Slide 1 COVID-19 Modellingaiid Health System Readiness Update April 28, 2020 Saskatchewan a Health Authority Slide 2 *This presentation is EMBARGOED until 2:30 pm. on Tuesday, April 28, 2020* 1 Haiafat??vt??grity saskatchewan.ca/COVID19 PURPOSE SHA services will adapt and expand to meet the projected COVID-19 patient demand, while continuing to deliver essential services to non-COVlD-19 patients throughout the duration of the event. Saskatchewan Health Authority ?eauhv eOp/e ACCOUNTABILITY Patient and Family Centred Care RESPECT COLLABORATION ?0 $0 a ska?td?e saskatchewan.ca/COVl019 OUTLINE - Introduction - Saskatchewan COVID-19 Modelling Update - Offensive Strategy Update - Defensive Strategy Update - Resumption of Health Services - Questions Saskatchewan Health Authority saskatchewan.ca/COVl019 Slide 5 Saskatchewan Modelling Update Update: COVID-19 Modelling and Health stem Readiness Saskatchewan Health Authority KEY DEFINITIONS BASIC REPRODUCTIVE NUMBER (R0) EFFECTIVE REPRODUCTIVE NUMBER (Rt) Average number of people one person Average number of people one person with the virus could infect where the with the virus infects at the current time entire population is susceptible and no after the effects of interventions. interventions have been undertaken. Purpose: support planning for health Purpose: guide decisions about public system readiness. health measures. Note: April 8 modelling presentation was based on Basic Reproductive Number (R0) Saskatchewan . Health Authorlty saskatchewan.ca/COVI019 HOW Is SK DOING WITH CURRENT INTERVENTIONS Reported Case Counts per 100,000 People since 100th Case: Canada Beyond E-l' Case count per . 100:000 People similar to BC 10 ?Flattening the curve? with a Confirmed Cases per 100,000 People 1 . .. hammer . 10?Saskatchewan ?Alberta British Columbia Manitoba Ontario Quebec 0'1 United Kingdom United States Australia Italy .- a a 5 Spain 0.01 Days Since 100th Case ?agg??gm?grity saskatchewan.ca/CO VID19 GOOGLE COMMUNITY MOBILITY REPORTS Saskatchewan Retail recreation Grocery 8. pharmacy Parks ~43% compared to baseline 42% compared to baseline +496 compared to baseline .302?. v80?. ?we. ?40% ?om. Baseline Baseline 88mm MW 402?. 40s. 40% '30I'll Apt 17 Transit stations Workplace Residential -53% compared to baseline -48% compared to baseline +20% compared to baseline .302?. ?30% mos. +40% Basa'ne Baseline Baseline 409?, 40% 40% 30% -80Saskatchewan . I I Health Authorlty saskatchewan.ca/COVl019 COVID-19 GOOGLE COMMUNITY MOBILITY REPORTS Slide 9 CANADA Retail recreation - 5 3 0 compared to baseline Grocery 8. pharmacy 2 2 0 compared to baseline Parks -22% compared to baseline 940% Baseline FLWI 27 17 Baseline 80Mobility trends for places like restaurants, cafes, shopping centers. theme paks. museums. libraries. and movie theaters Mobility trends for places like grocery markets. food warehouses. farmers markets. specialty food shops. stores. and pharmacies. Mobility trends for places like national parks public beaches. marinas. dog parks. plazas. and plblic gardens. Transit stations - 6 7 0 compared to baseline Workplaces - 5 9 0 compared to baseline Residential +27% compared to baseline Mobility trends for places like public transport ?ow. hubs such as subway. bus. and train stations. Baseline 40% 80% 7' M3127 (WM 17 Mobility trends for places of work 940% Baseline 40% .mw, Tl Mk 6 7' W127 Pl A0 17 Mobility trends for places of residence. 940*; easelme 40% 80% r: Mar? M3127 F'IAav?l7 Saskatchewan . Health Authority saskatchewan.ca/COVl019 EFFECTIVE REPRODUCTIVE NUMBER (Rt) Describes how well the Effective Reproductive Number various interventions are decreasing the spread of COVID-19 at the current time Also reflects fluctuating public compliance Once Rt<1, virus is at the tipping point Rt consistently <1 is a major Danger Zone consideration in determining public health measures . ?The Hammer and the Dance? Effective Reproductive Number in SK April 25 Rt: 0.7 (lagging indicator by 7-14 days) This reflects strong SK compliance with public health measures Saskatchewan . 