Nearly one week after Ontario shared its COVID-19 modelling information, the federal government released its own projections — suggesting the country could see up to almost 32,000 cases and 700 deaths by April 16 and, in a best-case scenario, between 4,400 and 44,000 deaths during the course of the pandemic.
Meanwhile, one Toronto-based epidemiologist said that while it's hard to translate the federal government's projections into Ontario-specific numbers, they do "reinforce" the need to continue practicing physical distancing and boost testing and contact tracing — something provincial officials have been signalling in the past week.
Federal officials including Chief Public Health Officer Dr. Theresa Tam and her deputy Dr. Howard Njoo released the projections on Monday, with Tam stressing during a media briefing that "we are the authors of our fate, together we can plank the epidemic curve."
Referring to what she described as forecasting models — which use data of the number of cases in the country to estimate how many cases Canada can expect in the coming weeks — Tam said there could be 22,580 to 31,850 cases by April 16, with approximately 500 to 700 deaths by that date. As of Thursday at noon, the federal government reported 19,774 confirmed and probable cases in Canada, with Ontario accounting for about 29 per cent of that figure with 5,759 cases.
The federal government also released various scenarios through "dynamic models," which show what the virus' impact could be in the coming months by taking into account things like the number of people an infected person could contact in a day or the percentage of cases that would be identified or isolated.
In the the scenario described as having "stronger epidemic control," where there is a "high degree of physical distancing" and where a high percentage of people with COVID-19 and their contacts are traced and isolated, the models projected between 4,400 and 44,000 deaths over the course of the pandemic. In this scenario, which officials referred to as the "green zone" during a briefing, between 1 and 10 per cent of the population could be infected.
The government only highlighted specific outcomes for the 2.5 per cent to 5 per cent range, with the former meaning 934,000 cases, 73,000 people in hospital with 23,000 in ICU and 11,000 deaths. If 5 per cent or nearly 1.9 million people were infected, this could mean 146,000 people in hospital, 46,000 in ICU and 22,000 deaths. In comparison, a scenario with no public health measures in place and in which 80 per cent of the population is infected projected around 350,000 deaths.
Tam said the models are "not a crystal ball" and that it's important to recognize they all have limitations, but a big part of "staying on course for that green zone" is in detecting cases and managing and tracing contacts.
Officials said while they hoped the first wave of the virus would end sometime in the summer, it is likely the country will see smaller waves after that. Tam said it's hard to determine exactly when the peak in terms of the number of cases will occur nationally and that this can only be ascertained after it happens. But even once Canada passes the peak of the first wave, it will be important to keep public health measures in place since 50 per cent of the infections could happen after that point, she said.
Tam acknowledged that the epidemic is different across provinces and territories and that decisions on adjusting public health measures will have to be based on local situations, meaning some provinces might be able to loosen some measures before others.
Prime Minister Justin Trudeau said Canadians can expect some sort of public health measures to remain in place for a year or more.
"We will have to be vigilant for a year or a year and a half, there are things that we will not be able to do, but there will be a lot more things that we will be able to do and that will be if and only if we come through the next few weeks and the next few months properly," he said during his now-regular morning media availability. "Normality as it was before will not come back full-on until we get a vaccine for this, and...that could be a very long way off."
Tam said at the end of January that a vaccine for COVID-19 was likely at least a year away.
"Once we get this through this first wave we will have developed both tools and habits that will allow us to be much more resilient and resistance to further outbreaks and spreads," Trudeau added.
Dr. Laura Rosella, an associate professor at the University of Toronto's Dalla Lana School of Public Health, said she was pleased to see that the federal government "emphasized that Canada is a series of regional epidemics." The way COVID-19 has played out in each of the provinces is very different, she said, because some, like Quebec, had an earlier March Break and therefore experienced the impact of travel-related cases sooner than others.
The federal government's projections didn't outline provincial differences, however, with Rosella noting this could be because provinces have been releasing their own models and federal officials likely didn't want to get into a situation in which they had different provincial projections than what provinces have themselves presented.
"There’s no way, directly with the numbers that they gave, that you can translate this into a provincial number other than the simple way of saying well 40 per cent of the population is in Ontario, so 40 per cent of this burden we can expect in Ontario," said Rosella, although she cautioned against taking this kind of an approach. "People will do those types of population translations, which are very crude and don’t take into account the different control measures and the different epidemics that are happening in every province.
"I would definitely defer to the Ontario-specific numbers because those are the ones that are taking into account how the epidemic started and evolved in the Ontario context," she said.
The federal numbers do, however, "reinforce the seriousness of COVID-19 and the need to continue with the physical distancing and other control measures," she said. "It’s consistent with the picture more or less that we saw provincially and it more clearly demonstrates what can happen if we do not continue with a sustained effort to mitigate the spread of this virus through physical distancing and increased testing and tracing."
She said while isolating, testing and quarantining is being done "to some extent" across the country, it "needs to be scaled up quite a bit," including in Ontario.
Ontario has "the most to grow" when it comes to ramping up testing, she said. This issue has received much attention in recent days, with Premier Doug Ford calling Ontario's daily average of around 3,000 tests "absolutely unacceptable" and promising to have that number increased to 13,000 soon.
Health Minister Christine Elliott announced on April 3 that the government was giving local public health units the ability to use volunteers, retired nurses and medical students to help with things like case and contact management.
"If some of the physical distancing measures are going to relax over time, definitely not now but sometime in the future, we really have to have confidence that those other two pieces are happening in a very robust way," said Rosella. "I think there’s lots of efforts underway to build those up."
Ontario released its own modelling information on April 3, projecting that the province could see between 3,000 and 15,000 deaths over the next two years even with public health measures in place. Without measures such as physical distancing in place, the models suggest Ontario could reach 100,000 deaths.
The Ontario government modelling also suggested that 1,600 people could die from cases contracted by the end of April, with that number jumping to 6,000 without any public health measures in place. But if stronger measures were put in place, a scenario officials described as "full future intervention," this projection could be reduced to 200 deaths.
Following the release of the provincial projections, Premier Ford announced his government was narrowing its list of essential businesses that are allowed to remain open. One day later after the province released its COVID-19 projections, the Ontario government issued its second message about the COVID-19 pandemic through its emergency alert system.
"Right now as a province, we are in the fight of our lives. And the difference between winning this fight and losing this fight is the different between life and death. And in this battle we can’t, we wont leave anything on the table," Ford said on April 4. "If it takes standing here every single day, if it takes mass messages to every single person in Ontario to save even one life, I’m prepared to do that," he said.
Photo Credit: Rene Johnston/Toronto Star
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