The Inexact Science: Ontario releases COVID-19 modelling

Ontario has released the modelling and projection data it has been using to inform its response to COVID-19. Key takeaways from Ontario’s health officials include:

• If no intervention had occurred, 300,000 cases and 6,000 deaths were projected by April 30 and 100,000 deaths projected over the course of the pandemic.
• With current public health interventions, the projection has been reduced to 80,000 cases and 1,600 deaths by April 30, and a range of 3,000 to 15,000 deaths over the course of the pandemic (until a vaccine is developed or immunity gained).
• With full future intervention, models project further decreases to 12,500 cases and 200 deaths by April 30.

In the inexact science of modelling, there is more confidence in the projections for the next thirty days, with the peak anticipated to arrive around April 20. The projections become less precise as the model looks further out. While Ontario has projected that the full course of the pandemic could be 18 months to two years, the outcomes depend on public health measures – both current and future – as well as adherence by the general public to these measures. This is not to say that the current shut down will last two years but rather that future outbreaks will need to be managed over the course of the next two years.

Hospitals preparing for rise in COVID-19 patients

Slowing the spread is critical to address the constraints on ICU capacity, which is changing day to day.  Currently, there are 410 ICU beds for COVID-19 patients, with an additional 900 additional planned beds coming on-line in the coming days. However, in a worst-case scenario model, ICU capacity is inadequate for any surge in mid to late April.

In preparation, the Ontario government is increasing health care system capacity. Health Minister Christine Elliott said that hospitals have been given permission to add capacity by using spaces in hospitals, retirement homes, hotels, and field hospitals to create spaces to treat COVID-19 patients. This has been supported by a new emergency order under the Emergency Management and Civil Protection Act, enabling public health units to deploy retired nurses and use medical students in assessment centres and for contact tracing. A similar order was issued for retirement homes, providing flexibility in staffing and implementing protocols and procedures to keep residents safe, as well as requiring reporting of any outbreak of COVID-19.

The province also launched an online portal for secure access to COVID-19 lab test results. Actions are being focused on protecting the most vulnerable, building an “iron ring” around long-term care centres and other vulnerable populations, such as the homeless, and enhancing testing of healthcare workers.

Slowing the Spread to Protect Health and the Economy

Ontario has updated its list of essential services and it has been considerably whittled down from the list that was published on March 24. This includes shutting down all construction, with limited exceptions for critical infrastructure projects – such as hospitals, and residential construction that is already underway. An updated list of essential services in Ontario can be found here. The new list takes effect as of 11:59pm on Saturday, April 4.

From today’s modelling, increased efforts and restrictions to control the spread of COVID-19 cannot stop for Ontario to avoid the devastation witnessed in Italy and Spain. Dr. Peter Donnelly, President and CEO of Public Health Ontario said that there was no dilemma between saving lives and saving the economy, arguing that bearing down on the response to shorten the duration of the disease achieves both objectives.

The Ford government has clearly taken this advice knowing that further restrictions on businesses and increasing physical distancing are critical to slowing the progress of the virus. As such, companies and organizations across all sectors should prepare for the long haul, expectations of “business-as-usual” must be adjusted for the foreseeable future.

Made-in-Ontario Solutions

Premier Ford is also emphasizing the need for Ontario and for Canada to enhance their manufacturing capacity, committing Ontario’s manufacturing sector to supplying the province and the country. This commitment to domestic manufacturing was reinforced by the Trump Administration’s order today to 3M to cease export of N95 respirator masks to Canada and Latin America, and to prioritize American orders. Canadian governments, federal and provincial alike, have been working closely with the US to emphasize the need for trade in essential products across the border.

Similarly, the federal government has also been mobilizing Canadian industry to respond to the pandemic. Ford’s message of self-reliance also demonstrates the shift back to domestic manufacturing capacity of supplies like masks and ventilators for consumption in Ontario and across the country. This will certainly have substantial impacts on the Canadian supply chain of protective equipment as well as longer-term industrial policy writ large.

Escalating and sustaining the response across Canada

With Ontario’s escalation of measures, it is likely that other governments will take further action to stop the spread of COVID-19. Ontario was the first domino in a chain of actions across the country to shut down non-essential workplaces and businesses and a similar set of actions can be expected, such as Quebec’s request to the military for support in northern Quebec (Nunavik), for COVID testing and management.

In presenting the modelling, Public Health Ontario indicated further measures that could be considered, such as enhancing focus on enforcement and fines for non-compliance, expanded direction and guidance on physical distancing, considering entry restrictions in some communities, including First Nations, and use of technology to reinforce self-isolation. These future measures provide an indication of how much future actions may go.

The debate continues whether the federal government should implement the Emergencies Act. The issue was discussed by the First Ministers last evening. Thus far, the consensus has been that it is not needed and should be a last resort measure if circumstances require unequivocal federal control.

Sustaining physical distancing measures and the disruption of day-to-day life for all Canadians will be critical for managing the pandemic in the coming weeks. However, these measures are no doubt challenging and are putting Canadians under strain. Front-line organizations like food banks have been hit hard and the federal government responded today with $100 million in emergency funding for food banks/local food organizations across Canada.

The call from governments across Canada is the same message: stay at home. This is how we all work together to fight this war, protect the vulnerable, and keep our healthcare systems from being overwhelmed. The modelling evidence demonstrates this is how we save lives and mitigate the economic impact of COVID-19 in the weeks ahead.