By Jessica Smith Cross, Sneh Duggal and David Hains
Modelling released by the Ontario government projects that, with the public health interventions currently in place, 1,600 people could die from COVID-19 cases contracted by the end of the month, down from a projected 6,000 deaths if no actions had been taken.
With a scenario described as "full future intervention" the deaths could be reduced to 200, according to the modelling information released Friday. As of late Thursday afternoon, 67 people had already died.
But the entire course of the pandemic is longer, and the provincial modelling suggests that in Ontario, even with public health measures, fatalities could range from 3,000 to 15,000, over the next two years. Without those public health measures, the total number of deaths would have reached 100,000, the modelling found.
The province predicts that in a best-case scenario, if Ontario has successfully expanded its ICU capacity by 900 additional beds, there will be enough critical care beds for all of the patients who need them — but just barely. But in a worst-case scenario, ICUs would be completely overwhelmed.
The modelling information was released at a press conference held by President and CEO of Ontario Health Matthew Anderson, Dean of the Dalla Lana School of Public Health at the University of Toronto Adalsteinn Brown, and President and CEO of Public Health Ontario Dr. Peter Donnelly.
(This slide is from the briefing deck provided by the provincial government.)
Taking a step toward the "full future intervention" scenario, Ontario Premier Doug Ford announced the province is narrowing its list of essential business that are allowed to remain open.
Ford said that the modelling shows that Ontarians have collectively saved thousands of lives by following the advice of public health officials to stay home and keep apart from others, despite the personal and economic hardship that advice has cost.
"These numbers tell the story of Ontario's fight against COVID-19 and the reality is the early chapters of our story have already been written, and there are some things that are out of anyone's hands," he said. "But what matters is that the ending of our story is still up to us."
"If we work together we can write the last chapter of our story because these forecasts are projections and they can change with your actions and with the government's actions," he continued. "We've seen today that we can lower these numbers."
Ford didn't appear to hold back and warned Ontarians that 1,600 people could be dead by the end of April.
"Each one could be your brother, your sister, your mother, your father, your grandparent or a friend," he said. "We all have to ask ourselves, what is the cost of a life? Is a life worth a picnic in a park? Is a life worth going to the beach? Is a life worth having a few cold ones with your buddies in the basement? The answer is no, none of those things is worth as much as a life."
On Thursday, Ontario Chief Medical Officer of Health Dr. David Williams said models should be considered in the proper context: they are not predictions of what will come to pass, but provide useful information about what to prepare for, and can show how effective the interventions that have been put in place have been.
He likened modelling to a weather forecast of a large blizzard — only after you gather the data on how much snow has fallen can you tell if it was more or less severe than you expected. And it's wise to prepare for a big blizzard.
The modelling presented to the public came together quickly, as Williams said he hadn't seen it as of Thursday afternoon. Just one day before, he had said Ontario would need several more days of data before he would be confident in the reliability of the models.
Flattening the epidemic curve has two main goals: to reduce the overall number fatalities from COVID-19 and to avoid overwhelming the health-care system. The latter is accomplished by delaying the peak of the epidemic, giving the government and hospitals more time to prepare and build capacity, and spreading out the cases over time so the number of people needing critical care at once does not exceed the system's capacity to provide it.
Deputy Premier and Health Minister Christine Elliott said all hospitals have plans to increase the number of beds, and the health-care worker manpower, to achieve the necessary surge capacity should the number of intensive care cases peak in mid-April, as forecast.
"For some of them, it may mean renting spaces in hotels or motels. Some of them are using space in retirement homes and some of them are actually creating field hospitals," she said. "So they're ready to go whenever they need to increase their capacity, and that is something that is calibrated on an hour-by-hour basis, depending on where the outbreaks are happening."
Dr. Laura Rosella, an associate professor at U of T's Dalla Lana School of Public Health, said that the modelling scenarios are "high-level" but reinforce the seriousness of the crisis. To experts, they weren't particularly surprising given existing models and scenarios in other countries, but there remains a high level of uncertainty, particularly in the longer-term fatality figures.
