Update on COVID-19 Projections

Science Advisory and Modelling Consensus Tables

December 7, 2021
Key findings
• COVID-19 cases are rising in most Public Health Units due to the Delta variant. Testing has not
increased, but positivity is rising. This is a real rise in cases.
• Vaccine effectiveness in Ontario remains very high but experience in other countries suggests we will
need to boost immunity with third doses.
• Even without Omicron, ICU occupancy will likely grow to 250-400 beds in January, putting hospitals
under strain again.
• To control cases and the impact on our health system, we need to increase vaccination (particularly
5-11 year-olds) and continue to use public health measures to reduce transmission now.

• Spread of the new Omicron variant will likely drive COVID-19 cases above current projections.
• In South African data, vaccination appears to protect against serious illness due to Omicron and most
hospitalizations are in the unvaccinated. There is likely an increased risk of re-infection even amongst
people those who have had COVID-19, emphasizing the importance of vaccination.
• Low global vaccine coverage means that we can expect new variants to arise.

2
 Weekly new cases per 100,000 residents

100
120
140
160
180
200

20
40
60
80

0
Timiskaming
Algoma
Haldimand-Norfolk
KFLA
Windsor-Essex
Southwestern
Simcoe Muskoka
Brant
Hastings & PEC
Chatham-Kent
the dominant variant

Thunder Bay
Eastern
Waterloo
Lambton
Durham
14-day increases

Data note: Data for the most recent day have been censored to account for reporting delays
Peterborough
November 15

York
Hamilton
Halton
Middlesex-London
Renfrew
Average weekly cases on:

Toronto
Peel
Grey Bruce
November 28

Northwestern
Haliburton KPR
Data: CCM

Sudbury
Huron Perth
Analysis: Ontario Health

Niagara
Ottawa
Leeds Grenville Lanark
Wellington-Dufferin-Guelph
North Bay Parry Sound
Cases are increasing in most public health units while Delta is

14-day decreases

Porcupine
3
Testing rates are flat since mid-July

4.3

1.6

1.0

Data: OLIS via SAS VA, data up to November 26 4

Analysis: Ontario Health
 Even with unchanged testing rates, test positivity is rising

Apr 3: Province-wide emergency brake

Apr 17: Enhanced PH measures

Jun 11: Re-opening Step 1

Jun 30: Re-opening Step 2

Jul 16: Re-opening Step 3

Sep 7: Schools open

Sep 22: Vaccine passports take effect

settings can lift capacity limits

Oct 25: Proof-of-vaccination
16
% positivity of daily testing episodes

14

12

10

6 Haldimand-Norfolk, 5.6%
Southwestern, 5.5%
Windsor, 5.1%
4

Ontario, 2.5%
2

0
Jul 19

Aug 16

Aug 30
Aug 2

Oct 11

Oct 25
Jun 21
Jun 7

Nov 22
Nov 8
Apr 12

Apr 26

May 10

May 24

Jul 5
Mar 15

Mar 29

Sep 13

Sep 27
Mar 1

Specimen Date
Data: OLIS via SAS VA, data up to November 26 5
The most recent 3 days have been removed to account for incomplete data. Data are smoothed. Analysis: Ontario Health
 Vaccination continues to be highly effective
Unvaccinated people have a 5-fold higher risk of symptomatic COVID-19 disease, a 13-fold higher risk of
being in the hospital and 23-fold higher risk of being in the ICU compared to the fully vaccinated

COVID-19 Cases COVID-19 Patients in Hospital COVID-19 Patients in ICU

240 240 240

COVID-19 Patients in Hospital per 1 Million Inhabitants

220 220 220

COVID-19 Patients in ICU per 1 Million Inhabitants

COVID-19 Cases per 1 Million Inhabitants per Day

200
Cases Among 200 200
Unvaccinated Individuals
180 180 Hospital Occupancy Among 180

160 160 Unvaccinated Individuals 160

140 140 140

120 120 120 ICU Occupancy Among

100 100 100 Unvaccinated Individuals
80 80 80

60 Cases Among Fully 60 60

40 Vaccinated Individuals 40 Hospital Occupancy Among 40

ICU Occupancy Among Fully
20 20 Fully Vaccinated Individuals 20 Vaccinated Individuals
0 0 0
-O 1
-O 1
2- t-21

