Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

November 12, 2020
Purpose
• Share latest trends in Ontario epidemiology, health system indicators
• Provide an update on progress in controlling pandemic

2
Key Findings
• Key indicators of the Pandemic continue to worsen but the impact of the
Pandemic varies widely across regions
• Other countries have struggled to control spread after allowing strong growth in
case numbers in the early Fall
• Long-Term Care Home resident mortality is increasing each week
• Outbreaks continue to account for 10% of cases, recent research suggests indoor
environments where health protection is difficult account for majority of cases
• At a 5% rate of growth, our case numbers likely exceed several jurisdictions in
Europe that are now in some form of lockdown
• ICU occupancy will exceed the 150 bed threshold under any scenario within two
weeks. It will exceed 400 beds under the worst scenarios within six weeks.
• Wastewater tracking suggests that the restrictions had some effect in reducing
potential growth.

3
 Total new cases per 100,000 residents per week across PHUs
140
Sept. 17 Sept. 19 Sept. 25 Oct. 9 Oct. 16 Nov. 7
In-person classes Limits on Restrictions Modified Modified COVID19 Response Framework Peel 130.5
started for all social on bars and Stage 2 Stage 2 Durham, Halton, Eastern to Protect;
major school gathering restaurants begins in begins in Ottawa and York to Restrict; Peel to
120 boards sizes Toronto, York Control + local restrictions;
Ottawa, Peel Toronto remains in Modified Stage 2

100
7-day new cases per 100,000 residents

Toronto 88.5

80

York 59.8

60

Halton 56.1

Ottawa 35.6
40
Durham 32.8
Eastern 31.1

20 All other PHUs 23.3

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

Date case reported to PHU 4

Data Source: Case and Contact Management System (CCM), extracted November 10
 New cases with no epidemiological Link across PHUs
80%
Data for recent
cases subject
to change
70%

Toronto 61.6%
60%
7-day % of new cases with no known epi link

50%

40%

30% Durham 29.9%

Ottawa 26.1%

20% All other PHUs 13.6%

York 13.6%
10%
Peel 11.5%
Halton 3.7%
0% Eastern 3.1%
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

Date case reported to PHU

5
Data Source: Case and Contact Management System (CCM), extracted November 10
 COVID-19 testing % positivity across PHUs
11%
Sept. 24 Oct. 1 Oct. 6
Testing School & Changes to
10% guidance child care Assessment Peel 10.1%
update screening Centre booking
guidance
% positivity of daily testing episodes - 7 day daily moving average

9% change

8%

7%

6% Toronto 5.8%

York 5.1%
5%
Halton 4.8%
4%

Durham 3.2%
3%

Ottawa 2.0%
2%
All other PHUs 1.9%

1%
Eastern 1.3%

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
Date test performed
6
Data Source: Ontario Laboratory Information System (OLIS), extracted via MOH SAS VA November 10
 Percent of tests processed within 2 days across PHUs
100%
Sept. 24 Oct. 1 Oct. 6
Testing School & Assessment
90% guidance child care centres York 86.1%
update screening change to
% of testing episodes with results released within 2 days of test - 7 day moving average

guidance advance Toronto 81.6%

change booking Peel 80.3%
80%
ONTARIO 76.3%
Ottawa 75.9%
70% Eastern 71.4%
Halton 71.4%
60% Durham 67.0%

50%

40%

30%

20%

10%

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

Date test result released

7
Data Source: Ontario Laboratory Information System (OLIS), extracted via MOH SAS VA November 10
Weekly % positivity by age group
Month Apr2020 May2020 Ju n 2020 Jul2020 A u g 2020 Se p 2020 Oct2020 No...

Week No 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Age group
75+ 15.4 16.4 11.0 5.0 4.3 3.4 4.7 5.3 3.2 2.9 1.8 1.0 0.9 0.6 0.6 0.4 0.4 0.3 0.2 0.2 0.3 0.4 0.3 0.5 0.5 1.1 1.3 1.4 1.8 2.3 2.8 3.4

65to74 12.7 11.4 7.2 5.5 4.4 3.6 4.1 3.8 1.9 1.3 0.9 0.5 0.5 0.4 0.4 0.4 0.3 0.4 0.2 0.3 0.3 0.4 0.5 0.5 0.7 1.0 1.2 1.3 1.7 1.9 2.2 2.6

55to64 12.1 11.4 8.6 6.2 4.8 3.7 4.9 5.7 2.8 2.0 1.0 0.9 0.6 0.6 0.4 0.6 0.5 0.4 0.4 0.3 0.4 0.3 0.5 0.6 0.8 1.1 1.4 1.6 2.3 2.4 2.4 3.0

45to54 10.5 10.9 8.1 6.2 5.3 4.2 4.6 6.6 3.3 2.2 1.2 1.1 0.7 0.8 0.7 0.7 0.7 0.5 0.5 0.4 0.5 0.5 0.6 0.8 1.0 1.4 1.9 1.9 2.7 2.8 3.0 3.8

