David Fisman Profile picture
30 Oct, 12 tweets, 3 min read
👇🏼
Schools are also an upstream enabler if the rest of our economy in a way that bars, gyms and restaurants are not.
Look, I’ve been saying for months now that schools are the one mass gathering it’s hard to cancel.

We don’t want to close them. That’s why reducing class sizes is so critically important.
Looking at data, our hospitalizations and icu’s are surprisingly flat in Ontario. I get that this sucks for people in affected businesses, but the closures are targeted, and many of the outbreak hotspots aren’t close-able.
LTC and hospitals? No, need those.

Food processing plants and food stores? Need those too.

Religious gatherings? I think those could be restricted but I’m not a person of faith and many others are. To them these are essential services.
So what about schools? Does it make sense to inflict this pain on bars, restaurants and gyms only to amplify disease in schools? No, it doesn’t.

That’s why teachers have been calling for action on reducing class sizes for months. Your move, @Sflecce
And given that people seem to regard Ontario as sui generis, a place so unique that lessons and data from other places can’t possibly be assumed to apply to us, let’s make some Ontario data.
Let’s replicate this cdc study in Ontario with a focus on the 50% of cases with no epi link

cdc.gov/mmwr/volumes/6…
Let’s start using phylogenetics to understand our epidemiology better as has been done in Quebec. Which outbreaks are pseudo-outbreaks? Which outbreaks are we missing? This tech can help.

virological.org/t/genomic-epid…
This was the sort of work PHO was created to do, though at this point that agency is so diminished that I don’t think that’s on the table.
To be clear: Ontario is doing ok, and better than I expected. People are getting sick from, and dying from, this f*ing disease, but we don’t have a health crisis on our hands to rival what’s emerging in western Canada.
That means measures in place are doing what they’re intended to do.

Spare me the “we shut stuff and nothing happened” garbage. You’re smarter than that. Yeah, you.
Could we do with an upgrade on PH leadership? Sure. I’ve been saying that for months, as has @DorisGrinspun, but there’s clearly no appetite for that. So, let’s play the cards we’re dealt as best we can.

Here endeth ye rant.

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More from @DFisman

26 Oct
Asked by a friend to comment on the reasonableness of the IHME forecasts for Canada (30+k deaths by Feb). (covid19.healthdata.org/canada?view=to…). The IHME model is impressive...
And again, based on the 2nd (winter) wave of the pandemic ahead of us, and given that we currently stand around 10k deaths, the projection of 30k deaths by February seems reasonable. Note my earlier tweet about 2:1 ratio of 2nd to 1st wave in 1918/1919.
What's impressive to me in IHME is the forecast that we would/could save 10,000 Canadian lives in the months ahead with a national mask mandate. This, again, seems reasonable, based on best available data.
Read 8 tweets
25 Oct
Global R(t) has been remarkably stable since the first wave. Here it is plotted against global doubling time. Will try to unpack this further when I get a chance but it’s a good news/bad news story: many infections ahead, but this isn’t open-ended.
“Moving average” = 7 day moving average for doubling time.
Just to unpack this a bit, there's a direct relationship between R and doubling time, inasmuch as R(t) is a function of growth rate, as is doubling time. Doubling time may just be a bit more intuitive.
Read 12 tweets
24 Oct
This is amazing. We're headed into the second wave of a once in a century pandemic. Ont and Qc have been backstopped by the feds. Now here come the Cons with a motion to initiate a massive AUDIT of the public health response? Now? October 2020?
ourcommons.ca/DocumentViewer…
Like, THIS is when you're going to tie up PHAC, Procurement, Health Canada, not to mention the companies the govt is working with to procure vaccines and tests, with what looks to be the audit from hell?

Really?
Because PHAC, Health Canada, and every other federal office/bureau/department isn't already hanging on by their fingernails trying to build systems, structures and responses to protect Canadians?

Now? Really?
Read 10 tweets
13 Oct
This (as with the Quebec karaoke superspreader event) is extremely difficult to explain without invoking aerosol. High viral load in resp mucus of the index case (asymptomatic) created a superspreader event.

It would be extremely interesting if the index case was the instructor: prolonged shouting/exhorting during a spin class would make sense in terms of aerosol generation...is that info out there?
Events like this are literally showing us the gateway out of this situation. It is distressing to see that institutional public health across Canada is still reluctant to acknowledge the importance of aerosol: costing time, money, lives now.
Read 4 tweets
12 Oct
I had some wonderful back-and-forths with @aatishb about this and it’s fantastic to see the finished product on “math of masks” at

aatishb.com/maskmath/
There is a wonderful YouTube video here:

If you want a mathy-er version of same, we have an approach using next generation matrices which you can access here (and which we’ll cover this week in chl5425 at @UofT_dlsph)

sciencedirect.com/science/articl…
Read 4 tweets
10 Oct
Thanks to the friend who reached out to suggest that having my own dedicated troll army suggests that our messaging and information are effective. That's a nice shot in the arm.
With that in mind, I'll use this account to disseminate good info on what's happening with covid...and hopefully drive the trollbots crazy.

Let's start with covid in Canada today:
R(t) by province...note New Brunswick is the place with a qualitative change in status, and is few days into a LTC outbreak after a few months of elimination of local trans.
Read 8 tweets

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