THREAD:
My last #COVID19 tweet rant was a few weeks ago. A lot of work has been done but we are still falling short & dealing w/ new issues on a daily basis. Time to prepare is running out. Critical issues at present are: 1) Testing Capacity; 2) PPE; 3) Case definition; 4) LTC 1/
My last #COVID19 tweet rant was a few weeks ago. A lot of work has been done but we are still falling short & dealing w/ new issues on a daily basis. Time to prepare is running out. Critical issues at present are: 1) Testing Capacity; 2) PPE; 3) Case definition; 4) LTC 1/
1) Testing Capacity - ideally we would be testing everyone with symptoms to get an accurate picture of just how widespread #COVID19 is now. Unfortunately with limited testing because of swab & reagent shortages/lab capacity this is not possible. 2/
On an individual level telling someone they definitely have COVID19 vs they may have it likely modifies behaviour. Hopefully everyone w/ symptoms stays home but confirming infection may improve isolation *especially* in those w/ mild symptoms. 3/
On a population level having a realistic idea of true case counts is helpful to reinforce the importance of #socialdistancing and is necessary to understand if we are actually #flatteningthecurve or just missing many cases. 4/
If we are not able to improve testing capacity we need to save the tests for hospitalized patients, vulnerable groups and HCWs. We need to establish a way to count the many probable cases without lab confirmation to have a realistic idea of case counts. 5/
2) PPE - Possible shortages of PPE are caused by irrational use, and lack of supply. We are doing everything we can to conserve PPE & educate HCW on appropriate use but we also need to know there is a back up plan and more PPE is available. 7/
.@ONThealth needs to tell us if the stockpile of expired masks exists & distribute them if they do. We need to know now if more PPE is available or if each hospital is on our own. Canadians are smart & innovative - the time is now to come up with solutions. 8/
3) The case definition from @ONThealth has continued to be weeks behind. It finally included all non-Canadian travel but by then we had COMMUNITY TRANSMISSION. This mismatch & lack of recognition of the increasing number of cases with NO LINK TO TRAVEL is irresponsible. 9/
This lack of transparency is dangerous & is putting lives at risk as it leads to delayed identification of cases & exposure of HCW, especially @OntarioEMS. We need a clear statement openly acknowledging community transmission & letting go of the preoccupation with travel. 10/
My hospital has changed our approach to look for symptoms of #COVID19 regardless of travel. If we followed the ministry definition we would be missing many cases and allowing the spread of infection to other patients & HCWs. 11/
Re-emphasizing travel when community transmission is present falsely reassures the public that they are not at risk if they are not in contact with those who travel. People need to modify their behaviour NOW & we need to give them accurate information so they can do so. 12/
This tool covid-19.ontario.ca/self-assessmen… tells you "It is unlikely that you have COVID-19" if you have symptoms but no travel or contact with someone who has travelled. This was true 3 weeks ago but is no longer accurate and is harmful. 13/
4) Long term care facilities - We are now seeing cases & outbreaks in multiple facilities. There is lots of great planning happening for mobile teams to provide care & increase testing but this all needs to happen now. 14/
Patients are being transferred regularly for testing & assessments which should be done in LTC. In 2 weeks if these transfers continue & increase the system will have difficulty coping with the increase demands when coupled with the expected rise in critically ill patients. 15/
All of this to say - this is our chance to get it together. There are many things missing in this list but these are my problems today.
And now we need regular, up to date, evidenced based communication, decision making, and action. 16/
And now we need regular, up to date, evidenced based communication, decision making, and action. 16/