However, she stressed that the short-term need for increased ICU capacity isn't in doubt. Even in the best-case scenario for the spread of the virus, and an additional 900-bed capacity devoted to COVID-19 patients, Ontario would be very near its capacity for a week in mid-April.
"We're going to feel it in the next week or two," she warned. "Even in the best-case scenario we're going to feel it."
Those concerns were echoed by the University Health Network's Dr. Beate Sander, who contributed to a model that the government used to put together its own ICU bed projections.
"With increased capacity we could just scrape by," she said optimistically, but cautioned that this would rely on Ontario both achieving its best-case scenario and dramatically increasing ICU beds in a very short timeframe.
Failing to increase capacity right away could have significant consequences, as the projections in the best-case scenario see the province exceeding current capacity as soon as April 5. "We may be out of capacity by the end of the week or early next week," Sander cautioned.
The number of COVID-19 cases in Ontario ICUs has already begun to rise.
Some daily reports from Critical Care Services Ontario have been leaked online (see left). A report on ICU occupancy on April 1 showed that overall, 80 per cent of Ontario's 2,012 critical care beds were occupied, and 56 per cent of its 1,319 beds equipped with ventilators were in use. In the Central West LHIN, which covers hospitals in Brampton, north Etobicoke and Orangeville, the number of patients requiring ventilators has already exceeded its base capacity.
The William Osler Health System, the major hospital system in the Central West LHIN, said it has engaged a "multi-stage surge plan" in recent weeks. "These efforts include moving non-critical care patients to different areas of the hospital and actively pursuing relocation of chronically ventilated patients within Osler or to chronic ventilation facilities in the community," it said in a statement. "This represents a huge organizational effort to provide staffing, space, ventilators, equipment and safe care to a significantly higher number of patients compared to Osler’s usual critical care capacity."
Officials are creating ethical guidelines for how to allocate health-care resources if the number of patients exceed hospitals' ability to care for them, based on patients' likelihood of survival. A draft triage document obtained by QP Briefing and other media outlets outlined a worst-case scenario in which hospitals would restrict some life-saving care to patients who have a 70-per-cent chance of survival or better to keep occupancy levels under 200-per-cent capacity.
The modelling, and the experts speaking on behalf of the provincial government, had little light to shed on what Ontarians can expect over the next two years, or any forecast of how the pandemic will end. Donnelly said that the social distancing measures will have to be lifted very carefully, but gave no timeframe on when that might occur. He also said it's possible widespread blood testing could determine who has survived the virus and developed immunity, and if enough of the population has been infected for there to be herd immunity.
Toronto has been particularly hard-hit by COVID-19. Mayor John Tory said Friday he supported the provincial government’s decision to release its modelling information so Ontarians have the information they need to protect their own health and the health of others.
Tory said he knows “many people will be scared” after seeing the government’s numbers, and that he too felt the same way.
“Who wouldn’t be?” he said, adding that it was “beyond heartbreaking” to think about all the people potentially at risk. Tory said Toronto is on the frontline of the pandemic and that the data released today makes it “crystal clear that this is a deadly global virus” and that every person needs to do their best to stop the spread.
Meanwhile, Prime Minister Justin Trudeau said during his daily public address on Friday the federal government would be releasing national modelling information, but did not disclose when that would be.
"We have been releasing information every single day on data received from the provinces, updating it regularly on websites so Canadians can see the latest numbers and look at various models, use those numbers to make various projections," said Trudeau. "We are very much looking to share national projections with Canadians in the coming days."
He said the federal government is working with the provinces to "be able to build a robust model to give the projections people want to see."
"People are wondering how long is this going to last, how many Canadians are going to be severely affected, these are things that we will be sharing with Canadians, but we need to make sure we have a better grasp on the accuracy of the data before we put projections out there."
The prime minister acknowledged there are some "very challenging projections" circulating that will reinforce how important it is for people to abide by public health officials' guidelines.