Modelling and Potential Scenarios April 20, 2020 COVID-19 Update: Today’s Presentation • • • • 2 The information and analysis provided was developed by several experts at Ontario Health, Public Health Ontario and researchers at Ontario universities, led and coordinated by the COVID19 Command Table. Today’s presentation will share the most up-to-date modelling and projections that Ontario’s COVID-19 Command Table is using to inform the province’s ongoing response. The government believes the public deserves to have access to the same information as it receives in regular briefings. Providing this information is key to ensuring continued transparency with the public about the current challenges that Ontario faces in dealing with COVID-19 and where there has been progress in flattening the curve. Current Situation in Ontario COVID-19: Key Public Health Measures Timeline April 11 Work deployment for service provide organizations, municipalities and DSSABs Jan 24 Minister’s Order made novel coronavirus a reportable disease March 13 Jan 25 February Rapid testing ramp-up Aggressive case and contact management of all confirmed cases March 12 Closure of public schools 4 Essential visitors only in LTC and other congregate care settings Stop cycling of intermittent inmatesand personal visits in correctional facilities Prohibit gatherings over 250 people March 16 Practice physical distancing Self-isolate for 14 days if travelled outside Canada Prohibit gatherings over 50 people Make virtual work arrangements where possible March 17 Closure of public places and establishments March 21 Work deployment for health services providers March 23 March 30 Closure of non-essential workplaces Closure of parks and outdoor recreational amenities March 24 Work deployment for LTC homes March 25 Prohibit gatherings greater than 5 people Jan 25 March 17 March 24 Ontario confirms first caseof COVID-19 Ontarioreports Emergency first COVID-19 Declaration death (from March11) Ontario reports first deaths (2) in LTC homes Limit outings to essential needs Self-isolation for those over 70, with compromised immune systems or underlying medical conditions April 14 Extension of Emergency Declaration for 28 days April 2 April 15 Enhance capacity for contact tracing April 3 Revised essential workplaces list April 9 Prohibit camping on crown land Release of COVID-19 Action Plan for LTCH, including EO restricting staff from working in more than one setting Current Status • • • 5 The wave of new community spread cases of COVID-19 in Ontario appears to have peaked. While earlier models predicted a peak in cases in May, public health interventions, including widespread adherence to physical distancing, have accelerated the peak to now. The sacrifices people are making to stay home and wash their hands are making a difference. • Peak is important because epidemics follow what is called Farr’s Law, where epidemics have a symmetrical shape. • Total cumulative cases for span of the outbreak now likely less than 20,000, substantially lower than worst case (300,000) or even expected case (80,000) projected by previous models. • Projections now show Ontario’s COVID-19 outbreak behaving more like best case. However, data shows that province is facing two different disease processes. • Community spread of COVID-19 seems to have peaked and is coming under control. • Spread in long-term care and other congregate settings seems to be growing. Epidemic Curve: Cumulative confirmed COVID-19 cases, number of days since the 100th case By country, including the Canadian provinces of Ontario, Alberta, British Columbia and Quebec Cumulative confirmed COVID19 cases (log scale) 1,000,000 New York 247,815 cases QC 17,950 cases 100,000 Canada 35,632 cases 10,000 ON 11,561 cases BC 1,647 cases S. Korea 10,661 cases 1,000 AB 2,803 cases 100 0 5 10 15 Date on which 100+ cases reached: - Canada - March 11 - Ontario - March 15 - British Columbia - March 16 - Alberta and Quebec - March 19 6 Italy 178,972 cases 20 25 30 35 40 45 50 Days since cumulative cases surpass 100 Data from: Dong, E., Du, H., & Gardner, L. (2020). An interactive web-based dashboard to track COVID-19 in real time. The Lancet Infectious Diseases, as of April 19, 2020. Data compiled by Johns Hopkins University from the following sources: WHO, CDC, ECDC, NHC, DXY, 1point3acres, Worldometers.info, BNO, state and national government health department, and local media reports. 