Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

November 26, 2020

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

3Data Source: Case and Contact Management System (CCM), extracted November 24

Recent data may be incomplete

Total new cases per 100,000 residents per week across PHUs

4

Data Source: Case and Contact Management System (CCM), extracted November 24

Recent data may be incomplete

New cases with no epidemiological Link across PHUs

Data Source: Ontario Laboratory Information System (OLIS), extracted via MOH SAS VA November 24

COVID-19 testing % positivity across PHUs

Data Source: Ontario Laboratory Information System (OLIS), extracted via MOH SAS VA November 24

6

Percent of tests processed within 2 days across PHUs

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

Weekly % positivity by age group

LTC Home cases and outbreaks

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 posted by the local public health units (i.e. iPHIS database) due to lags in reporting time.

Current status (Nov 24)

104 Long term care (LTC) homes currently in outbreak, 964 active confirmed cases in these homes

542 resident, 453 staff active cases in total

2,173 cumulative resident deaths, 8 cumulative staff deaths

34 of the 104 homes in outbreak are based on 1 staff case

There have been 328 resident deaths since Aug 1st, 64 of which have been in the past 7 days

8

0

100

200

300

400

500

600

700

800

Aug 1 Aug15

Sep 1 Sep 15 Oct 1 Oct 15 Nov 1 Nov15

COVID-19 cases and deaths for LTC residents and staff

Daily Deaths, Residents Daily Deaths, Staff

Daily Active Cases Residents Daily Active Cases Staff

Cumulative deaths since Aug 1

Cases in LTC flattening while cumulative mortality has increased (64 deaths in the past 7 days).

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Nu

mb

er o

f C

ases

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

ON 2nd wave - Daily ON 2nd wave - 7-day average ON Constant ON 1.01

ON 1.03 ON 1.05 France Germany

Netherlands UK Michigan

A number of jurisdictions struggle to control case numbers following public health interventions

France

ON 1.03

UK

Netherlands

Germany

Michigan

ON 1.01

ON 1.05

ON 1.00

Partial or full lockdown (according to the country’s trajectory – does not match date on horizontal axis as epi curves are aligned at 10 cases/100,000/day)

0

50

100

150

200

250

300

350

400

450

500

550

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

Confirmed COVID19 Acute Inpatients (excluding ICU)

Confirmed COVID19 ICU Patients

10Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System. Extracted via MOH SAS VA November 24

63.2% increase in hospitalizations over most recent 4 weeks

COVID-19 Hospitalizations continue to rise

Projections: ICU Occupancy > 200 beds under all scenarios

11

-

50

100

150

200

250

300

350

400

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

Directive #2 LTC Action PlanSurgical Restart

Resume LTC (re)admissions

0

2,000

4,000

6,000

8,000

10,000

12,000

-100%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

Act

ive

CO

VID

Cas

es

20

20

vs

20

19

(%

)

Active COVID Cases

Diagnostic Imaging

Surgery

ALC (Acute)

0% Line (No Change vs 2019)

ER

ER (Projected from triage volumes in eCTAS)

Occupancy Rate

Access to care continues well below 2019 volumes

The impact of the COVID-19 epidemic in Ontario is not evenly distributed

13FSA, Forward Sortation Area

Household density and occupation places individuals and relations most at risk of COVID-19

• ↑ Odds for COVID-19 if residing in neighbourhoods with• Higher household density/size

• Higher proportion of essential service workers (measured by proxies for occupation)

• Steeper ↑ in COVID-19 cases in neighbourhoods with lowest % of suitable housing 0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

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

Cu

mu

lati

ve C

OV

ID-1

9 C

ases

/ 1

00

,00

0 P

op

ula

tio

n

1 2 3 4 5 6 7 8 9 10

14

Areas with lowest % of homes considered suitable housing

Areas with highest % of homes considered suitable housing

Suitable Housing Decile:

https://www.medrxiv.org/content/10.1101/2020.11.09.20223792v1

City of Toronto

One-size-fits-all approaches lead to prevention gaps

Neighbourhood A Neighbourhood B

15

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

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

Pro

po

rtio

n o

f P

op

ula

tio

n In

fect

ed

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”

PREVENTION GAP

Interventions ↓ transmission risk by 25% in both neighbourhoods

No Interventions

Interventions ↓ transmission risk by only 10% in neighbourhood A

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