Andrew Morris Profile picture
Sep 11, 2020 9 tweets 2 min read Read on X
This is real and is not related to school transmission.

Let's look at what Ontario COULD, SHOULDN'T, and SHOULD do (thread):
1. It COULD just wait and see what happens. It SHOULDN'T do that, and SHOULD act NOW.
2. It COULD act in a province-wide manner. It SHOULDN'T do that, but rather focus regionally on the hot-spots, and minimize unnecessary hardship where benefit is minimal.
3. It SHOULD increase testing capacity, but it can't. (Media should ask why we haven't increased capacity over the summer, because I dunno.)
4. It SHOULDN'T continue the mantra of "everyone who wants can get a test". It SHOULD articulate a proper capacity-based testing strategy.
5. It SHOULD reduce test turnaround times--esp. in hotspots--and optimize contact tracing as much as possible.
6. It SHOULD do what was announced in Toronto by @JohnTory today and support isolation and quarantine measures: temporary hoteling, guaranteed sick pay.
7. It COULD but SHOULDN'T go to lockdown.
8. It SHOULD consider a cordon sanitaire as was done in Wuhan & Melbourne: the movement of people will threaten more jurisdictions than are currently affected. Draconian: yes. But the longer we delay acting, the greater the overall pain.
9. If large gatherings are currently the primary source of spread of disease (and count me as a skeptic, as we don't know source of ~50%), then they SHOULD be stopped. Now.
10. They SHOULDN'T close schools.That needs to be a last resort. Kids have paid too high of a price already
11. It COULD and SHOULD get a better situational awareness using other forms of surveillance (incl. waste water testing, pooled testing, research labs). It SHOULDN'T use our limited testing healthcare testing capacity for surveillance if at all possible.
12. It COULD employ more behavioural scientists in the effort to figure out how to get more people to avoid risky behaviours.
13. It SHOULDN'T shut down healthcare. Global experience has been the 2nd wave gives a fair amount of healthcare lag, because it initially affects young.
14. It SHOULDN'T respond by shutting down LTC again.
15. It SHOULD continue its recent trend of increased transparency (see new school data being posted). All PHUs should do the same.

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More from @ASPphysician

Feb 24, 2022
Yesterday, @COVIDSciOntario released updated treatment guidelines, focusing on patients with mild illness. It is a substantial change from prior guidance, so we thought we would walk people through the noteworthy changes.

You can find the document here: covid19-sciencetable.ca/sciencebrief/c…
First, as always, this is the work of +++people incl. the, er, volunteers of the Drugs & Biologics Clinical Practice Guidelines Working Group of @COVIDSciOntario. Co-chair is @MPaiMD.

Second, the update is a response to:
1. New data & evidence
2. Changes in drug supply & demand.
The first thing you will notice is that we have done away with Tiers (cue the cheers), and instead have put in a grid that takes a more nuanced approach to risk for disease.

[NEW] We are now aiming for treating pts whose risk of progression is comparable to ~5% hospitalization.
Read 12 tweets
Jan 22, 2022
🔥JUST RELEASED: New clinical guidelines for COVID now including #Paxlovid (nirmatrelvir/ritonavir).

A 🧵 on why Paxlovid is NOT first-line.

covid19-sciencetable.ca/sciencebrief/c…
"W-w-wait! Paxlovid is NOT first line? I thought everyone was saying this is the best thing since the mute function!"
You have it right. If you look carefully at our guidelines on the 2nd page (where we cover outpt therapy for "Mildly Ill Patients") you can see where it lies.
"That is waaaay too small to see on my phone."

Sorry, let me try again.

"Oh, I think I can see. So Paxlovid is only for the highest risk patients, and only if they cannot get sotrovimab or remdesivir?"

That's right. And in Ontario, we don't have enough remdesivir for outpts.
Read 18 tweets
Jan 8, 2022
Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19 - Ontario COVID-19 Science Advisory Table covid19-sciencetable.ca/sciencebrief/c…
The guidelines are based on a blend of pathogenesis, clinical trials, and local realities of drug supply and burn rate.

If we got it right, phew!
If we got it wrong, recognize that this is a rapidly evolving situation, with new evidence, new variants, and new drug availability.
Omicron has shortened the presymptomatic period, but we have little certainty of the rest of the time course.
Read 25 tweets
Dec 28, 2021
I have received messages, texts, and reply-tweets regarding my stance on COVID management in ON (and elsewhere). As a strong early proponent of a #COVIDzero approach for a variety of reasons which, I believe, will show merit historically, I have never minimized COVID. However ...
1. I continue to have uncertainty regarding the severity of Omicron. I believe we will establish considerably more certainty in days ahead. Certainly, some evidence is emerging of a lesser severity—both mechanistically & epidemiologically—but I remain uncertain and thus cautious.
2. I don't accept the experience of the UK, Denmark, or anywhere else right now because they are at roughly the same time period in Omicron as we are—very early. The reasons why we cannot generalize from Gauteng are well documented, including in my weekly newsletter from Dec. 18.
Read 18 tweets
Dec 22, 2021
The latest COVID Therapeutics Guidelines from @COVIDSciOntario are now available here (covid19-sciencetable.ca/sciencebrief/c…)

Lots of new stuff, so let's take a drive ...
1. The dominance of Omicron in cases means that the monoclonal antibody cocktail of casirivimab + imdevimab is no longer useful. It is sotrovimab or bust!
2. Because we don't have tons of sotrovimab, we are recommending it for the groups most likely to gain overall benefit.
These are symptomatic mildly ill patients who are:
70+ years with 1 additional risk factor
50+ AND Indigenous + 1 additional risk factor
Residents of LTC or other congregate care
Hospital-acquired
* other high-risk patients can also be considered (e.g. +++ immunocompromise)
Read 8 tweets
Dec 5, 2021
A few thoughts on the anticipated Omicron wave:

1/ People are increasingly fed up with COVID, so measures to control Omicron cannot/should not rely on measures used for prior waves. (Which means that governments would be wise not to allow COVID to reach a crisis situation.)
When I highlighted several days ago that case growth was worrying me, several Twitterati assumed that I was alluding to lockdowns. (I was doing nothing of the sort)

But failure to pay attention to cases in EUR shows that countries can be forced into lockdowns if they don't act.
2/ Engineering/environmental controls (e.g. ventilation, filtration) will be the smallest imposition on people's lives.

Better masking (understanding, adherence, quality) would make a difference.

This is without assuming any properties of Omicron.
Read 13 tweets

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