Thread by @DrRramchandani

Growth rate is key during a disease outbreak. The rate of growth in the the total confirmed #cases in #Canada seems to be showing signs of slowing and pulling away from the continued steep trend line seen, for example, in the United States (Green). #COVID19 #coronavirus 1/25

This is a +ve sign, but still very early to tell, esp. with an est. 1M+ #Canadians having just returned from travel, and #COVID-19 #testing only targeting >severe cases (due to rationing & backlog in lab testing), we don’t have a good grasp on the level of community spread. 2/25

The number of total cases is what we want to know, but the true number of these is not known. Not by us epidemiologists, nor by any other research, governmental or reporting institution. 3/25

When media outlets claim to report the ‘number of #cases’ they're not being precise and usually don't say that it's the number of confirmed cases we are all talking about. 4/25

But it's certain that the total number of true COVID-19 cases are higher than the number of known confirmed cases – this is mainly due to limited #testing. 5/25

Ideally, we’d have as much detail about COVID-19 #testing as possible. We’d like to know how many people in the world are being tested for #COVID-19 every day, and in which countries. 6/25

We’d like to know what the #results of these tests are, and how the available tests are being used – are countries testing only people in #hospitals? People with #symptoms? How severe? And where is the line being drawn? 7/25

Unfortunately, @WHO doesn’t have a centralized #database for #COVID-19 testing #data, but something to #innovate around in the #future. 8/25

Here is the most recent look at #tests performed in #Canada by #province, per 100K #population, and the total. 9/25

#Ontario's assessment centres have been conducting ~3,000 #tests per day, the province's #labs are currently producing only 2,000 to 2,100 test results each day. Ontario currently has a backlog of > 8,400 tests, with people waiting at least four days between test and result.10/25

Nonetheless, the fact that #Canada is starting to see its trend line pulling away (see original graph in this thread), amidst a greater number of tests being conducted over the past week, and still seeing the trend line pulling away gives reason for optimism. 11/25

#Ontario is aiming to process 5,000 #covid_19 tests per day by the “end of the week”. cbc.ca/news/canada/to…

12/25

#Testing is critical. Without widespread testing for #COVID_19 we can’t know how the #pandemic is truly spreading nor appropriately respond to it. Testing allows us to understand the spread of the #disease and to take evidence-based measures to slow down its spread. 13/25

The most common tests for #COVID_19 involve taking a #swab from a patient’s nose/throat and checking them for genetic footprint of the #virus. They are called “#PCR tests”. 14/25

The first #PCR tests for #COVID_19 were developed very quickly – within 2 weeks of the disease being identified – and are now part of @WHO’s recommended protocol for dealing with the #disease. Check out this @WSJ video to understand more:

@DrTedros noted today that asking people to #StayAtHome and other physical #distancing measures are an important way of slowing down the spread of the #coronavirus and buying time – but they are #defensive measures. To win against the #coronavirus we have to attack as well. 16/25

"We need to attack the #coronavirus with aggressive and targeted tactics – testing every suspected #COVID19 case, isolating and caring for every confirmed case, and tracing and quarantining every close contact" @DrTedros 17/25

While its likely still too early to provide any concrete predictions for #Canada, we can glean the potential future by looking at places recently infected, places that aren’t infected, and places where it first started. 18/25

#China, for e.g., identified the #virus in early Jan, had a “full-on” #response, & it’s now late March & they seem to be estimating that within the next 2wks or so they will start coming out of it (curve will start declining) – so at least a full 3 months till decline. 19/25

In NA, Europe, Middle East – we're still in phase of #exponential growth (but at varying rates). Still have months to go (even under proper response). Canada can hope to see a flattening (see countries in red - 1/25) in latter part of April IF the current trend continues 20/25

When you look at #Africa and parts of the #Indian sub-continent we can see things are just beginning. They are also in a phase of #exponential growth. 21/25

In 6 mnths, we're likely to still be emerging, with the disease still in various parts of the world. Most of the planet should be through the “bad #wave”, but we will be back into #flu season, and so an important question is whether we will see another #surge at that time. 22/25

Many of my colleagues think we are unlikely to see #COVID_19 disappear completely, as it #transmits too easily in humans. We’re more likely to see more #waves or low-level disease. 23/25

This will depend on what we do as a #society & global #community. Test every potential case, rapidly isolate, & we should be able to keep cases low. If we only rely on big shut down measures w/out finding every case, we're likely to see more waves every time we loosen up. 24/25

Shutdowns buy us time. They don’t stop the #virus. They suppress it & slow it down, while it continues to circulate in households before we loosen up restrictions.
We should use that time to get the systems in place to manage the individual level cases that will remain. 25/25