Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

January 12, 2021

CONFIDENTIAL - DO NOT CIRCULATE

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
 Total new cases per 100,000 residents per week across PHUs
Sept 17 Sept 25 Oct 16 Nov 7 Nov 23 Dec 14 Dec 26
In-person Restrictions Modified COVID-19 RESPONSE Toronto and Peel York and Province-wide
classes for on bars and Stage 2 FRAMEWORK enter 28-day Windsor- lockdown
all major restaurants begins in Durham, Halton, Eastern lockdown Essex enter 14 days N. ON
400 school York to Protect. Ottawa and lockdown 28 days S. ON
boards York to Restrict. Peel to
Sept 19 Oct 9 Control + local restrictions. Dec 4
Limits on Modified Toronto remains in Middlesex-
social Stage 2 Modified Stage 2. London + T-Bay
350 gathering begins in to Restrict.
sizes Toronto, Haliburton to
Ottawa, Protect Windsor-Essex, 323
and Peel
Weekly new cases per 100,000 residents (7-day avg.)

300 Recent data

subject to
change

250 Lambton, 253

Peel, 232

200 York, 197

Niagara, 182
Toronto, 180
Hamilton, 158
Durham, 145
Southwestern, 145
150 Waterloo, 145
Eastern, 142
Middlesex-London, 132
Wellington-Dufferin-Guelph, 128
Chatham-Kent, 126
Halton, 115
100 Haldimand-Norfolk, 106
Brant, 103
Ottawa, 80
Simcoe Muskoka, 72

50 CONTROL (cases ≥ 40)

RESTRICT (cases ≥ 25) All Other PHUs, 32
PROTECT (cases ≥ 10)
0

Nov 7

Nov 14

Nov 21

Nov 28
Aug 1

Aug 8

Aug 15

Aug 22

Aug 29

Sep 5

Sep 12

Sep 19

Sep 26

Dec 5

Dec 12

Dec 19

Dec 26

Jan 2
Oct 3

Oct 10

Oct 17

Oct 24

Oct 31

3
Data source: Case and Contact Management System, data up to January 8
 COVID-19 testing % positivity across PHUs
Sept 24 Oct 6 Nov 7 Nov 23 Dec 14 Dec 26
Testing Assessment COVID-19 RESPONSE Toronto and Peel York and Province-wide
guidance Centres move FRAMEWORK enter 28-day Windsor- lockdown
update to advance Durham, Halton, Eastern lockdown Essex enter 14 days N. ON
16 28 days S. ON
booking to Protect. Ottawa and lockdown
York to Restrict. Peel to
15 Control + local restrictions. Dec 4
Toronto remains in Middlesex- Windsor-Essex, 14%
Oct 1 Modified Stage 2. London + T-Bay
14 School & childcare to Restrict.
screening guidance Haliburton to
13 change Protect
Peel, 13%
12
% positivity of daily testing episodes (7-day avg.)

11
York, 10%
10 Lambton, 10%
Toronto, 10%
9 Chatham-Kent, 9%

8
Durham, 8%
Southwestern, 7%
7 Waterloo, 7%
Halton, 7%
Eastern, 7%
Hamilton, 6%
6 Middlesex-London, 6%
Niagara, 6%
Brant, 5%
5 Haldimand-Norfolk, 5%
Wellington-Dufferin-Guelph, 5%
4 Ottawa, 5%
All Other PHUs, 4%
Simcoe Muskoka, 3%
3
CONTROL (positivity ≥ 2.5%)

2
RESTRICT (positivity ≥ 1.3%)
1
PROTECT (positivity ≥ 0.5%)
0

Nov 7

Nov 14

Nov 21

Nov 28
Aug 1

Aug 8

Aug 15

Aug 22

Aug 29

Sep 5

Sep 12

Sep 19

Sep 26

Dec 5

Dec 12

Dec 19

Dec 26

Jan 2
Oct 3

Oct 10

Oct 17

Oct 24

Oct 31 4
Data source: Ontario Laboratories Information System (OLIS), data up to January 4
 Percent of COVID test results returned within 2 days across PHUs
Sept 24 Oct 6 Nov 7 Nov 23 Dec 14 Dec 26
Testing Assessment COVID-19 RESPONSE Toronto and Peel York and Province-wide
guidance Centres move FRAMEWORK enter 28-day Windsor- lockdown
update to advance Durham, Halton, Eastern lockdown Essex enter 14 days N. ON
110 28 days S. ON
booking to Protect. Ottawa and lockdown
York to Restrict. Peel to
Control + local restrictions. Dec 4
100 Oct 1 Toronto remains in Middlesex- Toronto, 92%
School & childcare Hamilton, 91%
% of testing episodes with results released within 2 days of test (7-day avg.)

