19. Forecasts suggest more deaths in wave 2 in long-term care than in wave 1.

• COVID-19 ICU occupancy is now over 400 beds. Surgeries are being cancelled and the access to care deficit will continue to increase with real consequences for health.

• Mobility, and contacts between people have not decreased with the current restrictions. Survey data show that the majority of Ontarians are helping limit spread by following them. However, case numbers will not decline until more of the population follows their example.

• A new variant of concern of SARS-CoV-2 (B117) could drive much higher case counts, ICU occupancy and mortality if community transmission occurs. The doubling time for cases could drop by more than 2/3. This new variant is now in Ontario.

• Without significant reductions in contacts, the health system will be overwhelmed and mortality will exceed the first wave totals before a vaccine has time to take effect.

24

Content provided by Modelling Consensus and Scientific Advisory Table members and secretariatBeate 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

25

update on covid-19 projections · 2021. 1. 12. · update on covid-19 projections science advisory...

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