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Ontario Premier Doug Ford holds a media briefing on COVID-19 following the release of provincial modelling in Toronto, Friday, April 3, 2020. The briefing also included a stark look at the impact of COVID-19 on the province’s hospital capacity.Frank Gunn/The Canadian Press

Even with strict adherence to physical distancing measures, Canada’s most populous province could see between 3,000 to 15,000 deaths because of COVID-19, according to projections from Ontario public health officials.

At the upper end of that range, the forecast would easily place COVID-19 among the leading causes of death in Ontario during the two-year period over which the pandemic is expected to run its course. In comparison, seasonal flu claims about 1,350 lives across the province in a typical year.

At a Friday news briefing, Peter Donnelly, president and chief executive officer of Public Health Ontario, said the difference between the best- and worst-case scenarios for the province will come down to the success of physical distancing, including new measures aimed at further reducing the spread in public places of the new coronavirus that causes COVID-19 disease.

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"There is a range because where we end up depends on all of us,” Dr. Donnelly said. “We need people to stay home, stop the spread and stay safe.”

The growing number of deaths owing to COVID-19 in Ontario – officially at 67 as of Friday – is precisely on track with the fatality rate in the United States. However, because of the time elapsed due to the incubation period of the virus and the additional interval during which a severe case can end in death, the Ontario figures are still reflective of what was happening in the province before distancing measures were in place.

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Dr. Donnelly presented the Ontario projections together with Matthew Anderson, who heads Ontario Health, the new agency created by the Ford government to oversee the province’s health system, and Adalsteinn (Steini) Brown, dean of the Dalla Lana School of Public Health at the University of Toronto.

The presentation also included a stark look at the impact of COVID-19 on the province’s hospital capacity. Starting as early as next week, the forecast suggests that severe cases of COVID-19 cases will likely exceed the province’s regular capacity of about 600 intensive care unit beds, 410 of which are currently available. In the worst-case scenario, even the province’s present ability to more than double those resources would be exceeded by mid-month.

Ontario ICU capacity for COVID-19

Ontario confirmed COVID-19 ICU cases

Best case

Worst case

3,600

3,000

2,400

1,800

Known expansion capacity

1,200

Current available capacity

600

0

March 20

April 1

14

21

28

THE GLOBE AND MAIL, SOURCE:

GOVERNMENT OF ONTARIO

Ontario ICU capacity for COVID-19

Ontario confirmed COVID-19 ICU cases

Best case

Worst case

3,600

3,000

2,400

1,800

Known expansion capacity

1,200

Current available capacity

600

0

March 20

April 1

14

21

28

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF ONTARIO

Ontario ICU capacity for COVID-19

Ontario confirmed COVID-19 ICU cases

Best case

Worst case

3,600

3,000

2,400

1,800

Known expansion capacity

1,200

Current available capacity

600

0

March 20

25

April 1

7

14

21

28

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF ONTARIO

“Fairly soon it will push beyond the capacity we can bring," Mr. Anderson said.

He added the province was looking to purchase more ventilators and set up more intensive care beds, beyond the 900 now planned, in case demand spikes higher even further.

Ontario is the latest province to offer the public a look at the numbers that are guiding decision makers as they assess policies aimed at reducing transmission of COVID-19. Last week, British Columbia released data that suggested measures there are “flattening the curve” on the number of infections, though this may also depend on other factors relating to testing rates.

Experts say the Ontario figures are in broad agreement with those that modellers are discussing with the Public Health Agency of Canada. On Thursday, reporters pressed Prime Minister Justin Trudeau to release best- and worst-case scenarios for the pandemic across Canada but the federal government has not yet done so.

Speaking of the forecast for deaths in Ontario, Dr. Donnelly said that, for many people, “these will be shocking figures." Yet, they pale in comparison to an estimate of 100,000 deaths that he said would be in the cards for the province if no measures were taken. That number would roughly correspond to the virus infecting 70 per cent of Ontario’s 14.6 million people with a fatality rate of about 1 per cent.

Projected Ontario deaths over

course of the pandemic

100,000

3,000 to

15,000

Range depends on implementation of maximum public health measures

Without public

health measures

With public

health measures

THE GLOBE AND MAIL, SOURCE:

GOVERNMENT OF ONTARIO

Projected Ontario deaths over

course of the pandemic

100,000

3,000 to

15,000

Range depends on implementation of maximum public health measures

Without public

health measures

With public

health measures

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF ONTARIO

Projected Ontario deaths over course of the pandemic

100,000

3,000 to 15,000

Range depends on implementation of maximum public health measures

Without public health measures

With public health measures

THE GLOBE AND MAIL, SOURCE: GOVERNMENT OF ONTARIO

Many experts caution that such “baseline” figures, while important as a starting point for mathematical models, are difficult to equate with reality because so much remains unknown about the transmission of the virus, including the number of unreported or asymptomatic cases.

Jonathan Dushoff, a computational biologist at McMaster University in Hamilton whose work focuses on infectious disease, said he was glad Ontario was making its modelling results available, though he added that those results implied more confidence than is warranted based on all the unknowns surrounding the virus.

“There’s really more uncertainty than the province is choosing to let on,” he said.

Jane Heffernan, a mathematician and director of communication for the Centre for Disease Modelling at York University in Toronto, said that asymptomatic transmission of COVID-19 “is really the culprit” that has prevented epidemiologists from gauging how much the virus has penetrated into the community.

The knowledge gap relates directly to the need for people to remain physically isolated from one another, Dr. Heffernan added. For now, it remains the only way to prevent the virus from being passed on, especially to vulnerable individuals, including the elderly.

Among the Ontario data released on Friday are figures that show that known cases of COVID-19 are fatal in nearly 3 per cent of those who are over 60 and 15 per cent of those over 80.

Caroline Colijn, a Canada 150 Research Chair who specializes in the mathematics of infection, said the other big source of uncertainty in the models is how well people are adhering to public health measures today and how well they are able to continue doing it.

“Human behaviour is harder to predict that viral behaviour,” Dr. Colijn said.

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