1 Health Authority saskatchewan.ca/COVl019 Saskatchewan Health Authority Effective reproduction number 24 Feb. 2 Mar. 9 Mar. 16 Mar. 23 Mar. 30 Mar. 6 Apr. 24 Feb. 2 Mar. 9 Mar. 16 Mar. 23 Mar. 30 Mar. 6 Apr. Daily confirmed cases 6000 4000 2000 Germany Effective reproduction number .Feb. 17 Feb. 2 Mar. 16 Mar. 6 Apr. 3 Feb. 17 Feb. 2 Mar. 16 Mar. 6 Apr. Daily confirmed cases 01 Singapore 3-7-2020 3-8-2020 3-9-2020 3-10-2020 3-1 1-2020 3-12-2020 3-13-2020 3-14-2020 3-1 5-2020 3-16-2020 3-1 7-2020 3-18-2020 3-19-2020 3-20-2020 3-21-2020 3-22-2020 3-23-2020 3-24-2020 3-25-2020 3-26-2020 3-27-2020 3-28-2020 3-29-2020 3-30-2020 3-31-2020 4-1-2020 4-2-2020 4-3-2020 4-4-2020 4-5-2020 4-6-2020 4-7-2020 4-8-2020 4-9-2020 4-10-2020 4-1 1-2020 4-12-2020 4-13-2020 4-14-2020 4-1 5-2020 4-16-2020 4-1 7-2020 4-18-2020 4-19-2020 4-20-2020 4-21-2020 4-22-2020 4-23-2020 4-24-2020 4-25-2020 F-- oi F- 1.- y- .LJ..L.L.L -. ?1 71'?va n4 Estlmate of Effective Reproductlve Number over Tlme (Assumlng that Cons?tute 40% of Infections:55 BASIC REPRODUCTIVE NUMBER (R0) IN SK R0 Average number of people one person with the virus could infect where the entire population is susceptible and no interventions have been undertaken. Previously, no history of how it spreads in Saskatchewan, so needed to use what we knew from other areas that had experience SK case data has been used to estimate a SK R0 of 3.12, to guide planning activities for a worst case scenario Saskatchewan . Health Authority saskatchewan.ca/COVl019 BASIC REPRODUCTIVE NUMBER (R0) IN SK Cases Cumulative COVID-19 Cases 800K No Intervention High Range 700K Mid Range Low Range 600K Sask R0 500K 400K Saskatchewan?s 300K I Worst Case 200K Planning Scenario (R0) 100K UK Time Saskatchewan . I Health Authority saskatchewan.ca/COVl019 KEY MESSAGES 0 Dynamic modelling is not a prediction, it provides a range of ?what if? scenarios to guide planning and will evolve over time. Effective Reproductive Number The Rt value is helpful in determining effectiveness of current interventions right Danger Zone now, and can be a guidepost to use when choosing to implement new measures, or Effective Reproductive Number in SK loosen existing ones. April 25 Rt: o_7 (lagging indicator by 7-14 days) 0 Early warning system shared with the public is key during the ?dance.? saskatchewan.ca/COVI019 Slide 15 Offensive Strategy Update Update: COVID-19 Modelling and Health System Readiness Saskatchewan Health Authority COMMUNITY SURGE PLAN Our offensive strategy continues to progress and is rooted in the service delivery model: Connected Care for the People of Saskatchewan - As the province begins to re-open, care in the community remains the foundation of our health care system - The SHA has already implemented a number of initiatives to support care in community to reduce the burden on the acute care system Saskatchewan . i 0 Health Authorlty saskatchewan.ca/COVl019 COMMUNITY SURGE PLAN Testing strategy supports contain and delay approach Broad availability of testing based on guidelines that support testing for virtually anyone with even a single Work to further scale up testing is in progress including: 0 Testing contacts identified through public health contact and outbreak investigations 0 Outreach to populations less likely to seek testing 0 Sending consistent messages to the public and health care providers regarding testing Over 50 testing sites are located across the province, including 18 on First Nations Lab capacity is available to support more than 1,500 tests per day 0 Ongoing expansion of access to rapid testing capability with GeneExpert equipment across 8 sites to date with 11 more sites in coming weeks (inclusive of SHA supporting 4 First Nations sites) Saskatchewan . 0 Health Authority saskatchewan.ca/COVIDJ9 COMMUNITY SURGE PLAN Contact tracing surge plan Adoption of SHA Contact Tracing Application to streamline the process and enhance reporting and monitoring 0 Saskatchewan is a leader in adoption of this common application Load leveling of resources across the province to support outbreaks Surge capacity available to stay ahead of demand and respond to outbreaks 0 Current capacity available for more than 300 new cases perday Modelled potential new cases per day of 618 was used to inform planned capacity of 460 full time equivalent staff Saskatchewan . 