35to44 7.1 8.3 7.1 5.7 4.3 3.3 3.9 5.7 3.4 2.3 1.3 1.4 1.0 0.9 0.8 0.7 0.7 0.5 0.5 0.5 0.4 0.5 0.7 0.7 1.0 1.2 1.5 1.7 2.4 2.7 2.9 3.7

25to34 7.7 8.7 7.4 6.1 5.2 4.0 4.8 6.3 3.7 2.4 1.4 1.5 1.2 1.0 0.9 1.0 0.9 0.6 0.5 0.6 0.6 0.6 0.9 1.3 1.7 2.0 2.5 2.2 2.9 3.2 3.4 4.0

18to24 10.6 9.2 7.8 6.5 4.1 3.7 4.3 6.3 3.7 2.5 1.4 1.4 1.2 0.9 0.8 0.9 1.1 0.8 0.7 0.5 0.7 0.9 0.8 1.6 2.4 2.8 3.6 2.6 3.5 3.9 4.3 4.6

14to17 8.3 5.9 7.1 4.8 3.7 3.4 5.0 6.6 2.2 2.9 1.5 1.6 1.4 1.3 1.1 1.4 1.3 1.4 1.2 1.1 0.8 1.3 1.7 1.8 1.7 1.5 1.9 2.1 2.9 4.1 4.1 5.4

9to13 7.5 5.7 6.2 4.9 5.8 5.0 5.5 6.5 4.3 3.7 3.4 2.4 1.9 1.0 1.5 1.2 1.7 1.3 0.8 1.4 1.0 1.5 1.4 1.4 0.9 0.8 0.8 1.2 1.8 2.8 3.7 4.8

4to8 2.7 1.9 4.0 2.3 4.1 2.2 3.0 3.4 3.5 3.4 2.1 2.7 1.7 1.2 0.9 1.1 1.2 1.0 1.0 0.7 0.8 0.5 0.9 0.6 0.5 0.3 0.4 1.0 1.5 2.7 2.7 3.7

0to3 4.6 1.5 1.6 1.5 1.7 1.6 2.2 2.2 1.4 1.1 1.9 1.4 1.3 0.7 1.0 0.8 1.3 0.4 0.5 0.6 0.3 0.6 0.6 0.3 0.4 0.6 0.7 1.3 2.2 2.5 2.2 3.0

Total 10.7 11.3 8.5 5.7 4.6 3.6 4.5 5.6 3.1 2.3 1.3 1.1 0.9 0.7 0.7 0.7 0.7 0.5 0.5 0.4 0.5 0.5 0.7 0.9 1.2 1.3 1.6 1.8 2.4 2.8 3.0 3.7

Notes:
Data Source: Ontario Laboratory Information System (OLIS) as of November 8, 2020 (Includes complete weeks), MOH
Weekly % positivity = total number of positive test within the week (based on reported date)/ C O V I D tests within the week
 Cases in LTC continue to accelerate with cumulative
mortality up substantially (71 deaths in the past 7 days)
COVID-19 cases and deaths for LTC residents and staff
700
Current status (Nov 10) 683

• 93 homes currently in outbreak, 1067 600

active confirmed cases in these homes Daily Deaths, Residents Daily Deaths, Staff
• 683 residents, 410 staff active cases in 500 Daily Active Cases Residents Daily Active Cases Staff
total
Cumulative deaths since Aug 1 410
• 2,041 cumulative resident deaths, 8 400
cumulative staff deaths
300
• 34 of the 93 homes in outbreak are
based on 1 staff case
200 196
• There have been 196 resident deaths
since Aug 1st, 71 of which have been in
the past 7 days 100
24
• Nov 10 showed the highest daily count
of deaths since Aug 1 (24 deaths) 0
Aug 1 Aug 15 01-Sep 15-Sep 01-Oct 15-Oct 01-…

9
Data Source: M-LTC Tracker
 A number of jurisdictions struggle to control case
numbers following public health interventions
Number of Cases per Day (other countries aligned at 10/100,000) Partial or full lockdown
(according to the country’s trajectory – does not
12,000 match date on horizontal axis as epi curves are

> 100 / 100,000 Threshold

aligned at 10 cases/100,000/day)

France
10,000
Daily Cases

8,000

6,000
Netherlands

UK

4,000
Germany

2,000

0
09-18 09-25 10-02 10-09 10-16 10-23 10-30 11-06 11-13 11-20 11-27 12-04 12-11 12-18 12-25 01-01 01-08 01-15

ON 2nd wave - Reported Date ON 1.03 France 1.03 Germany 1.03 Netherlands 1.03 UK 1.03 100/100,000

Case numbers: www.ourworldindata.org; Lockdown info: https://www.bbc.com/news/explainers-53640249

