Thread by @NishaOttawa

I was asked by FB friends to share this post - thoughts on #covid19Canada from #IPAC and #frontlinemom. Breaking it down into a thread, recognizing the challenge to be timely and relevant (and brief?!) in this changing period... 1/n

There remains one constant guiding principle = WASH YOUR HANDS. My favourite message from impressive BC public health officer Dr. Bonnie Henry: "wash your hands like you just cut up a bunch of jalapeños and need to take your contacts out." Yes, yes, protect your eyeballs! (2/n)

Following this week's #WHO declaration of a pandemic (no change in pace of pandemic planning at CHEO) and the first cases of #COVID19 in #YOW (big change in pace!), I reflected on the questions that kept bubbling up. (3/n)

Summary of questions below -
1. Which is better - soap vs sanitizer?
2. Can you get COVID19 from a contact?
3. thoughts about travel?
4. Why close schools when we don't have an outbreak?!
5. Now that Canada has 200+ cases, are we looking at an outbreak on scale ~Italy? (4/n)

1. Back to basics: which is better, soap or hand sanitizer?
They both have different objectives: soap washes off dirt + microbes from surfaces of hands, whereas alcohol-based hand rub inactivates microbes. So both are fine and recommended by the WHO for COVID-19. (5/n)

Good lather + right moment + right technique can dramatically reduce amount of germs on hands IN 20 SEC (would you wash for less after cutting them jalapeños?!). Same can be achieved with 70%-alcohol based sanitizer if you RUB UNTIL HANDS ARE DRY (6/n)

2. Can u get infected from a contact of a case? So you're friends of a friend w/ #COVID19 -should you get tested?? If sx'ic (cx, fx, SOB) + friend in close contact w/case + developed sx ~3-5d later, DURING WHICH u had close contact with your friend = considered "exposed". (7/n)

We would NOT TEST asymptomatic people. The test is not reliable in the absence of symptoms - and while asymptomatic people may have detectable virus up their noses, they are NOT driving outbreaks as super-spreaders (8/n)

3. Should I defer travel? YES. Social distancing+ controlling exposure risks is key, travel companies are smart to offer credits to keep your business/their reputations. Announcement by the feds makes return home complicated + more provinces recommending self-isolationx14d. (9/n)

Are personal risks + occupational impact worth the trip? Personal decision. Yet it's become cool to state how we've canceled travel plans to help #FlattenTheCurve + reduce spread within our families and communities. I love this. We're all in it together =less daunting! (10/n)

4. Why close schools when no outbreak?! March break =highest risk for imported cases +unrecognized local spread. ON declared school closures with 10d lead time + prior to exponential increase in community-acquired cases = strategy informed by other countries' experiences. (11/n)

Those countries with early school closures (HK, Singapore) had fewer cases that overwhelmed their healthcare system compared to Italy, S. Korea and, shockingly, US.
(12/n)

But it is not without intense disruption, and I support it WITH contingency plans in place for working parents and guardians. The government announced some financial support - employers have a week to figure out how to support employees with young kids. (13/n)

As for anticipated disruption to our lives, we're staggering clinical and operational duties - my husband's chief recruited all their colleagues' teens as babysitters to help look after our kids! #ItTakesAVillage to #FlattenTheCurve (14/n)

5. Is #covid19Canada ~ Italy?
The news out of Italy is devastating, incl stories of HCWs making life-or-death decisions. Likely that mitigation + containment strategies came too late after ++ unrecognized community transmission. (15/n)

Canada's story can be different. Reassured by region's response in past wks: 1) broad surveillance (test ill travelers from non-hotspot areas), 2) simulations, 3) frequent contact w/PH (bless!) +hospital partners, 4) assessment centre opened 48h after first #YOW case (16/n)

As of last night, 4 cases in Ottawa. A recent model suggests that we're at a tipping point, with a 50% likelihood of going on to have an outbreak. I am optimistic, given our collective hard work to control spread in the hospital and community
thelancet.com/journals/lanin… (17/n)

and GRATEFUL to colleagues who canceled travel plans, signed up for shifts at assessment centre, who are realigning call schedules, clinical duties, AND sharing childcare strategies during school closure - all so we can serve patients safely and effectively. (18/n)

It haunts me, this observation from MD at epicentre of the epidemic in Italy: "And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us." ja.ma/2xE3McZ (19/n)

We are working upstream + in solidarity to beat the odds of having COVID-19 overwhelm our communities and healthcare system. (20/n)

@DFisman @AshTuite @BogochIsaac @TorontoIDDoc @CanucksFan80 @HotaSusy @janinemccready @DrGregRose @bonniehenryfans @CPHO_Canada @mvankerkhove @VeraEtches @lmsamson @celliottability