Mathematical modeling of COVID-19 transmission and mitigation strategies in the population of Ontario, Canada

Tuite, Ashleigh; Fisman, David N; Greer, Amy L

BackgroundWe evaluated how non-pharmaceutical interventions could be used to control the COVID-19 pandemic and reduce the burden on the healthcare system. MethodsUsing an age-structured compartmental model of COVID-19 transmission in the population of Ontario, Canada, we compared a base case with limited testing, isolation, and quarantine to scenarios with: enhanced case finding; restrictive social distancing measures; or a combination of enhanced case finding and less restrictive social distancing. Interventions were either implemented for fixed durations or dynamically cycled on and off, based on projected ICU bed occupancy. We present median and credible intervals (CrI) from 100 replicates per scenario using a two-year time horizon. ResultsWe estimated that 56% (95% CrI: 42-63%) of the Ontario population would be infected over the course of the epidemic in the base case. At the epidemic peak, we projected 107,000 (95% CrI: 60,760-149,000) cases in hospital and 55,500 (95% CrI: 32,700-75,200) cases in ICU. For fixed duration scenarios, all interventions were projected to delay and reduce the height of the epidemic peak relative to the base case, with restrictive social distancing estimated to have the greatest effect. Longer duration interventions were more effective. Dynamic interventions were projected to reduce the proportion of the population infected at the end of the two-year period. Dynamic social distancing interventions could reduce the median number of cases in ICU below current estimates of Ontarios ICU capacity. InterpretationWithout significant social distancing or a combination of moderate social distancing with enhanced case finding, we project that ICU resources would be overwhelmed. Dynamic social distancing could maintain health system capacity and also allow periodic psychological and economic respite for populations.