10
 Daily Cases

-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
11-1-20

11-2-20

11-3-20

11-4-20

11-5-20

11-6-20

11-7-20

11-8-20

11-9-20

11-10-20

11-11-20

ON 2nd wave - Reported Date

11-12-20

11-13-20

11-14-20

11-15-20

11-16-20

ON 1.03
11-17-20

11-18-20

11-19-20

11-20-20

11-21-20 > 100 / 100,000 Threshold

France 1.03

11-22-20

11-23-20

11-24-20

11-25-20

11-26-20

11-27-20
Germany 1.03

11-28-20

11-29-20

11-30-20

12-1-20
Number of Cases per Day (other countries aligned at 10/100,000)

12-2-20

12-3-20
Netherlands 1.03
Germany

12-4-20

12-5-20

12-6-20
Projections of cases per day at 3% rate of growth

12-7-20
UK 1.03

12-8-20

12-9-20

12-10-20

12-11-20

12-12-20

12-13-20
UK

France
ON 1.03
Netherlands

11
 Daily Cases

-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
11-1-20

11-2-20

11-3-20

11-4-20

11-5-20

11-6-20

11-7-20

11-8-20

11-9-20

11-10-20

11-11-20

ON 2nd wave - Reported Date

11-12-20

11-13-20

11-14-20

11-15-20

11-16-20

ON 1.05
11-17-20

11-18-20 > 100 / 100,000 Threshold

11-19-20

11-20-20

11-21-20
France 1.05

11-22-20

11-23-20

11-24-20

11-25-20

11-26-20

11-27-20
Germany 1.05

11-28-20

11-29-20

11-30-20
Projections of cases at 5% rate of growth

Germany

12-1-20
Number of Cases per Day (other countries aligned at 10/100,000)

12-2-20

12-3-20
Netherlands 1.05

12-4-20

12-5-20

12-6-20

12-7-20
UK 1.05

12-8-20

12-9-20

12-10-20

12-11-20

12-12-20

12-13-20
UK

France
ON 1.05
Netherlands

12
 COVID-19 Hospitalizations continue to rise
450

61% increase in hospitalized COVID-19

patients over the past 3 weeks
400
Confirmed COVID19 Acute Inpatients (excluding ICU) 167% increase over the past 6 weeks
Confirmed COVID19 ICU Patients
350

300

250

200

150

100

50

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 13
Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA November 10
 Average length of stay in hospital for COVID-19 has
declined
25

20

15
Days

10

0
Ward ICU, No Vent ICU+Vent
March April May June July August September

14
Projections: ICU Occupancy under all scenarios

Predicted ICU Occupancy

450

400

350 ON 1.05

300

250 ON 1.03

200 ON 1.01

150

100

50

ON ON 1.01 ON 1.03 France 1.03 Germany 1.03 Netherlands 1.03

UK 1.03 ON 1.05 France 1.05 Germany 1.05 Netherlands 1.05 UK 1.05

15
Access to care continues well below 2019 volumes
 The Pandemic will have a substantial impact on mental
health and mental health care
• Overdose deaths have been a serious public health issue for over a decade. An average of 34
deaths per week occurred in the 3.5 months pre-pandemic. This increased to 46 deaths per
week in the first 3.5 months of the pandemic (38% increase).1 We should not expect this to
improve after the pandemic.

• Although the majority of community-based mental health and addictions services remain open
with some modifications, access to some services has been limited, particularly residential
treatment. We should expect to see long-term consequences of a decline in access or delay in
treatment.

• Like other aspects of health care access, service volumes are increasing again but are somewhat
below 2019 levels building a substantial deficit in access.

• We need to continue to monitor the impact of the pandemic on mental health and addictions
and the ability of the system to respond to population needs.
1. Ontario Drug Policy Research Network; Office of the Chief Coroner for Ontario/Ontario Forensic Pathology ; Ontario Agency for Health Protection and Promotion (Public Health Ontario); Centre on
Drug Policy Evaluation. Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic. Toronto, ON: Ontario Drug Policy Research Network; 2020.
Wastewater analysis suggests that restrictions can help
control spread but may not be sufficient (I)

18
Wastewater analysis suggests that restrictions can help
control spread but may not be sufficient (II)

19
Key Findings
• Key indicators of the Pandemic continue to worsen but the impact of the
Pandemic varies widely across regions
• Other countries have struggled to control spread after allowing strong growth in
case numbers in the early Fall
• Long-Term Care Home resident mortality is increasing each week
• Outbreaks continue to account for 10% of cases, recent research suggests indoor
environments where health protection is difficult account for majority of cases
• At a 5% rate of growth, our case numbers likely exceed several jurisdictions in
Europe that are now in some form of lockdown
• ICU occupancy will exceed the 150 bed threshold under any scenario within two
weeks. It will exceed 400 beds under the worst scenarios within six weeks.
• Wastewater tracking suggests that the restrictions had some effect in reducing
potential growth.

20