Ontario could see 5,000 to more than 10,000 COVID-19 cases per day and swamped hospitals by January without immediate indoor capacity restrictions and a rapid expansion of the third dose rollout, new provincial modelling suggests.

On the province’s current trajectory, the COVID-19 Science Advisory Table says there could be as many as 600 patients in hospital ICUs – quadruple the province’s current number in just two weeks – and pandemic-record high daily case counts before that time.

“Without prompt intervention, ICU occupancy could reach unsustainable levels in early January,” the modellers wrote in a presentation released Thursday morning, with Dr. Adalsteinn Brown, Dean of University of Toronto’s Dalla Lana School of Public Health, telling reporters it would likely be “the worst wave of the pandemic so far.”

They urge the province to immediately reduce capacity in all indoor settings and increase their distribution of rapid tests to the general populace, an effort that got underway yesterday with pop-up stations at transit hubs.

“Circuit breakers with strong additional public health measures (at least 50% fewer contacts) and strong booster campaigns (250,000 per day) could blunt the Omicron wave. High-quality masks, physical distancing indoors, improved ventilation, and increased access to rapid testing can help buy time for boosters to take effect and keep schools open,” the modellers wrote.

The province was able to administer 137,000 COVID-19 vaccine doses on Wednesday.

“I do believe we can do this without shutting down schools or closing businesses as we have done during previous waves,” Brown said Thursday.

He later elaborated that the health measures he and the modellers are looking for include capacity restrictions of about 50 per cent in places where people gather indoors, similar to what was present in restaurants and gyms in Ontario until Oct. 25.

“That may be capacity limitations in different settings– stronger enforcement of masking indoors. . . . it’s not really any sort of new things that we haven’t seen before. It’s those core public health measures.”

He said what the table is suggesting would not resemble an earlier lockdown or one of the province’s stay-at-home orders.

The modellers say that if additional public health measures went in place on Wednesday, the province would still eclipse its all-time pandemic high of 4,844 cases in a single day by Dec. 31, but would largely blunt further case growth beyond then.

With a circuit breaker effort and more boosters, the modellers suggest the province could keep ICU occupancy due to COVID-19 to between 300 and 325 people by Jan. 1.

Danish data suggests the rate of hospitalization due to Omicron is not less than earlier waves caused by Alpha, Delta and wild-type COVID-19, with between 0.7-0.8 per cent of current confirmed cases requiring hospital intervention.

Even if Omicron turns out to cause 25 per cent fewer severe cases, as was observed in one preliminary South African study, ICU occupancy could approach 500 by January if no further measures are enacted and vaccination rates remain at their current pace.

Brown said reductions in severity of infection only help at a population-wide level if they are accompanied with a major reduction in the burden of infection.

“High transmissibility means that the decrease in severity has to be so substantial to make up for the spread of the disease.”

The science table estimated Omicron made up 53 per cent of cases reported on Thursday.

The modellers estimate the Omicron coronavirus variant is 6.1 times more transmissible than Delta.

Brown also touched on the public’s use of masks, saying the issue now isn’t just whether we mask but what type of mask the public uses.

“It’s an airborne disease – I think that’s clear – and I think the highest quality mask you can get is useful.”

Public Health Ontario issued an advisory on Wednesday saying all healthcare workers treating COVID-19 patients should wear respirator masks, a more stringent suggestion than anything issued earlier in the pandemic.

Asked what he thought of the Science Table’s suggestions, Peel Region’s Chief Medical Officer of Health Dr. Lawrence Loh said he agreed with them.

“If you’re on fire, you don’t keep running, you stop, drop and roll,” he told CP24.

“We know we’re not going to be able to vaccinate our way out of this, even with the eligibility changing,” he said, saying several local medical officers of health are discussing new measures they could introduce in their respective health units.

Brown’s colleague at the Dalla Lana School of Public Health, Dr. Alon Vaisman, told CP24 everything going forward depends on what shape a suggested “circuit breaker” will take.

“It all depends on how we operationalize the word ‘circuit breaker’.”

In other Canadian jurisdictions and across the globe, a circuit breaker has meant a three to seven day period of time where all interactions between households for virtually any reason are discouraged or outright banned.

Vaisman said it’s clear the Ontario public is tired of some of these public health measures.

“We’re almost two years into the pandemic now so every time we have these waves, every time we have these recommendations to reduce contacts, there are going to be fewer and fewer in the public who are going to adhere to those recommendations because we’ve been through this so many times,” he said.

Science Table scientific director Peter Jüni said the province does not need to fully close any indoor settings.

“We don’t need to go back to curbside pickup, we don’t need to shut down things completely, that is not needed.”

But he said we are past the time where simply increasing booster shot output will prevent a near vertical climb in cases.

He also reiterated that the public needs to ditch the thinking that because it may cause less severe illness in some circumstances, it shouldn’t be taken seriously.

“I find it very unfortunate that this continues to be circulated in the media. It is just a wrong hope. This thing for the situation in Ontario it would need to be 10 times less severe not to cause a problem for the health care system. We calculated that. That is biologically implausible.”

For its part, Ontario’s Ministry of Health issued a statement that agreed vaccinations will rise to the daily rate proscribed by the modellers but said little about any additional public measures beyond a 50 per cent capacity limit in large venues issued yesterday.

“Today’s modelling would not have factored this action into their assumptions,” spokesperson Alexandra Hilkene said.

She said that the Ministry believes it could treat 600 COVID-19 patients in hospital ICUs and even surge to 1,100 if necessary.

“Approximately 600 ICU beds are immediately available with nearly 500 more ICU beds available for surge capacity if required. Ontario is ready for an increase in hospital and ICU admissions as we accelerate the booster rollout,” she said.

“The Chief Medical Officer of Health will continue to review data and evidence and act as necessary to limit transmission and protect the health and safety of Ontarians.”

Last week, Ontario health officials suggested the province’s total staffed ICU capacity was around 2,350 beds.

NDP Leader Andrea Horwath said that the Ford government urgently needs to announce new measures based on what modellers predicted today.

“(Doug Ford) put us in a position where we need a circuit breaker to avoid completely overwhelming our hospitals and causing shut downs for schools and businesses,” Horwath said. “Reducing capacity everywhere is now our best chance to avoid shutdowns.”
“Doug Ford needs to tell us today what he’s doing — we do not have time to waste.”