55 60 Epidemic Curve: Cumulative COVID-19 deaths, number of days since the 5th death By country, including the Canadian provinces of Ontario, Alberta, British Columbia and Quebec New York 17,671 deaths Cumulative COVID19 deaths (log scale) 50,000 Italy 23,660 deaths 5,000 QC 820 deaths 500 ON 591 deaths 50 0 5 10 15 Date on which 5th death was reported: - Canada - March 17 - Ontario - March 22 - British Columbia - March 18 - Quebec - March 25 - Alberta - March 31 7 20 25 S. Korea 234 deaths BC 81 deaths AB 51 deaths 5 Canada 1,563 deaths 30 35 40 45 50 Days since cumulative deaths surpass 5 Data from: Dong, E., Du, H., & Gardner, L. (2020). An interactive web-based dashboard to track COVID-19 in real time. The Lancet Infectious Diseases, as of April 19, 2020. Data compiled by Johns Hopkins University from the following sources: WHO, CDC, ECDC, NHC, DXY, 1point3acres, Worldometers.info, BNO, state and national government health department, and local media reports. 55 60 Epidemic Curve: Cumulative confirmed cases, number of days since the 10th case West By 5 Ontario Regions (Central, East, North, Toronto, West) 2,265 cases 10,000 Cumulative confirmed COVID19 cases (log scale) East 2,492 cases Central 4217 cases 1,000 No postal code recorded 889 cases North 169 cases 100 10 8 Toronto 1,144 cases 0 5 10 15 Date on which 10+ cases reached: - Central - February 29 - East - March 12 - North - March 23 - Toronto - March 11 - West - March 11 - Ontario - February 28 20 25 30 Days since cumulative cases surpass 10 Data source: Integrated Public Health Information System, as of April 19 (8pm) 35 40 45 50 LTC Snapshot: Cumulative long-term care homes with a COVID-19 outbreak 600 Number of LTC homes 500 400 300 200 Homes with a COVID-19 outbreak 9 101 105 108 111 117 125 125 127 127 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 02-Apr 65 99 09-Apr 01-Apr 56 89 08-Apr 31-Mar 51 83 07-Apr 39 06-Apr 28 05-Apr 19 04-Apr 18 75 03-Apr 14 30-Mar 0 29-Mar 100 Homes without an outbreak Data source: LTC COVID-19 daily report via COVID-19 dashboard. All data current as of April 19. LTC Snapshot: Cumulative resident COVID-19 cases, staff COVID-19 cases and resident deaths 1600 1533 1400 Cumulative confirmed C19+ cases: Residents Cumulative confirmed C19+ cases: Staff Number of cases/death 1200 Cumulative deaths: Residents 1000 847 800 600 400 367 200 10 Data source: LTC COVID-19 daily report via COVID-19 dashboard. All data current as of April 19. 18-Apr 17-Apr 16-Apr 15-Apr 14-Apr 13-Apr 12-Apr 11-Apr 10-Apr 09-Apr 08-Apr 07-Apr 06-Apr 05-Apr 04-Apr 03-Apr 02-Apr 01-Apr 31-Mar 30-Mar 29-Mar 0 11 Modelling: Continuing to Inform Ontario?s Planning Hospital Demand Modeling Scenarios • • The projections presented here draw from COVID-19 health system impact models developed by a multidisciplinary collaborative of researchers and clinician scientists. Three scenarios were modeled: • South Korea (“Best Case”): Restrained growth in infected cases slowed early through impact of public health measures. • Ontario in March (“Medium Case”): Moderate growth in infected cases slowed later on through impact of public health measures. • Italy (“Worst Case”): Moderate then rapid growth in COVID-19 cases that continue to climb at an exponential rate without public health measures. • Based on recent data, if current measures restricting spread of the disease remain in place, Ontario appears to be tracking toward the South Korea (“best case”) scenario. • The rate of growth in COVID-19 hospitalizations has slowed, while the number of COVID-19 patients in intensive care units has remained relatively constant over the past week. • • 12 These models focus on predicting COVID-19 requirements for hospital intensive care unit and ward beds. They are not designed to predict impacts on community services such as long-term care and retirement homes. The recent experience in long-term care demonstrates that the disease multiplies rapidly in congregate settings, emphasizing the need for redoubled efforts to restrict spread of COVID-19. 