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What is the end game? Ontario's stark modelling forecast could help Canadians cope with COVID-19

The grim forecast of Ontario COVID-19 deaths could drive a sense of resilience Canadians will need to deal with a surreal situation, experts say.

“By and large, people want to know,” says Dr. Judy Illes, Canada Research Chair in neuroethics at the University of British Columbia. “Information engenders trust, and trust engenders resilience.” The opposite makes people feel as if they have no control whatsoever.

The country must brace for a pandemic that will last 18 to 24 months, Ontario health officials said Friday, prompting millions to wonder: How long must we, can we, live like this?

Stark modelling data suggests 3,000 to 15,000 people in Ontario alone will die over the course of the COVID-19 pandemic, 1,600 deaths by the end of April, more than 20 times the number of dead as of Friday — if stricter measures aren’t taken.

Should anyone consider those numbers unnecessarily “scary” and highly improbable, Dr. Peter Donnelly, head of Public Health Ontario, suggests they “pause and consider carefully” that 1,350 souls are lost to normal seasonal flu every year in Ontario. In a bad year, “we may well lose 1,500.”

COVID-19’s mortality rate is up to 10 times that of season flu. In Ontario, it is hovering at roughly two per cent overall, but as high as 16 per cent for those aged 80 and over. There are no vaccines, no specific treatments and the virus that causes COVID-19 came out of the blue, meaning the entire population is vulnerable. “Suddenly, the figure of 15,000 (deaths) becomes entirely logical and comprehensible,” Donnelly said at a technical briefing Friday.

Had the province done nothing — not shuttered schools and parks, prohibited gatherings, not closed non-essential business, pulled tables from restaurants or pleaded with workers to stay home — Ontario would have seen as many as 100,000 deaths over the next 18 to 24 months.

So far, it would seem, the province has dodged a bullet. The measures so far, according to the modelling, will spare some 85,000 lives.

That is why we need to continue to bear down

“People will find that (100,000) figure understandably alarming,” Donnelly said. “That is not where we are. That is not what we believe is going to happen.

“But that is why we needed to do all to the things that we have done thus far and that is why we need to continue to bear down.”

More aggressive measures are coming; measures that could further reduce the number of cases by the end of April to 12,500, instead of the forecasted 80,000, and slash deaths to 250. Effective Saturday, Ontario will direct more businesses to close, industrial construction will halt, more fines for “non-compliance.”

The province has 410 intensive care beds, with the capacity to surge by another 900 beds, quickly. The system is on track to absorb the projected growth rate in cases. But the lines on the slides are brushing closely. If cases spike faster than hospitals can ramp up capacity, the pandemic virus will overwhelm the system by April 15.

The trajectory depends on several crucial numbers, including the basic reproductive number — the number of people each infected person goes on to infect. It is now around two. It needs to be below one. Then the disease begins to peter out. Another is the velocity — how fast this thing is spreading. As of Friday, the velocity of the virus was spreading at a rate of 10 per cent, more or less, every day in Canada, but faster in Ontario and Quebec and slower in Alberta and B.C., according to analytics developed by York University’s Schulich School of Business. “It’s looking grim,” said Schulich’s Murat Kristal.

Models describe a range of possibilities, and are based on assumptions. The science isn’t exact. Donnelly said the number of tests being done or not being done doesn’t affect the Ontario projections. Ontario is doing less testing than Quebec, but projections shouldn’t be based on confirmed cases. More important is the death count, because deaths aren’t subject to a “testing bias,” he said.

For now, the average person needs to maintain physical distance from others, unless they are an essential worker or need to leave their homes for essential tasks — to get food or pharmacy supplies, he said. If people wish to go outside to walk or exercise, it is “imperative” they do so on their own, or with a very small group with whom they already live, he said. “It is not appropriate if one is out walking to stop in a normal way and speak to neighbours or strangers because you need to maintain social distancing.”

There is nothing normal about this otherworldly world.

Unlike B.C., Ontario is following a trajectory similar to the U.S. But the further out the modelling goes, the more uncertainty.

The 100,000 deaths was an estimate of what could have happened if social distancing measures hadn’t been taken. Still, the virus remains a formidable threat. People can’t relax or “assume we’re in safe territory,” said Adalsteinn (Steini) Brown, dean of the Dalla Lana School of Public Health at the University of Toronto.

The full course of the pandemic may last for 18 months or even two years, because there may be a second smaller wave, perhaps multiple waves.

What’s the end game? No one knows for certain. Where we end up on the death slide depends on whether people follow the rules, Donnelly said. Bear down hard now, and the disease ends more quickly, allowing the economy to rebound, he said. It’s not one or the other.

But how do we eventually climb down from here? If the virus can be suppressed, it will be possible to selectively lift some of the social distancing measures, experts said. When? “We’re some way off,” Donnelly said. “But the time to start thinking about that is now.”

Background serological testing — testing large swaths of the population to determine what proportion has already been exposed to the virus — is needed, because the assumption is that COVID-19 is a disease humans get only once, and then develop immunity. If there’s little background evidence of infection, “you clearly would need to be very careful about lifting social measures, because there is still a large proportion of the population who is vulnerable,” Donnelly said. Most of Ontario’s cases are in the GTA, where there could be a higher level of background infection, and if enough people have the disease and are now immune to it, you move closer to herd immunity.

When, and where the social distancing can be lifted will depend on hospital capacity, said Robert Smith, a professor of disease modelling at the University of Ottawa. “If hospitals are full and overflowing, where they’re turning people away, then obviously we have to keep doing the distancing.”

Models become fuzzier the further out they go, he said. “I think we will all be social distancing for several months. As things become a little easier, as more people have passed through, and large numbers of people are probably going to die from this, there will be a second wave in the fall, but we’ll presumably get better at social distancing.

“When we hit a lockdown for the third or fourth time, we’ll know what to do, and do it quickly,” he said. “We were just not set up for this and it took time for people to realize, ‘wait, I can’t go into work.’”

If it becomes more predictable, businesses can build it in as well. The downside is, people may get lockdown fatigue. Dire predictions will create intense anxiety in some people, said Dr. Steven Taylor, a professor and clinical psychologist at UBC.

“But that anxiety isn’t entirely a bad thing because it will motivate people to redouble their efforts to keep themselves and their loved ones safe.”

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