Modified Stage 2. London + T-Bay

Halton, 90%
screening guidance to Restrict. Peel, 86%
change Haliburton to Middlesex-London, 86%
90 Protect Eastern, 85%
Chatham-Kent, 84%
Ottawa, 84%
Niagara, 84%
Haldimand-Norfolk, 84%
80 Durham, 81%
All Other PHUs, 77%
Waterloo, 76%
Brant, 75%
York, 75%
70 Southwestern, 73%
Windsor-Essex, 72%
Simcoe Muskoka, 71%
Wellington-Dufferin-Guelph, 66%
60 Lambton, 63%

50

40

30

20

10

Nov 7

Nov 14

Nov 21

Nov 28
Aug 1

Aug 8

Aug 15

Aug 22

Aug 29

Sep 5

Sep 12

Sep 19

Sep 26

Dec 5

Dec 12

Dec 19

Dec 26

Jan 2
Oct 3

Oct 10

Oct 17

Oct 24

Oct 31
5
Data source: Ontario Laboratories Information System (OLIS), data up to January 4
Weekly % positivity by age group
Weekly % positivity by age group

Legend:

Data Source: Ontario Laboratory Information System (OLIS), MOH – extracted from SAS VA Jan 10
Note: 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 6
Weekly % positivity = total number of positive tests within the week (based on reported date)/COVID tests within the week
 Cases and cumulative mortality LTC increasing (198
resident and 2 staff deaths since January 1st)
Current status
COVID-19 cases and deaths for LTC residents and staff
252 LTC homes have COVID-19 1500
outbreaks (40% of all homes) with 105
Daily Active Cases Residents
outbreaks involving resident cases 1250
Daily Active Cases Staff
Outbreaks are occurring across almost
all public health units, with 1000 Cumulative deaths since Sept 1
91 outbreaks (37%) occurring in
priority vaccination areas of Toronto, 750
Peel, York and Windsor-Essex
Since January 1st, 198 LTC residents 500

have died of COVID-19 and 2 staff

deaths have been reported 250

Forecasts suggest there will

0
be more LTC residents deaths in wave Sep 1 Sep Oct 1 Oct Nov Nov Dec 1 Dec Jan 1
2 than in wave 1 (1,815 total deaths) 15 15 1 15 15

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 7
(i.e. iPHIS database) due to lags in reporting time.
Projections: second wave cumulative LTC resident COVID-19
deaths >2,600 by Feb 14 in worst case scenario
Projected and actual cumulative LTC resident COVID-19 deaths (Sep 1, 2020-Feb 14, 2021)
3,000

2,639 projected deaths as of

Feb 14, 2021 (worst case)
Projected deaths
2,500

Actual cumulative deaths (MLTC tracker)

Last day of forecast: Feb 14, 2021

Cumulative LTC resident COVID-19 deaths

2,000

1,500
1,119 actual deaths as of
Jan 9, 2021

1,000

500

Predictions: MOH Capacity Planning and Analytics Division 8

Date Data: (Cumulative Deaths): MLTC Tracker Tool
Long-term Care
Outbreaks
July 1, 2020

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 Size of outbreak (staff and residents)
2270 York Region Public Health
3895 Toronto Public Health
4913 Southwestern Public Health
5183 Huron Perth Health Unit

9
Long-term Care
Outbreaks
October 1, 2020

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 Size of outbreak (staff and residents)
2270 York Region Public Health
3895 Toronto Public Health
4913 Southwestern Public Health
5183 Huron Perth Health Unit

10
Long-term Care
Outbreaks
January 7, 2021

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 Size of outbreak (staff and residents)
2270 York Region Public Health
3895 Toronto Public Health
4913 Southwestern Public Health
5183 Huron Perth Health Unit

11
Despite some reduced mobility from “Grey Zone” restrictions,
there was a pre-holiday spike

% change relative to January 2020 Analysis: UofT, St. Michael’s Hospital, ICES
Data: Google 12
“Grey Zone” restrictions did not affect the proportion of people
working from home; holiday decreases are not likely to persist

% change relative to January 2020 Analysis: UofT, St. Michael’s Hospital, ICES
Data: Google 13
With current restrictions, almost 2/3 of the population are
acting in a way that will decrease COVID-19 spread
• Are people in your neighbourhood physically distancing?

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

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

3 or more 1-2 None

• And if so, did you observe restrictions?

Didn’t observe restrictions Observed restrictions

14
Survey: Fields Institute
As happened in other jurisdictions, case growth
continues under current levels of restrictions
Daily New Cases (Other Countries Aligned at 230/1M Population/Day)
45,000
ON 7%↑
40,000

35,000

30,000

25,000

20,000 ON 5%↑

15,000

ON 3%↑
10,000

5,000 ON 1%↑
ON 0%↑

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

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

ON 7%↑ FRA GER NLD UK

Note: Ontario reached 23/100,000 cases between 1.5 Predictions informed by modeling from McMasterU, Fields Institute, COVID-19 ModCollab, PHO;
and 3 months after these countries recent growth in new daily cases; reported cases in peer jurisdictions 15
Data (Observed Cases): covid-19.ontario.ca; https://ourworldindata.org
Projections: COVID-19 ICU occupancy around 500 beds in mid-
January, potentially over 1,000 beds in February in more severe,
but realistic scenarios
3,500

ON 7%↑
ICU Beds Occupied with COVID-19 Patients (per Day)

