OTTAWA—Canada is facing the grim prospect of multiple COVID-19 outbreaks rolling in waves across the country from now until December and beyond, killing anywhere between 4,400 and 44,000 Canadians, federal data suggests.

The numbers are “stark,” Prime Minister Justin Trudeau said Thursday. “Our health-care systems across the country are coping for the time being, but we’re at a fork in the road between the best and the worst possible outcomes.”

Trudeau and his top public health officials conceded the federal government is looking at whether tougher public health restrictions on movements and travel will be necessary.

He would not say what options are under consideration, nor when Canadians might see any relaxation of measures if best-case scenarios play out, but he said there may be slight lifting of restrictions once the intense first wave passes.

“Normality as it was before will not come back full on until we get a vaccine,” Trudeau said, adding, “that could be a very long way off.”

Canada is still in the early stages of the epidemic, according to Dr. Theresa Tam, the country’s chief public health officer, and she says it is too early to say when the peak will hit.

If the initial peak of the first wave comes in late spring, with the end of the first wave in the summer, Trudeau said it will still “take months of continued determined effort” to beat back the disease.

He underscored that if Canadians follow guidelines for physical distancing and cough shielding, the numbers could improve dramatically.

Trudeau acknowledged COVID-19 is taking a brutal toll on Canadians and the economy. New data shows more than 1 million people lost their jobs in March.

Another 2.1 million workers who kept their jobs worked only half their usual shifts or no hours at all.

Trudeau said repeatedly that Ottawa will support workers and businesses for as long as it takes to emerge from the crisis, and Deputy Prime Minister Chrystia Freeland insisted the federal government has the necessary fiscal resources to do so.

The Liberal minority government has so far pledged $105.5 billion in budgetary measures to backstop workers and the economy.

The Parliamentary Budget Office said Thursday that spending on that order will jack up the federal budget deficit to a whopping $184.2 billion, up from about $27.4 billion that it had forecast for the fiscal year that just ended — and it said more spending may well be needed.

The forecasts for coronavirus infections and deaths that Ottawa released Thursday provide a range of projections based on many variables, such as how the disease has behaved elsewhere, the impact of infection control measures like physical distancing, cough hygiene, and the health resources available to patients.

The best-case scenario foresees 4,400 deaths, with tough control measures and one per cent of the population becoming infected; a more moderate scenario, based on weaker adherence to control measures, would see some 22,000 Canadians perish.

A worst-case scenario would result if no effective control measures were taken, resulting in a 10 per cent infection rate and some 44,000 deaths over the pandemic’s span, said Simon Lucas, Canada’s deputy minister of health, at a news briefing in Ottawa.

Canada is currently seeing a 2.2 per cent fatality rate among those stricken with the disease.

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Tam said a “best case” infection rate of one per cent is “aspirational” but achievable. That still means about 376,000 people could get COVID-19.

The forecasts say that by April 16, a week from now, Canada could see a case range of 22,580 to 31,850 people infected, with anywhere from 500 to 700 deaths.

Tam reported that on Thursday morning there were 19,774 COVID-19 cases in Canada with 461 deaths, numbers that would change throughout the day as provinces report new infections.

She said tests have been completed for more than 373,000 people, with more than five per cent confirmed positive.

Tam said the government is scrambling to ramp up testing, and acknowledged a shortage of ingredients for domestic testing “concoctions” is bedevilling that effort.

To date, she said the rate of growth here is slower than seen in many other countries, with confirmed cases doubling about every three to five days.

Susan Bondy, associate professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health, said Canadians will see lot of different modelling studies released as COVID-19 plays out.

She said one goal of communicating those studies is “to make the case that our behaviour can change the extreme outcomes possible from ridiculously devastating to merely devastating.”

Bondy said there should be one important takeaway: Canadians must urgently “take action to turn the tide on our rates of transmission among vulnerable populations” including the frail, elderly, homeless, Indigenous and addicted populations. If they fail to do so, the result will swamp the acute care system as it did in Italy, she said.

And if intensive-care units are overwhelmed, the proportion of infected people who die will grow because the system will be unable to turn around serious cases that might otherwise recover.

Tam said the numbers already show the global pandemic showing up disproportionately across the country, with Quebec hardest hit.

That may be because its citizens had an earlier March break, many people vacationed outside the country before travel restrictions hit, returned and mingled among their communities, said Tam. She noted Quebec’s rate of testing for the virus is also, like Alberta’s, the highest, so it is detecting more cases as well.

Given the clusters of outbreaks in long-term care homes, deputy public health officer Dr. Howard Njoo said the federal public health agency is looking at changing directives or guidance for care in nursing homes and seniors’ residences, which come under provincial regulation.

Tam said the modelling projections are not “a crystal ball” that represent exactly what will happen, yet are useful to drive public actions and government policy choices.

“We cannot prevent every death, but we must prevent all the deaths that we can,” she said.

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