0 Health Authority saskatchewan.ca/COVIDJ9 COMMUNITY SURGE PLAN Assessment and treatment sites 16 sites available across Saskatchewan and more opening soon Virtual Care Total clinician users: 2,000 Total sessions: 35,000 Protecting our most vulnerable - Early implementation of screening of staff and visitors in long-term care facilities Cohorting strategy to restrict staff to work in a single facility Continuation of home care services, maintaining Seniors House Calls and Community Paramedicine programs Meeting the needs of our vulnerable populations and supporting the homeless Contingency plans to use hotels to cohort positive patients who require intermediate care Saskatchewan . i Health Authorlty saskatchewan.ca/COVID19 Slide 20 Defensive Strategy Update Update: COVID-19 Modelling and Health System Readiness Saskatchewan Health Authority ACUTE SURGE PLANNING - Opportunity to adjust planning scenario based on updated modelling information - Sustain conservative capacity estimates and contingency to be prepared for a worst case surge - Retain staged response to patient demand Capacity Steps Demand Curve Saskatchewan . I Health Authority saskatchewan.ca/COVl019 Planning Scenario ORIGINAL PLANNING SCENARIO mid-point patients only Peak values, except where cumulative ICU census Patients requiring ventilation Cumulative total deaths between Upper Range Mid Range Low Range Scenario 1 Scenario 2 Scenario 3 (R0 4.0) (R0 2.76) (R0 2.4) 408,000 335,000 262,000 153,000 710 458 205 60 4,265 2,765 1,265 390 215 138 60 20 1,280 830 380 120 1,230 800 370 120 8,370 6,815 5,260 3,075 saskatchewan.ca/COVID19 PLAN NG SCENARIO 3:35;: patients only Upper Range Peak values, except Scenario 1 where cumulative (R0 4.0) Revised Planning Scenario: 408,000 335,000 254,756 Ensures 5K remains prepared for a major 4,265 2,765 1,736 - Informed SK R0 in new Max capacnty can be 1,280 830 412 reduced by 1,000 Patients requiring 1,230 800 403 hOSP'tal beds, 400 ICU beds, 400 ventilators ventilation (total ventilators in planned Cumulative total deaths 8,370 6,815 3,050 scenar'o 01:4.03 are W'th.m current ventilator capaCIty of 486 ventilators) saskatchewan.ca/COVID19 PLANNING UPDATE - SHA is currently adjusting local surge plans based on the updated planning scenario - Cohorting of patients forms the foundation of a staged response - Staged activation of and mixed hospitals remains part of the response plan - Timing and trigger points for deployment of the plan may be adjusted Saskatchewan . i 0 Health Authorlty saskatchewan.ca/COVl019 FIELD HOSPITALS Prepare field hospitals with two stages of activation: Stage one: Required base infrastructure preparation complete and equipment available for activation within a predetermined amount of time Stage two: Capacity available for expansion of services as needed Stage 1 Stage 2 Total beds Beds Additional Beds Saskatoon (Merlis Belsher) Regina (Evraz Place) 184 216 400 Total 309 341 650 Saskatchewan . Health Authority saskatchewan.ca/COVl019 Slide 26 Health System Service Resumption Update: COVID-19 Modelling and Health System Readiness Saskatchewan Health Authority HEALTH SYSTEM SERVICE RESUMPTION - SHA and Ministry of Health are developing a plan to resume, in a staged approach, community services, elective surgeries and diagnostics that were impacted by the service slowdown - The plan will include a methodical and cautious reintroduction of services Identification of which services to resume will consider factors such as highest priority patient needs, risk of transmission of the virus, impact on COVID-19 surge capacity, impact on personal protective equipment inventory, and other considerations The system must remain able to respond to potential COVID-19 surge in demand Saskatchewan . i i Health Authorlty saskatchewan.ca/COVl019 SUMMARY Updated modelling information provides insight into Saskatchewan situation and potential scenarios Offensive strategy aims to sustain low rates of transmission Continued vigilance by the public has the most impact - Defensive strategy provides surge capacity for potential future demand - Resumption of Health Services plan will be phased to support patient care while ensuring ability to respond to potential COVID-19 surge in demand Saskatchewan . i 0 Health Authorlty saskatchewan.ca/COVl019 SI QUESTIONS Saskatchewan Health Authority . "COVID-19 Modelling and Health System Readiness Update 1? Saskatchewan Health Authority saskatchewan.ca/COVI019 Healthy People, Healthy Saskatchewan The Saskatchewan Health Authority works in the spirit of truth and reconciliation, acknowledging Saskatchewan as the traditional territory of First Nations and M?tis People. Slide 30