COVID-19 will kill 1,600 in Ontario by month’s end without more controls, modelling shows

Ontario could see 1,600 deaths from COVID-19 in April alone if stricter physical distancing measures aren't followed - and hospital intensive care units could be swamped soon, modelling projections released by the province show.

But hundreds of lives can be saved, with deaths in April limited to 200 and ICU capacity stretched but not overwhelmed, if the province adopts stricter interventions to limit person-to-person contact - and if residents comply with those orders, health officials said Friday.

"If we do all that we can, we get a much better result," said Peter Donnelly, the president of Public Health Ontario.

The measures taken so far have thwarted far worse outcomes: 300,000 cases and 6,000 deaths by the end of April if left unchecked, the models suggest. As of 5 p.m. Friday, the province's regional public health units were reporting 3,675 confirmed or probable cases of COVID-19 and at least 105 deaths.

Premier Doug Ford, who ordered more commercial shutdowns soon after the models were released, pleaded with Ontarians to stay home, noting that 1,600 potential deaths is 50 a day or two an hour.

"Each one could be your brother, your sister, your mother, your father, your grandparents or a friend," he said.

"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."

The researchers whose work underpinned Friday's projections said forecasting the path of a new infectious disease is uncertain because of limitations on the data available which has muddied by Ontario's laggard and limited testing.

But they all agree that without strict physical distancing orders - and everyone in the province complying - thousands of lives will be lost.

"What we can say is we have exponential growth in Ontario, which is a very scary thing. We have to bend that because it will drown our health-care system," said David Fisman, an epidemiologist at University of Toronto's Dalla Lana School of Public Health.

Depending on how effective public health interventions are, between 3,000 and 15,000 fatalities over the next 18 to 24 months are projected as the epidemic runs its course.

Donnelly urged people not to scoff at those numbers given high casualty counts in other countries, noting about 1,350 Ontarians die annually from seasonal flu.

"When you think that the mortality of this disease is up to 10 times higher and you remember that we have no vaccine, we have no specific treatment, and this is a disease which is entirely new, then suddenly the figure of 15,000 becomes entirely logical and comprehensible."

More steps are essential to keep hospitals from being overwhelmed by the end of April, warned Matthew Anderson, president of Ontario Health, a new agency overseeing the provincial health system.

Another model the province presented on Friday showed that in the best-case scenario, COVID-19 related admissions to intensive care units (ICU) will strain Ontario's critical-care units to the limit, even with significantly expanded capacity.

In the worst-case scenario, the province's ICUs, which have specialized staff and equipment in place to treat the sickest patients, could be overwhelmed within days or weeks. Ontario's ICUs are now 70 per cent full on average across the province.

Epidemiological modellers also stress that the exact number of cases and deaths in any projection is less important than the range of possible outcomes: they are not intended to be a crystal ball, and are most useful for comparing how different interventions might affect the course of the outbreak.

"We need to take (physical distancing) very, very seriously, because there's a possibility that we do run out of ICU beds next week or this weekend already, depending on how fast and how much we increase capacity and what trajectory we're on," said Beate Sander, a scientist at the University Health Network whose COVID-19 modelling group, a collaboration between UHN, U of T and Sunnybrook Hospital, also contributed to the projections.

Health Minister Christine Elliott said hospitals, which are now treating 462 COVID-19 patients, including 194 in intensive care with 140 of those on ventilators, have been authorized to do whatever necessary to increase capacity. Plans are underway to add 900 beds.

"For some of them, it may mean renting space in hotels or motels, some of them are renting space in retirement homes and some are actually creating field hospitals," she told reporters in a separate news conference Friday.

Hospital officials have a hotline to call if they need more ventilators to help patients breathe or are full and need to send patients elsewhere.

Sander noted that building ICU capacity goes beyond just adding beds and equipment.

"Staffing is hugely important. We've seen already quite a few health-care workers being infected. Capacity at the end of the day also depends on whether we have enough doctors and nurses and support workers to staff all these beds, and whether they have their PPE - everything needs to be place."

With the current measures, the province might see 80,000 cases by the end of April the models suggest, a number that can be reduced to 12,500 with stronger public health interventions.

The modelling report recommended shrinking the number and types of essential workplaces allowed to operate, enhanced enforcement of business and industry closings and social distancing, "entry restrictions" for some communities, including vulnerable First Nations, and more sheltering in place with "limited exceptions."

More tracing of contacts of COVID-19 patients and better testing is also necessary.

Ford brushed aside a question on whether more lives could have been saved with better testing - which was slowed by lengthy backlogs - and stricter measures sooner than the ones imposed in mid-March.

"I look at the lives we've saved," Ford said. "You can always look back. I always want to look forward."

Donnelly said "bearing down hard" on the virus at this point will help to stamp it out and allow the economy to recover sooner.

"There is no dilemma between saving lives and saving the economy."

Rob Ferguson is a Toronto-based reporter covering Ontario politics. Follow him on Twitter: @robferguson1

Kate Allen is a Toronto-based reporter covering science and technology. Follow her on Twitter: @katecallen