9- -21

-N 1

9- -21

-N 1
-S 1
-S 1
5- -21

-O 1
-O 1
2- t-21

-S 1
-S 1
5- -21

-O 1
-O 1
2- t-21
-O 1

-D 1
-D 1
1

-S 1

-O 1

-S 1

-O 1
-A 1
-A 1
-A 1
7- -21

-D 1
-D 1
1

-A 1
-A 1
-A 1
7- -21

-D 1
-D 1
1
-D 1
-N 1
-N 1
7- -21

-D 1

-D 1
-N 1
-N 1
7- -21

-N 1
-N 1
7- -21
9- -21

-N 1
-S 1
-S 1
5- -21
-S 1
-A 1
-A 1
-A 1
7- -21

19 t-2
26 t-2

16 v-2

16 v-2
21 p -2
28 p -2

19 t-2
26 t-2

21 p -2
28 p -2

19 t-2
26 t-2
21 c-2
28 c-2

-2

14 p -2

14 p -2
17 g-2
24 g-2
31 g-2

21 c-2
28 c-2

-2

17 g-2
24 g-2
31 g-2

21 c-2
28 c-2

-2
14 c-2
23 v-2
30 v-2

14 c-2

14 c-2
23 v-2
30 v-2

23 v-2
30 v-2
16 v-2
12 t-2
21 p -2
28 p -2

12 t-2

12 t-2
14 p -2
17 g-2
24 g-2
31 g-2

v
ep

ep
ug

ug
ec
ov

ec

ec
ov

ov
v
ep
ug

c
c
c

c
c
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c
c
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No
No
u
u
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-A

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10

10
10

Date Date Date

Data: https://data.ontario.ca/ and CCM plus; estimates of patients in hospital and ICU are age standardized 6
Analysis: Secretariat of the Science Advisory Table (https://covid19-sciencetable.ca/ontario-dashboard/)
Ontario data shows vaccines maintaining high effectiveness

Effectiveness of 2 doses of mRNA vaccines over time*

100
Hospitalization or death
90
Symptomatic infection
Vaccine effectiveness (%)

80
Infection (with or without symptoms)
70
60
50
40
30
20
10
0
7-59 d 60-119 d 120-179 d 180-239 d ≥240 d
(0-1 m) (2-3 m) (4-5 m) (6-7 m) (≥8 m)
Time Since second dose in days (d)

7
* Ontario, test-negative design, ≥16 years, any SARS-CoV-2 lineage, data to 1 Nov 2021 Data Source and Analysis: ICES
 Cases continue to rise substantially, even without Omicron.
To flatten the curve, we need to reduce transmission by
increasing vaccination and public health measures.
Figure shows predictions based on a 3000
Current behaviour (e.g., no
consensus across models from 4 Reported cases
change in contacts) and
30% of 5–11 year-olds
scientific teams. 7-day average
vaccinated by end of Dec

• All scenarios assume continuing

current public health measures.
• All scenarios include vaccinating
2000

Current behaviour (e.g., no

kids 5-11 years of age, but differ

Daily cases
change in contacts) and
50% of 5–11 year-olds
on the proportion of kids vaccinated by end of Dec

vaccinated by end of December.

• Different models use different 1000
15% decrease in
transmission through
approaches and assumptions. additional public health
measures (e.g., decrease
• Omicron not included in these in contacts) and 30% of
5–11 year-olds vaccinated
scenarios, and would likely Range from
last briefing
by end of Dec

worsen these projections.

0
September October November December January

Predictions informed by modeling from McMasterU, PHO, WesternU, YorkU 8

Data (Observed Cases): covid-19.ontario.ca
 COVID Patient Census

0
500
1,000
1,500
2,000
2,500
01-Sep
08-Sep
15-Sep
22-Sep
29-Sep
06-Oct
13-Oct
illness

20-Oct
27-Oct
03-Nov
10-Nov
17-Nov
active COVID19

24-Nov
01-Dec
08-Dec
15-Dec
22-Dec
29-Dec
05-Jan
12-Jan
19-Jan
26-Jan
02-Feb
09-Feb
16-Feb
23-Feb
02-Mar
09-Mar
Patients in inpatient beds (incl. ICU) with

16-Mar
Patients in ICU with COVID-related critical

23-Mar
30-Mar
06-Apr
13-Apr
20-Apr
27-Apr
04-May
11-May
18-May
25-May
01-Jun
08-Jun
15-Jun
22-Jun
29-Jun
06-Jul
13-Jul
20-Jul
27-Jul
03-Aug
10-Aug
17-Aug
24-Aug
31-Aug
07-Sep
14-Sep
21-Sep
28-Sep
05-Oct
12-Oct
19-Oct
26-Oct
02-Nov
09-Nov
16-Nov
Analysis: Ontario Health

23-Nov
30-Nov
COVID-19 hospitalizations and ICU admissions are stable for now

9
As cases increase, ICU occupancy will also increase, likely exceeding
250 by end of December without accounting for Omicron
500

Observed ICU occupancy

7-day average Current behaviour (e.g., no change in

contacts) and 30% of 5–11 year-olds
400
vaccinated by end of Dec

Current behaviour (e.g., no change in

contacts) and 50% of 5–11 year-olds
vaccinated by end of Dec
ICU occupancy

300

15% decrease in transmission through

additional public health measures
(e.g., decrease in contacts) and 30% of
200 Range from
5–11 year-olds vaccinated
last briefing by end of Dec

