Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

November 26, 2020

CONFIDENTIAL - DO NOT CIRCULATE

Key Findings

• Key indicators of the Pandemic are flattening in some regions but the impact of
the Pandemic still varies widely across regions.
• Long-Term Care Home resident mortality continues to increase.
• ICU occupancy continues to increase and will hit 200 beds in December under any
scenario.
• It is difficult to determine whether we are seeing a turnaround in case growth.
Unlikely to see changes in ICU use until two weeks following decline in cases.
• Access to care continues below 2019 levels adding to the access to care deficit.
• Some communities face a much higher burden from the Pandemic because of
long-standing structural factors that lead to higher exposure to COVID-19. One-
size-fits-all public health interventions are unlikely to have the same impact in
some communities.

2
Recent data
may be
incomplete
Recent data
may be
incomplete
Weekly % positivity by age group
Weekly % positivity by age group

Month Apr2020 May2020 Jun2020 Jul2020 Aug2020 Sep2020 Oct2020 Nov2020

Week No 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 45 46
Age Group
75+ 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 3.6 3.3 3.1

65to74 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 3.4 3.4

55to64 11.4 8.6 6.3 4.8 3.7 4.9 5.7 2.7 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 1.2 1.4 1.6 2.3 2.4 2.4 3.0 3.4 3.2

45to54 10.9 8.2 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 4.4 3.9

35to44 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 0.8 1.0 1.2 1.5 1.7 2.3 2.7 2.9 3.7 4.5 3.9

25to34 8.7 7.4 6.2 5.2 4.1 4.9 6.2 3.7 2.4 1.4 1.5 1.2 1.0 0.9 1.0 0.9 0.5 0.5 0.6 0.6 0.6 0.9 1.3 1.8 2.1 2.5 2.3 2.9 3.3 3.5 4.2 5.0 4.7

18to24 9.1 7.8 6.5 4.1 4.0 4.4 6.2 3.6 2.5 1.4 1.4 1.1 0.9 0.9 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 4.0 4.4 4.8 5.7 5.3

14to17 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 4.0 4.4 5.4 6.6 5.6

9to13 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 0.9 1.2 1.8 2.8 3.7 5.0 4.6 5.6

4to8 1.9 4.0 2.3 4.1 2.2 2.9 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 0.8 0.6 0.5 0.3 0.4 0.9 1.5 2.7 2.7 3.6 4.0 4.5

0to3 1.4 1.5 1.4 1.5 1.5 2.1 2.1 1.3 1.1 1.8 1.3 1.3 0.7 1.4 0.8 1.2 0.4 0.8 0.5 0.3 0.5 0.5 0.3 0.4 0.6 0.7 1.3 2.7 2.2 2.6 3.0 5.2 3.6

Total 11.3 8.5 5.7 4.6 3.7 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 3.1 3.7 4.3 4.0

Legend:

Data Source: Ontario Laboratory Information System (OLIS), MOH – extracted from SAS VA Nov 24.
Note: Includes all data submitted to OLIS up to Nov 23, 2020. The last six days are considered interim data (week 46) and subject to change
Weekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week
 Cases in LTC flattening while cumulative mortality
has increased (64 deaths in the past 7 days).
LTC Home cases and outbreaks COVID-19 cases and deaths for LTC residents and staff
800
Current status (Nov 24)
700
104 Long term care (LTC) homes currently
Daily Deaths, Residents Daily Deaths, Staff
in outbreak, 964 active confirmed cases in 600
these homes Daily Active Cases Residents Daily Active Cases Staff
500
542 resident, 453 staff active cases in total Cumulative deaths since Aug 1
400
2,173 cumulative resident deaths, 8
cumulative staff deaths 300

34 of the 104 homes in outbreak are based 200

on 1 staff case
100
There have been 328 resident deaths since
0
Aug 1st, 64 of which have been in the past Aug 1 Aug Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov
7 days 15 15