0 13 20-May 19-May 18-May 17-May 16-May 15-May 14-May 13-May 12-May 11-May 10-May 09-May 08-May 07-May 06-May 05-May 04-May 03-May 02-May 01-May 30-Apr 29-Apr 28-Apr 27-Apr 26-Apr 25-Apr 24-Apr 23-Apr 22-Apr 21-Apr 20-Apr 19-Apr 18-Apr 17-Apr 16-Apr 15-Apr 14-Apr 715 13-Apr 12-Apr 11-Apr 10-Apr 09-Apr 08-Apr 07-Apr 06-Apr 05-Apr 2,000 04-Apr 03-Apr 02-Apr 01-Apr 31-Mar 30-Mar 4,000 29-Mar 5,000 28-Mar 27-Mar 26-Mar 25-Mar 24-Mar 23-Mar 22-Mar Projecting COVID-19 Demand for Health Care Resources in Ontario: ICU Beds Required 6,000 4917 Italy ("Worst Case") Scenario Ontario in March ("Medium") Scenario South Korea ("Best Case") Scenario 3,000 Projected ICU beds required at peak of epidemic: 387 1,000 8,000 4,000 3,000 0 14 22-Mar 23-Mar 24-Mar 25-Mar 26-Mar 27-Mar 28-Mar 29-Mar 30-Mar 31-Mar 01-Apr 02-Apr 03-Apr 04-Apr 05-Apr 06-Apr 07-Apr 08-Apr 09-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 20-Apr 21-Apr 22-Apr 23-Apr 24-Apr 25-Apr 26-Apr 27-Apr 28-Apr 29-Apr 30-Apr 01-May 02-May 03-May 04-May 05-May 06-May 07-May 08-May 09-May 10-May 11-May 12-May 13-May 14-May 15-May 16-May 17-May 18-May 19-May 20-May Projecting COVID-19 Demand for Health Care Resources in Ontario: Acute Ward Beds Required 10,000 9,000 Italy ("Worst Case") Scenario Ontario in March ("Medium") Scenario 774 9276 South Korea ("Best Case") Scenario 7,000 6,000 5,000 Projected acute ward beds required at peak of epidemic: 1862 2,000 1,000 How are we doing so far? COVID-19 patients in Ontario ICU beds each day vs. predicted ICU bed demands in 3 model scenarios 3,500 3,000 2,500 Additional expansion capacity 1497 additional pandemic vented ICU beds (April 19) 2,000 1,500 1,000 Base available capacity 687 available base ICU beds (April 19) in addition to beds currently filled with COVID19 patients 500 15 Italy ("Worst Case") Scenario South Korea ("Best Case") Scenario Additional planned ICU beds May 6 May 5 May 4 May 3 May 2 May 1 Apr 30 Apr 29 Apr 28 Apr 27 Apr 26 Apr 25 Apr 24 Apr 23 Apr 22 Apr 21 Apr 20 Apr 19 Apr 18 Apr 17 Apr 16 Apr 15 Apr 14 Apr 13 Apr 12 Apr 11 Apr 9 Actual Ontario COVID+ ICU patients Ontario in March ("Medium") Scenario Current baseline available ICU beds Apr 10 Apr 8 Apr 7 Apr 6 Apr 5 Apr 4 Apr 3 Apr 2 Apr 1 Mar 31 Mar 30 Mar 29 Mar 28 Mar 27 Mar 26 Mar 25 Mar 24 Mar 23 Mar 22 0 16 Looking Ahead Prevention and Disease Management in LongTerm Care Homes • • • 17 Ontario is urgently implementing the COVID-19 Action Plan for Protecting Long-Term Care Homes: • Aggressive Testing, Screening, and Surveillance: Enhancing testing for symptomatic residents and staff and those who have been in contact with persons confirmed to have COVID-19; expanding screening to include more asymptomatic contacts of confirmed cases; and leveraging surveillance tools to enable care providers to move proactively against the disease. • Managing Outbreaks and Spread of the Disease: Supporting long-term care homes with public health and infection control expertise to contain and prevent outbreaks; providing additional training and support for current staff working in outbreak conditions. • Growing our Heroic Long-Term Care Workforce: Redeploying staff from hospitals and home and community care to support the long-term care home workforce and respond to outbreaks, alongside intensive on-going recruitment initiatives. Issued an emergency order directing long-term care employers to ensure their employees, including registered nurses, registered practical nurses, personal support workers, kitchen and cleaning staff only work in one long-term care home. Enhanced guidance on personal protective equipment requiring staff to always wear appropriate protection, supporting by priority distribution to homes. Continued Adherence to Public Health Measures • • 18 Continued implementation of enhanced public health measures to stop the spread of COVID-19 and flatten the curve: • Extended the declaration of emergency to at least May 12 to support existing public health measures in place, including restricting social gatherings to five people and the closure of all non-essential workplaces, outdoor recreational amenities, public places and bars and restaurants, expect those that provide takeout and delivery. • Implementing the next phase of the testing strategy to expand testing to include several priority groups to identify and contain new cases, especially among vulnerable populations. • Extending actions taken in long-term care homes to retirement homes and other congregate settings, including group homes and homeless shelters, to further protect vulnerable populations. Public should continue to stay home and maintain physical distancing to ensure the province continues to stop the spread of COVID-19 and flatten the curve. These actions are making a difference and people need to stay the course and stay strong in order to save lives.