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New modelling from the Ontario government shows that if the daily mortality rate due to COVID-19 continues to increase, expected to be between 50 and 100 deaths per day between now and the end of February, it could be the greatest cause of death.
“This would really put COVID-19 into competition for being the single greatest cause of mortality on a daily basis, at that point,” Dr. Adalsteinn Brown, co-chair of Ontario’s COVID-19 science advisory said, adding that could be larger than cancer and heart disease.
Growth in COVID-19 cases in the province is over seven per cent on the worst days and if this rate of growth continues, the province could see more than 40,000 new cases a day.
Dr. Brown said that with growth consistently between three and five per cent, if there isn’t a “big”impact from the new variant, he expects growth to continue on between those two numbers, which will see between 10,000 and around 20,000 cases per day.
ICU occupancy due to COVID-19 is now over 400 beds, with an access to care deficit expected to continue to increase. More than half of Ontario’s intensive care units are at full capacity or have only one or two beds available.
“By end of first week of February, even under a very optimist scenario of one per cent growth, we will have over 700 beds filled,” Dr. Brown said. “If we’re in a more reasonable range between three per cent and five per cent, we’ll be looking at 1,000 to 1,500 intensive care unit beds occupied by COVID-19 patients.”
If the province sees a nine per cent growth rate, Ontario would see 2,000 ICU beds occupied by COVID-19 patients by Feb. 5.
“We will have to confront choices that no doctor ever wants to make and no family ever wants to hear,” Dr. Brown warned. “There will be choices about who will get the care they need and who will not, there will be choices about who receives oxygen or is transported to hospital.”
“This also means care for thousands of patients waiting for surgery will be delayed or cancelled while we add more patients to these wait lists... Simply put, delays kill.”
There are currently 252 long-term care homes in Ontario that are reporting an outbreak, which equates to 40 per cent of all facilities in the province. These outbreaks are occurring across almost all public health units.
“Long-term care homes across the province are now affected by COVID-19 outbreaks and while the virus spreads, so will the outbreaks and so will the deaths,” Dr. Brown said.
Ontario saw about 1,800 COVID-19 deaths in the first wave of the pandemic that devastated long-term care homes but in the second wave, the province has already exceeded 1,100 deaths.
Under the projected worst-case scenario, Ontario will see more than 2,600 deaths by Feb. 14.
Regions across Ontario have seen dramatic growth in COVID-19 cases recently, all the public health units are now above the “restrict” level of cases and the majority are above the “control” level, Ontario’s more severe benchmark.
Despite larger testing volumes than earlier periods of the pandemic, the test positivity across Ontario continues to increase significantly. All public health units are above the “control” level, with test positivity above 2.5 per cent.
“COVID-19 in now in every region of Ontario,” Dr. Brown said. “This is no longer a problem of a small group of cities or one regions of the province.”
Mobility data shared on Tuesday shows that there was a spike in retail just before the holidays, which dropped just after the lockdown measures were put in place.
Dr. Brown highlights that the mobility has largely not changed for months.
“We’re not seeing any real change in people staying at home,” he said. “This line is really flat since July,...despite growing case numbers.”
Survey results presented by Dr. Brown show that about two-thirds of Ontarians are following public health rules around close contacts and physical distancing.
“I think their efforts will...be undone if the entire province does not pitch in here,” Dr. Brown said, adding that physical distancing is a key step in breaking the transmission of COVID-19.
Concerns about new COVID-19 variant
Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, said the province has now confirmed eight more cases of the B.1.1.7 COVID-19 variant, initially detected in the U.K. This brings the total in the province to 14 but she warned there could be more.
Dr. Brown said that with significant increases in COVID-19 cases in a number of public health units, this new variant could be a contributing factor to that change, but that is not known at this time.
“If the variant spreads in the community, the doubling time of cases could drop to 10 days in March,” Dr. Brown said.
Currently, COVID-19 cases double in the province every 35 to 40 days.
“Even if there’s a chance that two thirds of any of these new cases introduced don’t get transmitted at all, you can see that explosive growth...as the total number of cases take off,” Dr. Brown said.