Update on COVID-19 ProjectionsScience Advisory and Modelling Consensus Tables

February 11, 2021

Key Findings

2

• Public health measures are paying off in declining mobility, cases, positivity, and hospitalizations.

• Focussing vaccination on long-term care homes is paying off with declining daily deaths.

• ICU occupancy is flat and the access to care deficit continues to grow. • The B.1.1.7 Variant of Concern is spreading. Cases will likely grow again in

late February with ICU admissions increasing afterwards. • Aggressive vaccination and sticking with stay-at-home order will help avoid

a third wave and a third lockdown.• Some key mental health indicators are unchanged. However, important

measures such as emergency department admissions, opioid deaths and care for eating disorders are worsening.

Declines in mobility have helped reduce cases

3

Ontario

Quebec

AlbertaManitoba

British Columbia

4 4

5 5

Cases and percent positivity declined across age groups.

6

7

Vaccine dose administrations

Data Source: COVax. Data to Jan 22nd extracted from COVax Dose Admin by Day Report. Jan 23rd-Feb 7th: COVax daily reports (Health Data Branch, MOH). Includes Pfizer and Modernavaccines. Excludes records where status is not known.

Current status

Since December 15, 2020, 426,834 vaccine dose administrations have been reported in COVax.

These administrations include Pfizer and Moderna vaccines.

92% of vaccine administrations have been since Jan 1, 2021.

7

Cumulative COVID-19 vaccine dose administrations (426,834 doses to Feb 10, 2021)

0

50

100

150

200

250

300

350

400

450

15-D

ec

17-D

ec

19-D

ec

21-D

ec

23-D

ec

25-D

ec

27-D

ec

29-D

ec

31-D

ec

02-Ja

n

04-Ja

n

06-Ja

n

08-Ja

n

10-Ja

n

12-Ja

n

14-Ja

n

16-Ja

n

18-Ja

n

20-Ja

n

22-Ja

n

24-Ja

n

26-Ja

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28-Ja

n

30-Ja

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01-F

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03-F

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05-F

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07-F

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09-F

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Dose

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Cumulative COVID-19 Vaccinations

2020 2021 Source: COVAX

426,834

The majority of deaths arise from long-term care.

8Analysis: COVID-19 ModCollab. Data: CCM+

Data Source: Ministry of Long Term Care Tracker, Feb 8th extraction based on data reported up to 3:30 pm Feb 7th, 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

213 LTC homes have COVID-19 outbreaks (34% of all homes) with 90 outbreaks involving resident cases.

25 of 34 PHUs have at least 1 home in outbreak.

Since January 1st 900 LTC residents and 3 staff have died of COVID-19. Wave 2 deaths (1,821) now roughly equal to Wave 1 (1,848).

9

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Sep1

Sep15

Oct1

Oct15

Nov1

Nov15

Dec1

Dec15

Jan1

15-Jan

01-Feb

COVID-19 cases and deaths for LTC residents and staff

Daily Active Cases Residents

Daily Active Cases Staff

Cumulative deaths since Sept 1

Long-term care key indicators improved.

10Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA February 9, 2021. Does not include patients in alternative health facilities (AHFs)

0

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

1,900

2,000

Confirmed COVID-19 Acute Inpatients (excluding ICU)Confirmed COVID-19 ICU Patients

Hospitalizations dropped and ICU occupancy stabilized.

The highly transmissible B.1.1.7 variant will soon dominate.

• Variants are likely between 5% and 10% of cases now.

• To prevent an increase in total cases Re for B.1.1.7 needs to be below 0.7.

• Current Re is between 0.8 and 0.9, it has only approached 0.7 once.

• Public Health Measures appear to be effective against all variants.

• First cases of B.1.351 (detected in South Africa) and P.1 (detected in Brazil) detected in Ontario.

11Predictions: QueensU

To control growth with variants, we must push R to 0.7

120

200

400

600

800

1000

1200

1400

1600

1800

15-Dec-20 04-Jan-21 24-Jan-21 13-Feb-21 05-Mar-21 25-Mar-21 14-Apr-21

Daily

Cou

nted

Cas

es

Toronto Forecast OV R = 0.7

Observed Cases

Old Variant (Estimated)

New Variant (Estimated)

Forecast OV R = 0.7

OV Forecast (R = 0.7)

NV Forecast (R = 0.98)

Predictions: DLSPH

At R=0.9 (just above current) variant triggers exponential growth

130

200

400

600

800

1000

1200

1400

1600

1800

15-Dec-20 04-Jan-21 24-Jan-21 13-Feb-21 05-Mar-21 25-Mar-21 14-Apr-21

Daily

Cou

nted

Cas

es

Toronto Forecast OV R = 0.9

Observed Cases

Old Variant (Estimated)

New Variant (Estimated)

Forecast OV R = 0.9

OV Forecast (R = 0.9)

NV Forecast (R = 1.26)

Predictions: DLSPH

If public health measures are lifted, cases could rise dramatically depending on spread of B.1.1.7.