100

0
September October November December January

Predictions: COVID-19 ModCollab based on case predictions in previous slide 10

Data (Observed ICU Occupancy): CCSO
 Ontario ICUs have been under unprecedented pressure and
will have trouble responding to another surge in patients
• Due to the need for urgent non-COVID-19
patient care, fewer staff are available to
be redeployed and fewer staffed surge
spaces are available
• Number of patients on ventilators has
been above average for over a year; the
pressure on ICUs has not let up
• There is a growing crisis in staffing for
critical care patients with significant
contribution from health care worker
burnout
• Despite new beds and strong
management, ICUs will be challenged in
responding to any new surge in patients
because of staffing constraints
CRCI: COVID-19 related critical illness

11
Source: Science Briefs of the Ontario COVID-19 Science Advisory Table (https://doi.org/10.47326/ocsat.2021.02.51.1.0)
 Rising cases, ICU occupancy, and deaths in European peer
jurisdictions show potential risk

Australia
Germany COVID-19 Patients in ICU COVID-19 Deaths
COVID-19 Cases 50 4.0
Australia
1,400 France
Germany Germany
45 Netherlands
France 3.5 France

ICU Beds Occupied per 1 Million Inhabitants

1,200

COVID-19 Deaths per 1 Million Inhabitants

United Kingdom
COVID-19 Cases per 1 Million Inhabitants

40 Netherlands
Netherlands
3.0
Ontario United Kingdom
1,000 United Kingdom 35

2.5 Ontario
Ontario 30
800
25 2.0

600 20
1.5
15
400
1.0
10
200 0.5
5

0 0 0.0

1
21

21

21
1

1
21
1

1
1

1
21

21

21
1

1
21
1

1
1

1
21

21

-2

-2
21
1

t-2
-2

-2
21

1
1

-2

-2

-2

-2
1

l-2

l-2

-2

-2
t-2
-2

-2
-2

-2

-2

-2
l-2

l-2
-2

-2

p-
n-

n-
-2

-2

-2

-2

v-
l-2

l-2

-2

-2
t-2

p-
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n-

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ct

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ct

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-N

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-D

-D
-A

-A

-S
Se

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-N

-N

-D

-D
-A

-A

-S
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5-
13

27
-D

-D
-A

-A

-S

7-
-N

-N

2-

5-
15

29

13

27

7-
21

19

2-
10

24

16

30

14

28
13

27

15

29
7-

5-

21

19
2-
15

29

10

24

16

30

14

28
21

19
10

24

14

28
16

30

Date Date Date

The Ontario Stringency Index (44) is similar to UK (47); the Netherlands are at 56, Australia, France and Germany are at ≥67.
Ontario vaccine coverage (77% of population fully vaccinated) similar to Netherlands and Australia (74%),
higher than remaining peer countries (~68%).

Data: https://data.ontario.ca/ and https://ourworldindata.org/explorers/coronavirus-data-explorer 12

Analysis: Secretariat of the Science Advisory Table (https://covid19-sciencetable.ca/ontario-dashboard/)
 A new variant of concern called Omicron became rapidly dominant
and caused a steep increase in cases in the province of Gauteng,
South Africa • Rapid increase in daily cases in Gauteng indicates
Number of Daily COVID-19 Cases and Hospital Admissions that Omicron is more transmissible than Delta.
in Gauteng, South Africa (15.8 Million Inhabitants)
400 8,000
• Previously infected people have an increased risk of
COVID-19 Hospital Admissions per Day

350
COVID-19 Cases per Day (7-Day Average)
7,000
reinfection, suggesting partial evasion of immunity
COVID-19 Hospital Admissions per Day

COVID-19 Cases per Day (7-Day Average)

by Omicron.
300 6,000

250 5,000
• Hospital and ICU admissions are increasing because
of steep increase in cases.
200 4,000

150 3,000
• Early data suggests vaccination protects against
hospital admission caused by Omicron. Most
100 2,000
patients admitted to hospital are unvaccinated.
50 1,000
• Omicron is transmitted exactly the same way as
0 0
previous SARS-CoV-2 strains. Public health
8 1

8 1

8 1

8 1

9 1

9 1

9 1

9 1

0 1

0 1

0 1

0 1

0 1

1 1

1 1

1 1

1 1

2 1

2 1

2 1

2. 1
21
08 .202

15 .202

22 .202

29 .202

05 .202

12 .202

19 .202

26 .202

03 .202

10 .202

17 .202

24 .202

31 .202

07 .202

14 .202

21 .202

28 .202

05 .202

12 .202

19 .202

26 .202
20
8

measures still work.

