Province on way to flattening COVID-19 curve, UNB team's projections suggest

New Brunswick's response to the COVID-19 outbreak has been effective in curbing the spread of the virus, according to a new report that offers one of the first projections for the province.

An outcome model developed by a team of researchers from the University of New Brunswick's NB Institute for Research, Data and Training suggests the province is tracking toward a best-case scenario.

"It looks like New Brunswick with the aggressive measures they've put in terms of closing schools, shutting down retail, that has really succeeded in curtailing the spread," Dr. Ted McDonald, the research team lead and director of the institute, told CBC News on Wednesday night.

"If we maintain those restrictions, we are trending in sort of a similar trajectory to South Korea, which is a really good outcome compared to some of the well-known worst outcomes that are happening in different regions and different countries."

The researchers developed prediction models based on data from other countries with a wide range of paths taken to address the pandemic, including lockdown and isolation strategies as well as testing rates. Demographic factors, like age and population density, were also considered.

The idea was to peer 10 days into the future starting March 31 and see what would happen if New Brunswick followed different sets of measures.

The team settled on South Korea, Denmark and Spain for the models.

"We looked at South Korea, which had a really good effort of mobilizing and reducing the spread of the disease," McDonald

He said Spain's initial response to the outbreak was not effective as of Wednesday, it stands only second to the United States in confirmed cases and second to Italy in deaths and Denmark represented a "middle ground" scenario since it has a similar median age to New Brunswick and 20 per cent of both populations is above 60 years old.

Using trajectory data from the three countries as of March 31 when New Brunswick had 70 confirmed cases the team forecast how many cases, hospitalizations and intensive care patients the province would have on April 10.

The best-case scenario: 120 cases, 16 hospitalized and four in intensive care. The maximum predicted numbers under the South Korea scenario: 147 cases, 19 hospitalized and four in intensive care.

The worst-case scenario, Spain's trajectory, paints a wildly different picture: 550 cases, 72 hospitalized, 17 in intensive care. The maximum numbers in that 10-day projection jump to 1,570 cases, 204 hospitalized and 47 in intensive care.

As of Wednesday, there have been 108 confirmed cases in the province and there are six current hospitalizations, four of which are in intensive care numbers that track closely with the South Korea model.

Although the institute receives funding from the provincial government, it is arm's-length and the report is an independent initiative.

The New Brunswick government is expected to release its COVID-19 projections for the province Thursday.

Dr. Kim Barker, the medical officer of health for the southern region of the province, offered the first glimpse into provincial projections earlier this month to the Town of Sussex. She said the peak of the outbreak is expected to hit the week of April 21.

What does this mean for the health-care system?

Tracking along the best-case scenario means the provincial health-care system should not be pushed beyond its 150 ICU-bed capacity, the research indicated.

McDonald noted the province and health authorities are already redeploying resources and moving long-term care patients in anticipation of a surge.

But from the institute's perspective, the long-term concern is what happens next. He said modellers are starting to examine how delaying medical procedures and surgeries to focus on urgent care will burden the system on the other side of the pandemic.

Plus, he said, we have to consider mental health issues following extended sheltering.

"Part about what we're going to be working on is thinking about those issues and thinking what the burden those issues might be as we kind of recover from this," he said.

Word of caution

The positive trajectory comes with a warning, however.

McDonald said forecasting is a "fraught business" and it's still too early to tell if the province has "sufficiently flattened the curve."

He said data is limited and there is a lot we don't understand yet, like why are some people more susceptible to the infection than others.

"The models really are like economic models," he said. "Models that are predicting employment growth rates or GDP next year or interest rates, they're all going to have a margin of error. They're only as good as the data that go in them and they rely on the assumptions that are made to generate those forecasts."

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The positive projection is also a sign that the restrictions in place are working and the public should continue to comply.

"Just because we're on a good trajectory now doesn't mean everything is fine, ease up on those restrictions because we're done," McDonald said.

"It doesn't mean that at all."

When to ease restrictions?

McDonald said the next big questions are when and how to ease restrictions.

He cited a quote from Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases and key official in the Trump administration's outbreak response, who was asked this week about loosening restrictions and restarting the American economy.

"It isn't like a light switch, on and off," Fauci said.

However, modelling using the trajectories of countries who are further along in the pandemic could offer some insight into best practices.

"China is now easing restrictions, so there is going to be some information there on their experiences," he said. "We've seen what's happened in Japan where there was an easing of restrictions and there's a recurrence.

"So as much as what has to go along with that easing of restrictions is also a system that can mobilize very quickly to deal with those cases, to isolate, to track every possible contact and to make sure those contacts are isolated as well."

Watching how other countries react can inform our own system, he said.