Dramatic surge in COVID-19 cases, deaths projected for fall, winter: new study

A new COVID-19 forecast is projecting the number of coronavirus deaths in Canada will soar, adding more than 8,000 deaths by the end of the year.

The University of Washington’s Institute for Health Metrics and Evaluation (IHME) is predicting more than 17,500 COVID-19 related deaths in Canada by Jan. 1, 2021 — a dramatic jump from the current number of more than 9,200 confirmed coronavirus fatalities.

The IHME’s Dr. Ali Mokdad says viruses like COVID-19 “like” the winter season.

• “This is a new virus, we’re still learning a lot about it. But if you look at even the Spanish flu, the second wave came in winter, it was way, way higher. We know from the flu, we know from pneumonia … we know all these viruses love winter, love us to come inside.” he said.

The U.S. Centers for Disease Control and Prevention (CDC) estimates the 1918 Spanish flu resulted in at least 50 million deaths worldwide. Most fatalities came during the second wave, in the fall of that year.

Mokdad says he thinks Canada and the U.S. are still in the first wave of the pandemic. Usually, a second wave starts after case numbers have gone down for a period of time.

• “A second wave means you went down to zero and then you start all over, so New Zealand had a second wave. We in the U.S. and Canada, we’re still in this first wave that [is] dragging,” he said.

But Mokdad says physical distancing, handwashing and mask-wearing can stem the spread of the virus. According to the IHME, if mask usage is near-universal at 95 per cent, scores of lives could be saved by the beginning of 2021.

The IHME’s projections are not outside of the realm of possibility, says Dr. Ashleigh Tuite, infectious disease epidemiologist with the University of Toronto.

• “In terms of the Canadian projections, they’re interesting because if you dig down and you look province by province, they’re basically entirely driven by Ontario and Quebec, so the assumption is that the rest of the provinces will have very, very few deaths moving into the winter.”
  she says. “And I would say I have less confidence in those projections because we are starting to see increases in cases in B.C. and in Alberta in particular,” she added.

Tuite says the projections serve as a way of showing us a potential future that we could see, but it’s important to note these are only projections.

• “We will see what’s happening and we will hopefully prevent this from happening," she says.

Some medical experts disagree with the models

While the modelling is often cited by top U.S. health officials, including the White House and used by the CDC, there’s been some pushback.

Ashish Jha, the dean of Brown University’s School of Public Health, told National Public Radio on Sept. 4 that he disagrees with the IHME’s findings when it comes to the predicted U.S. death toll of 378,000 by the end of the year.

• “I think that’s completely unrealistic. I see no basis for that,” says Jha.

He also said the IHME’s team assumes that people who are infected with coronavirus in the coming months will die at the same rates as those who were infected earlier on in the pandemic.

"The medical system has gotten much better at taking care of sick patients", he says.

There are also epidemiologists who believe any projection beyond just a few weeks into the future is useless.

Nick Reich, an epidemiologist at the University of Massachusetts told the Washington Post on Aug. 5 “models are heavily dependent on untested assumptions about what will happen in the future.”

This is a limitation Mokdad acknowledges, saying he’s more confident two weeks into the future, but less confident four months down the road. However, he says long-term projections can help plan for an uncertain future.

The Public Health Agency of Canada has not publicly released specific forecasting numbers through the fall. Instead, they’ve shared illustrations of two scenarios.

The “slow burn” is what they’re aiming for — keeping case rates low and within the public health system’s capacity to manage.

The other possibility is what they call a “reasonable worst-case scenario,” with a large “fall peak,” followed by ongoing peaks and valleys.

On Friday, Dr. Howard Njoo, Canada’s deputy chief public health officer says the recent jump in cases is concerning.

• “Everyone’s concerned about the ongoing increase, the trend is going the wrong way,” he said.

Projections for Ontario also “concerning” says study

The IHME models show 7,300 COVID-19 deaths in Ontario by the first day of 2021 — just over three months from now. This is a stunning surge from the current number of fatalities in the province of about 2,800.

• “These numbers are shocking, but the key issue here is we can change them by our behaviour,” says Mokdad.

Over the weekend, the Ford government expanded new measures province-wide aimed at stemming the spread of the virus by limiting private social gatherings to ten people indoors and 25 outdoors. Stiff fines for rule-breakers were also introduced.

Mokdad said these new measures are “very important.”

• “Our models take into account such mandates. So one of the mandates is gathering restrictions, the fact that Canada is doing that at this time is very good and encouraging because you want to be at the lower number when you start this peak going up into fall and winter,” he said.
  “And doing this at this time is very smart and a sound decision,” he said.