Data Source: Ministry of Long Term Care Tracker. 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 8
posted by the local public health units (i.e. iPHIS database) due to lags in reporting time.
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)
10,000
ON 1.05
9,000
Michigan
8,000 Netherlands

7,000
Number of Cases

6,000
UK
5,000
ON 1.03
4,000 France
Germany
3,000

2,000 ON 1.01
ON 1.00
1,000

ON 2nd wave - Daily ON 2nd wave - 7-day average ON Constant ON 1.01 Partial or full lockdown
(according to the country’s trajectory – does not
ON 1.03 ON 1.05 France Germany match date on horizontal axis as epi curves are
aligned at 10 cases/100,000/day)
Netherlands UK Michigan
 COVID-19 Hospitalizations continue to rise
550

500
Confirmed COVID19 Acute Inpatients (excluding ICU)
63.2% increase in
hospitalizations over
Confirmed COVID19 ICU Patients
450 most recent 4 weeks

400

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 14-Nov 21-Nov
10
Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA November 24
Projections: ICU Occupancy > 200 beds under all
scenarios
400

350

300

250

200

150

100

50

ON ON 1.0 ON 1.01 ON 1.03 ON 1.05 France Germany Netherlands UK Michigan

11
 Access to care continues well below 2019 volumes
80% 12,000
Surgical Resume LTC
Directive #2 LTC Action Plan Restart (re)admissions

60%
10,000

40%

20% 8,000

Active COVID Cases

2020 vs 2019 (%)

0%
6,000

-20%

Active COVID Cases

-40% Diagnostic Imaging 4,000

Surgery
-60% ALC (Acute)
0% Line (No Change vs 2019) 2,000

-80% ER
ER (Projected from triage volumes in eCTAS)
Occupancy Rate
-100% 0
The impact of the COVID-19 epidemic in Ontario is not
evenly distributed

FSA, Forward Sortation Area 13

Household density and occupation places individuals and
relations most at risk of COVID-19
• ↑ Odds for COVID-19 if 2,000

Areas with lowest % of

1,800
residing in neighbourhoods homes considered

Cumulative COVID-19 Cases / 100,000 Population

suitable housing
1,600

with 1,400

• Higher household density/size 1,200

• Higher proportion of essential 1,000

service workers (measured by 800

proxies for occupation) 600

• Steeper ↑ in COVID-19 cases 400

Areas with highest %

in neighbourhoods with 200 of homes considered
suitable housing

lowest % of suitable housing 0

03/01
03/11
03/21
03/31
04/10
04/20
04/30
05/10
05/20
05/30
06/09
06/19
06/29
07/09
07/19
07/29
08/08
08/18
08/28
09/07
09/17
09/27
10/07
10/17
10/27
Suitable
Housing Decile: 1 2 3 4 5 6 7 8 9 10

City of Toronto
https://www.medrxiv.org/content/10.1101/2020.11.09.20223792v1 14
One-size-fits-all approaches lead to prevention gaps

Neighbourhood A Neighbourhood B
10%
No Interventions
9%
Interventions ↓ transmission risk by
8% 25% in both neighbourhoods
Proportion of Population Infected

7% Interventions ↓ transmission risk by

only 10% in neighbourhood A
6% PREVENTION GAP
5%

4%

3%

2%

1%

0%
0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300

prevention gap = conditions that lead to disproportionate risks of acquisition and/or onward transmission → increase R, sustain transmission & “micro-epidemics” 15
Key Findings

• Key indicators of the Pandemic are flattening in some regions but the impact of
the Pandemic still varies widely across regions.
• Long-Term Care Home resident mortality continues to increase.
• ICU occupancy continues to increase and will hit 200 beds in December under any
scenario.
• It is difficult to determine whether we are seeing a turnaround in case growth.
Unlikely to see changes in ICU use until two weeks following decline in cases.
• Access to care continues below 2019 levels adding to the access to care deficit.
• Some communities face a much higher burden from the Pandemic because of
long-standing structural factors that lead to higher exposure to COVID-19. One-
size-fits-all public health interventions are unlikely to have the same impact in
some communities.

16