Evidence to Support Further Public Health Measures in High Transmission Areas: the need to act now Advice from the Science Advisory and Modelling Consensus Tables and Public Health Measures Table Endorsed by Chief Medical Officer of Health October 8, 2020 CONFIDENTIAL – DO NOT CIRCULATE Recent Ontario trends show an acceleration of the pandemic • Both leading (cases) and lagging (hospitalizations) indicators going in the wrong direction • Seven consecutive week-over-week increases in new infections per population, with especially steep increases in hotspot areas (Ottawa, Toronto, Peel) • Cases per 100,000 increasing far beyond the “Action Level 3” threshold of >25/100K, particularly in Toronto (58.7) and Ottawa (61.9) • The percentage of people testing positive is rising quickly on a provincial level, with some regions far above 3% positivity, the international benchmark • Increase in test positivity beyond 20-29 year old age group indicating broader spread to older population • There is an increasing number of outbreaks overall, with more vulnerable populations affected (e.g., long-term care homes, retirement homes) • Increasing hospitalizations and ICU cases • 250% increase in COVID inpatient occupancy over past 3 weeks, including ICU • Ontario ICU occupancy predicted to exceed threshold of 150 beds within 30 days, even in best case scenario CONFIDENTIAL - DO NOT CIRCULATE 2 Ontario case trends suggests exponential growth, following the Victoria State (Melbourne) trajectory Number of Cases per Day (based on 7-day average, aligned at 300 cases/day) 1,600 1,400 1,200 1,000 800 600 400 200 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 ON 2nd wave ON 2nd wave predicted - 14d doubling time ON 2nd wave - ADJ. ON 2nd wave predicted - 14d doubling time ADJ. ON 1st Wave Michigan Victoria adj. Italy adj. CONFIDENTIAL - DO NOT CIRCULATE Prediction based on doubling time for 7-day avg.3 Day 1: Sep 18, 2020 Increasing test positivity, despite high testing volumes, show we are in the second wave – in some communities it is especially concerning Adjusted percent positive shows substantial recent growth 7 day test % Positivity for 12 Public Health Units to September 29 CONFIDENTIAL - DO NOT CIRCULATE 4 Rising hospitalizations show increasing pressure from spillover 250 Last 3 weeks (Sept 13 – Oct 4): 249% increase in total COVID acute inpatient occupancy Confirmed COVID19+ Patients in ICU + Acute Care Beds August 1 - October 4 200 Confirmed COVID19 Acute Inpatients (excluding ICU) Confirmed COVID19 ICU Patients 150 100 50 0 01-Aug 08-Aug 15-Aug 22-Aug 29-Aug 05-Sep CONFIDENTIAL - DO NOT CIRCULATE 12-Sep 19-Sep 26-Sep 03-Oct 5 Age spillover will further increase hospitalizations and ICU admissions. Predicted ICU Occupancy 400 Ontario ICU occupancy predicted to exceed lower threshold of 150 beds in all scenarios within 30 days. 350 300 250 200 150 100 50 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ON - Low 15 16 ON - Medium 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ON - High CONFIDENTIAL - DO NOT CIRCULATE 6 Age spillover will increase further as community outbreaks enter nursing homes and vulnerable congregate settings (~25 deaths since August 15) COVID-19 in Ontario Long-Term Care Homes (Aug 15-Oct 3, 2020) 180 160 140 120 100 80 60 40 20 0 Number of COVID-19 LTC home outbreaks Number of LTC resident active COVID-19 cases Number of LTC resident COVID-19 deaths Number of staff active COVID-19 cases CONFIDENTIAL - DO NOT CIRCULATE 7 Clustering PHUs by number of cases shows Ontario is experiencing multiple smaller epidemics with surges at different levels of crisis Cases by Region - 7-Day Average 450 Action Level: 3 400 350 300 250 200 Action Level: ~1&2 150 100 50 Action Level: ~ Vigilance - > 25 Cases / 100,000 5-25 Cases / 100,000 < 5 Cases / 100,000 >25 Cases/100,000/week: Peel; Toronto; Ottawa 5-25 Cases / 100,000/week: Kingston, Frontenac and Lennox & Addington; Peterborough; Windsor-Essex; Leeds, Grenville & Lanark; Wellington-Dufferin-Guelph; Brant; Simcoe Muskoka; Durham; Middlesex-London; Hamilton; Niagara; Halton; Eastern Ontario; Waterloo; York 8 CONFIDENTIAL - DO NOT CIRCULATE <5 Cases/100,000/week: All other Public Health Units Key Findings: case growth and spillover will critically hinder health system response capacity • Growing case numbers and percent positivity indicate need for more testing but case backlog will grow • Health care workers will take longer to clear to return to work • Patient transfers from hospitals to long-term care will take longer to clear • Testing backlog will delay response to long-term care home and other congregate setting outbreaks • Growing case numbers with clear surges in specific communities indicate increased risk of long-term care home outbreaks and deaths despite increased IPAC measures • Growing case numbers and the number of contacts for each case mean that public health capacity for case management and contact tracing may be overwhelmed • Case growth and spillover will increase mortality due to COVID-19 infection with potential for long-term health system burden from COVID-19 “long-haulers” CONFIDENTIAL - DO NOT CIRCULATE 9 All jurisdictions show a surge followed by increasing public health interventions - earlier intervention slows growth faster and allows earlier relaxation 4,500 800 Australia Netherlands 4,000 700 3,500 600 3,000 500 2,500 400 2,000 300 1,500 200 1,000 100 500 0 0 7,000 Germany 18,000 6,000 16,000 France 14,000 5,000 12,000 4,000 10,000 3,000 8,000 6,000 2,000 4,000 1,000 2,000 0 0 Feb Mar Apr May Jun Jul Aug Sep CONFIDENTIAL - DO NOT CIRCULATE 10