3,000

2,500

2,000
ON 5%↑

1,500

ON 3%↑
1,000

ON 1%↑

500 ON 0%↑

150 beds
0

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

16
At 9% growth rate (not shown): >2,000 occupancy Feb 5 Predictions: COVID-19 ModCollab.
Data (Observed ICU Occupancy): CCSO
 COVID-19 hospitalizations and ICU admissions continue to climb
1500

1400
Over the past 4 weeks:
1300 72.2% increase in hospitalizations
Confirmed COVID19 Acute Inpatients (excluding ICU) 61.2% increase in ICU patients
1200
Confirmed COVID19 ICU Patients
1100

1000

900

800

700

600

500

400

300

200

100

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 28-Nov 05-Dec 12-Dec 19-Dec 26-Dec 02-Jan
17
Data Sources: Daily Bed Census Summary COVID-19 Report + Critical Care Information System, extracted January 9
 Percentage of L3 MSICU Beds Occupied

0%
20%
40%
60%
80%
100%
120%
140%
160%
Cornwall Community Hospital n = 11
Hamilton Health Sciences General n = 31
Humber River Wilson n = 46
Markham Stouffville n = 15
Michael Garron Hospital n = 17
Niagara Health System St. Catharines n = 14
Oakville Trafalgar Memorial Hospital n = 21
Quinte Healthcare Belleville n = 18
Scarborough Centenary n = 20

0 Free Beds
St. Thomas-Elgin General Hospital n = 8
Stratford General Hospital n = 6
Sunnybrook Health Sciences Centre n = 52
Trillium Credit Valley Hospital n = 24
William Osler Etobicoke Campus n = 14
Windsor Regional Metropolitan Campus n = 19
Chatham-Kent n = 10
Georgian Bay General Hospital n = 6
Mackenzie Health n = 30
Orillia Soldiers Memorial Hospital n = 8

1 Free Bed
Southlake Regional Health Centre n = 18
Unity Health St. Michael's n = 29
Bluewater Health Sarnia General Hospital n = 14
Cambridge Memorial Hospital n = 12
Grey Bruce Health Services Owen Sound n = 6
Guelph General Hospital n = 10
Hamilton Health Sciences Juravinski Hospital n = 23
Kingston Health Sciences Centre n = 33

Other ICU Patients

Queensway - Carleton Hospital n = 12
Royal Victoria Regional Health Centre n = 15

2 Free Beds
Scarborough Birchmount n = 15
Beds

St. Mary's General Hospital n = 13

The Ottawa Hospital Civic Campus n = 29
UHN Toronto Western Hospital n = 33
Unity Health St. Joseph's n = 18
Brantford General Hospital n = 15
Brockville Genearl Charles St n = 10
Grand River Kitchener Waterloo n = 20
Patients with COVID-19
quarter have only 1 or 2 beds free

Halton Healthcare Milton District Hospital n = 8

Health Sciences North n = 14
Hopital Montfort n = 12
Joseph Brant Hospital n = 24
Lakeridge Health Ajax n = 13
Lakeridge Health Oshawa n = 32
LHSC University Campus n = 25
LHSC Victoria Campus n = 31
Mount Sinai Hospital n = 21
Niagara Health System Greater Niagara n = 15
North Bay Regional Health Centre n = 16
North York General Hospital n = 23
3+ Free Beds

Pembroke Regional Hospital Inc. n = 9

Peterborough Regional Hospital Drive n = 28
Ross Memorial Hospital n =- 9
Sault Area Hospital n = 13
Scarborough General n = 29
St Joseph's Healthcare System Charlton n = 27
Percentage of Ontario L3 Medical Surgical ICU Beds Occupied on January 8, 2021, by Number of Available

The Ottawa Hospital General Campus n = 29

Thunder Bay Regional Health Sciences Centre n = 22
Trillium Mississauga Hospital n = 37
UHN Toronto General Hospital n = 38
William Osler Brampton Campus n = 24
Windsor Regional Ouellette Campus n = 20
Woodstock General Hospital n = 12
One quarter of hospitals have no ICU beds free, another

85%
100%

Occupancy
Occupancy

18
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

Assumption: continue current restrictions. 20

Forecasting: McMasterU.
Data (Observed Deaths): CCM+
 The Novel SARS-CoV-2 variant: B.1.1.7 appears to be
much more easily transmitted
• Novel SARS-CoV-2 variant, Daily New Cases per 1 Million People (7-Day Average)

B.1.1.7, emerged in southeast

1000

900

England in November
UK

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

800

• Transmissibility: 56% ↑ (95% 700

credible interval 50-74%)

600

500

• No increase in disease severity,

NLD
400

vaccines likely still effective 300 GER

FRA
ON
200

100

0
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

France Germany Netherlands United Kingdom Ontario

Sources: Public Health England Technical Reports; Davies NG et al (LSHTM) Sources: https://ourworldindata.org; CCM+
21
 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

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
Predictions: QueensU
Key components of hard lockdowns in peer
jurisdictions
Victoria, France (Fall) UK* Germany* Netherlands*
Australia
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 ✓ ✓ ✓ ✓ ✓

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

23
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 secretariat
Beate 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