14Predictions informed by modeling from COVID-19 ModCollab, McMasterU, QueensU, YorkU;

recent decrease in new daily casesData (Observed Cases): covid-19.ontario.ca

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

01-0

1

01-0

3

01-0

5

01-0

7

01-0

9

01-1

1

01-1

3

01-1

5

01-1

7

01-1

9

01-2

1

01-2

3

01-2

5

01-2

7

01-2

9

01-3

1

02-0

2

02-0

4

02-0

6

02-0

8

02-1

0

02-1

2

02-1

4

02-1

6

02-1

8

02-2

0

02-2

2

02-2

4

02-2

6

02-2

8

03-0

2

03-0

4

03-0

6

03-0

8

03-1

0

03-1

2

03-1

4

03-1

6

03-1

8

03-2

0

03-2

2

03-2

4

03-2

6

03-2

8

03-3

0

Daily Cases

ON - Daily ON - 7-Day Mean ON 5%↓ Low Medium High

The majority of ICU admissions arise outside of long-term care homes.

15Analysis: COVID-19 ModCollab. Data: CCM+

ICU Occupancy will follow changes in case rates by two weeks. Growth could start as early as the second week in March.

16Predictions: COVID-19 ModCollab. Data (Observed ICU Occupancy): CCSO

0

100

200

300

400

500

600

700

01-0

1

01-0

3

01-0

5

01-0

7

01-0

9

01-1

1

01-1

3

01-1

5

01-1

7

01-1

9

01-2

1

01-2

3

01-2

5

01-2

7

01-2

9

01-3

1

02-0

2

02-0

4

02-0

6

02-0

8

02-1

0

02-1

2

02-1

4

02-1

6

02-1

8

02-2

0

02-2

2

02-2

4

02-2

6

02-2

8

03-0

2

03-0

4

03-0

6

03-0

8

03-1

0

03-1

2

03-1

4

03-1

6

03-1

8

03-2

0

03-2

2

03-2

4

03-2

6

03-2

8

03-3

0

ICU Occupancy

ON Observed ON Predicted Low High Medium Capacity Threshold

The impact of the Pandemic has been inequitable and will continue to be inequitable

Analysis: COVID Heterogeneity Research GroupData: ICES

17

Mental health medication dispensing has been stable

Analysis: ODPRNData: ICES data is updated quarterly, with up to a 3 month reporting lag

Individuals dispensed benzodiazepines (per 1,000 population) [ICES data]

WHO pandemic declaration

18

Emergency department visits for mental health and addictions care have declined

-43%

-2%

-15%

-38%

6%

-17%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

2020-02-23 2020-03-23 2020-04-23 2020-05-23 2020-06-23 2020-07-23 2020-08-23 2020-09-23 2020-10-23 2020-11-23 2020-12-23 2021-01-23

Perc

ent

Mental Health-related ED visits Substance Use-related ED visitsWHO pandemic

declaration

Analysis: OH MHA Centre of ExcellenceData: Electronic Canadian Triage and Acuity Scale (eCTAS)

19

Overdose deaths have continued to climb

Notes: Data provided by the office of the Chief Coroner of Ontario (OCC); Suspect drug-related deaths are identified based on preliminary information reported by the investigating coroners to the office of the Chief Coroner of Ontario. It takes several months for these investigations to be completed and acute drug toxicity deaths to be confirmed; Opioid-related deaths includes confirmed and probable, and are considered preliminary; Once investigations are complete, acute opioid toxicity is typically deemed to be at least one of the substances directly contributing to about 65%-80% of suspected-drug related deaths (depending on the time period)

WHO pandemic declaration

Analysis: ODPRNData: Chief Coroner of Ontario

20

Eating disorder visits and admissions have increased.

21

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4-week average

Hospitalizations and emergency department visits* for eating disorders among children and adolescents (3 to 17 years) in Ontario by 4-week average, Jan 2017 to Sept 2020

Emergency department visits Hospitalizations

Analysis: OH MHA Centre of ExcellenceData: ICES)

Key Findings

22

• Public health measures are paying off in declining mobility, cases, positivity, and hospitalizations.

• Focussing vaccination on long-term care homes is paying off with declining daily deaths.

• ICU occupancy is flat and the access to care deficit continues to grow. • The B.1.1.7 Variant of Concern is spreading. Cases will likely grow again in

late February with ICU admissions increasing afterwards. • Aggressive vaccination and sticking with stay-at-home order will help avoid

a third wave and a third lockdown.• Some key mental health indicators are unchanged. However, important

measures such as emergency department admissions, opioid deaths and care for eating disorders are worsening.

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, Aysegul Erman, Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander

• DLSPH: Ashleigh Tuite, David Fisman• Fields Institute: 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, Michelle Rossi, Paul

Kurdyak (also DLSPH and CAMH)• ODPRN: Tara Gomes• PHO: Sarah Buchan, Kevin Brown

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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, Rob Reid, 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

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