Thread by @janinemccready

THREAD:
In Canada to date we have only seen travel-related #COVID19 cases. This will soon change.

China's containment attempts gave us time. We cannot squander this by being complacent. The time to increase funding, improve communication and prepare is now. 1/

IPAC teams have been preparing for weeks, now
We URGENTLY need action from the Ontario & Canadian government to ensure all of us on the front lines can keep health care workers (HCWs) and patients safe.

The window to prepare is closing and these things need to happen now: 2/

1) Rational Recommendations for Personal Protective Equipment (PPE) - Thankfully @CPHO_Canada updated guidelines on Feb 28 recommending contact and droplet precautions with the addition of N95 when performing AGMPs canada.ca/en/public-heal… 3/

We need @celliottability & @ONThealth to follow suit and align with Canadian and other provincial recommendations based on what we now know about COVID-19.

We need to use N95 masks rationally so we have enough to be able to keep HCWs safe for the duration of the outbreak. 4/

There were NO cases after a 15-hr flight of 350 passengers w/ symptomatic index case. "the lack of secondary cases after prolonged air travel exposure supports droplet transmission, not airborne" cmaj.ca/content/lack-c… . 5/

2) Increased Lab testing capacity - Sentinel surveillance at hospitals has started but once local person to person transmission is identified testing needs to rapidly increase. Need Investments now so there is no delay in testing if/when the need arises. 6/

Surveillance results from all provinces need to be rapidly disseminated so we can prepare and change screening protocols to avoid missing cases without epidemiological risk factors.

We do not want to be caught off guard like Iran, Italy & US. 7/ .

Surveillance is also needed outside hospitals.

Knowing when local transmission starts is key for timely implementation of strategies such as cancelling large gatherings to prevent more infections & attempt to spread out the curve, avoid overwhelming the health care system. 8/

3) Updated @ONThealth case definition must match rapidly evolving epidemiology - We all need to be working with the most up to date available info. At this point given extensive spread (& esp US cases) it likely means ANY non-Canadian travel + symptoms are possible cases. 9/

Case definitions which lag behind current data put us all at risk. Mismatched case definitions between EMS & hospitals creates confusion. Last week operating w/ the list of impacted countries at the time would have missed Iran & now would miss Washington state, or Egypt. 10/

4)Immediate funding for Modelling to guide response and preparedness in Canadian hospitals - support needs to provided now to ID epidemiologists like @DFisman & @AshTuite for creation of models to estimate needs of additional beds, ICU beds, vents, supplies and PPE 11/

5) Framework and discussion re: allocation of resources such as Vents, ECMO, ICU beds and surge capacity needs to occur now in case these precious resources are overwhelmed . 12/

6) Review of Goals of Care and decisions re: transfer to hospital for all people residing in Long Term Care facilities. Also improve system capacity to care for people in these facilities without transfer to hospital to avoid flooding the hospitals with cases. 13/

7) Ramp up virtual care/mobile testing/out patient clinics to perform assessments and testing but keep people with mild illness away from Hospital ERs 14/

@maureentaylor31 @jpowi @HotaSusy @Abx_ID_Doc @MarkADowning @carlyweeks @picardonhealth @BogochIsaac @AlonVaisman @DFisman @PHAC_GC @TOPublicHealth @PublicHealthON @CBCHealth @CDCofBC