.0

.0

.0

.0

.0

.0

.0

.0

.0

.1

.1

.1

.1

.1

.1

.1

.1

.1

.1

.1

.1

.1
01

Date
Data: https://www.sacmcepidemicexplorer.co.za/; https://www.nicd.ac.za/ and https://sacoronavirus.co.za/ 13
Analysis: Secretariat of the Science Advisory Table (https://covid19-sciencetable.ca/)
The current situation is very uncertain, but the potential impact
of Omicron on cases could be substantial
If Omicron is much more infectious
and vaccines are much less effective
3000

Possible range of
Reported cases Omicron effect
7-day average

If Omicron is moderately more

infectious and vaccines are
2000 moderately less effective

Current behaviour (e.g., no change in

Daily cases

contacts) and 50% of 5–11 year-olds

vaccinated by end of Dec

1000

0
September October November December January

14
Predictions informed by modeling from McMasterU, WesternU
Current public health measures are effective against Omicron

15
Adapted from: https://uihc.org/health-topics/why-swiss-cheese-may-be-key-keeping-you-safe-covid-19
Key findings
• COVID-19 cases are rising in most Public Health Units due to the Delta variant. Testing has not
increased, but positivity is rising. This is a real rise in cases.
• Vaccine effectiveness in Ontario remains very high but experience in other countries suggests we will
need to boost immunity with third doses.
• Even without Omicron, ICU occupancy will likely grow to 250-400 beds in January, putting hospitals
under strain again.
• To control cases and the impact on our health system, we need to increase vaccination (particularly
5-11 year-olds) and continue to use public health measures to reduce transmission now.

• Spread of the new Omicron variant will likely drive COVID-19 cases above current projections.
• In South African data, vaccination appears to protect against serious illness due to Omicron and most
hospitalizations are in the unvaccinated. There is likely an increased risk of re-infection even amongst
people those who have had COVID-19, emphasizing the importance of vaccination.
• Low global vaccine coverage means that we can expect new variants to arise.

16
Contributors

• COVID-19 Modeling Collaborative: Kali Barrett, Stephen Mac, David Naimark, Aysegul Erman,
Yasin Khan, Raphael Ximenes, Sharmistha Mishra, Beate Sander
• ICES: Jeff Kwong, Hannah Chung, Sharifa Nasreen, Siyi He, Sarah Buchan, Deshayne Fell, Maria
Sundaram, Peter Austin
• McMasterU: Irena Papst, Ben Bolker, Jonathan Dushoff, David Earn
• Modeling Consensus Table: Isha Berry
• Our Health Counts Toronto ICES COVID-19 AHRQ linkage project: Janet Smylie, Stephanie
McConkey, Beth Rachlis, Lisa Avery, Graham Mercredi, Cheryllee Bourgeois, Mike Rotondi
• Ontario Health: Erik Hellsten, Stephen Petersen, Anna Lambrinos
• PHO: Kevin Brown, Sarah Buchan, Alyssa Parpia
• Science Advisory Table: Peter Jüni, Karen Born, Kali Barrett, Nicolas Bodmer, Pavlos Bobos, Shujun
Yan
• Western University/London Health Sciences Centre: Lauren Cipriano, Wael Haddara
• YorkU: Jianhong Wu, Michael Glazer, Zack McCarthy

17
Content and review by Modelling Consensus and Scientific
Advisory Table members and secretariat
Beate Sander,* Peter Juni, Brian Schwartz,* Upton Allen, Vanessa Allen, Kali Barrett, Nicolas
Bodmer, Isaac Bogoch, Karen Born, Kevin Brown, Sarah Buchan, Yoojin Choi, Troy Day, David Earn,*
Gerald Evans, Jennifer Gibson, Anna Greenberg, Anne Hayes,* Michael Hillmer, Jessica Hopkins, Jeff
Kwong, Fiona Kouyoumdjian, Audrey Laporte, John Lavis, Gerald Lebovic, Brian Lewis, Linda Mah,
Kamil Malikov, Doug Manuel, Roisin McElroy, Allison McGeer, David McKeown, John McLaughlin,
Sharmistha Mishra, Andrew Morris, Samira Mubareka, Christopher Mushquash, Ayodele Odutayo,
Menaka Pai, Alyssa Parpia, Samir Patel, Anna Perkhun, Bill Praamsma, Justin Presseau, Fahad Razak,
Rob Reid,* Paula Rochon, Laura Rosella, Michael Schull, Arjumand Siddiqi, Chris Simpson, Arthur
Slutsky, Janet Smylie, Robert Steiner, Ashleigh Tuite, Jennifer Walker, Tania Watts, Ashini
Weerasinghe, Scott Weese, Xiaolin Wei, Jianhong Wu, Diana Yan, Emre Yurga

*Chairs of Scientific Advisory, Evidence Synthesis, and Modelling Consensus Tables

For table membership and profiles, please visit the About and Partners pages on the Science
Advisory Table website.

18