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SHA modelling outlines stark scenarios

Between 3,000- 8,000 deaths

The Saskatchewan Health Authority held its much anticipated technical briefing on COVID-19 Wednesday.

As has been the case for similar briefings in other provinces, SHA officials painted a stark picture of what could be in store for the province under their modelling scenarios for COVID-19. The SHA modelling points to a large number of potential cases and deaths in the province, even with physical distancing and other measures in place.

The range of cumulative total deaths using their three modelling scenarios runs between 3,000 on the low end to just over 8,000 on the high end.

For cumulative numbers of total cases, the range is between 153,000 cases on the low end and 408,000 on the high end.

Three modelling scenarios were presented by Dr. Jenny Basran on Wednesday in the briefing. These are the scenarios being used by the SHA for their planning.

The scenarios utilized a key variable called the basic reproductive constant (R0) — which is the average number of people that one person with COVID-19 would infect in a population of susceptible individuals. All were done under the assumption that Saskatchewan continues with current levels of COVID‐ 19 measures including testing, tracing and physical distancing.

Under the possible Scenario One, using a high range R0 or reproductive constant of 4.0, meaning one person with COVID-19 would infect four other people:

At the peak, 4,265 COVID‐19 patients would need to be in an acute care hospital at the same time. Of those hospitalized, 1,280 COVID‐19 patients will be in intensive care with 90‐95% requiring ventilation.

Cumulative total deaths were estimated at 8370 and cumulative total cases at 408,000.

Under Scenario Two, using a midrange reproductive constant of 2.76 which is also described as the “low Italy” range from the southern portion of Italy:

Under this scenario, at the epidemic’s peak, 1,265 COVID‐19 patients will require to be in an acute care hospital at the same time. Of those hospitalized, 380 COVID‐19 patients will need to be in the intensive care unit with 90‐95% requiring ventilation.

Cumulative total deaths under this scenario are 5,260 and cumulative total cases are 262,000.

Under Scenario Three, using a low range reproductive constant of 2.4 described as the “Wuhan model” or “Imperial model”:

At the peak, 390 COVID‐19 patients will require acute care hospitalization simultaneously. Of those hospitalized, 120 Covid‐19 patients would be in the ICU with 90‐95% requiring ventilation.

Cumulative total deaths under this scenario would be 3,075, with total cumulative number of cases at 153,000.

It was emphasized the dynamic modelling is not a prediction, but provides a range of “what if” scenarios to guide planning and will evolve over time. Basran also noted current interventions have made a difference, and that the most important variable to save lives and protect health care workers was public compliance with isolation measures, physical distancing and washing hands.

Dr. Julie Kryzanowski, SHA Senior Medical Health Officer, spoke on the planning ahead being done for their offensive strategy to deal with COVID-19.”

She said that as they enter April “I think the reality is hitting home. We are not immune, and in the weeks and months to come we can expect to more cases of illness and indeed more deaths.”

She said all models underscore the importance of “aggressive and sustained public health measures and population health approaches that can help us flatten the curve."

She noted the Saskatchewan Health Authority has based its response to the COVID‐19 pandemic on a strategy of “contain, delay, and mitigation on a foundation of population health promotion.” Key strategies include increasing testing ( with more than 14,000 tests performed), identifying cases early, expanding contact tracing capacity win a 300% increase in staff, enforcing Chief Medical Health Officer orders and using data tools to manage cases, clusters and outbreaks.

The SHA also pointed to expanded HealthLine 811 (+250 staff trained), deliverig more services through virtual care models, and the opening of testing and assessment centres in the province.

Derek Miller, Emergency Operations Centre Lead, presented on the defensive strategy being employed by SHA focusing on acute hospitals and services.

He noted the response will be staged according to increases in demand, with contorting of COVID‐19 positive patients as much as possible. Field hospitals will be used where demand exceeds facility based capacity.

Regarding planned ventilator capacity, Miller noted there are 450 ventilators available to meet modelled demand for low and mid‐range scenarios. There is a planned capacity ventilator requirement of 860 which creates a gap of 410 ventilators. However, the SHA is working to close the gap. Multiple orders for ventilators have been placed and there are confirmed orders for 200, with 100 expected in the next two to three weeks.

Regarding the staged response, according to Miller’s presentation it will be based on COVID‐19 demand in a given geographical area. His presentation noted that existing capacity will be accessed first before accessing expanded capacity.

For the North region, which includes the Battlefords and area, the plan is for a staged response to increased demand through a combination of mixed and non‐COVID hospitals. COVID‐19 hospitals will initially act as mixed hospitals. As COVID‐19 patient census increases, non‐COVID patients may be relocated from the facility to non‐COVID or mixed hospitals.

For our immediate area, hospitals in North Battleford, Meadow Lake and Lloydminster would be mixed-cohort, while those in Loon Lake, Turtleford, Maidstone and Unity would be designated non-COVID hospitals.

SHA officials at the presentation also included Scott Livingstone, CEO; and Dr. Susan Shaw, Chief Medical Officer for the province. While there were a lot of numbers presented, there was no indication provided yet on when the COVID-19 pandemic would peak, or how long the current isolation measures and restrictions would need to be in place.

The intention with the Wednesday briefing was to provide a provincial perspective. A media availability is scheduled for Thursday with local spokespeople regarding local decisions for each SHA service area: North, rural, Saskatoon and area, and Regina and area.