Thread by @ASPphysician

I have drafted multiple rage-tweets following today's 2 pressers, but realize that I am just emotionally exhausted from the inevitability of it all:
- people getting sick
- families and businesses ruined
- healthcare overwhelmed

Let's start with what won't work:

2- TO 4-WEEK CIRCUIT-BREAKER:
These WILL reduce the case load. But, if we take the examples of Melbourne and Belgium, the halving time will be somewhere between 7-14 days, depending on completeness and adherence of any "circuit-breaker".

If we start at, say, 1300 cases, then we can expect getting to 650 cases in, say 7-14 days, 325 in 14-28 days, and 162 in 21-42 days. That would bring us to where we were around Labour Day. Taking our foot off the breaks, though, would expectedly bring us back up to where we are.

The longer we delay this—with 6% growth at present—the more prolonged the circuit-breaker.

COLOUR-CODED STAGES
I used to believe in this concept, until I realized that—regardless of the stringency—it requires a situational awareness (surveillance) we do not have at present.

It also will result in clearly prolonged restrictions, based on our current experiences in Toronto and Peel. This will expectedly harm businesses for the next 4-6 months but (and this is key) no reasonable assuredness of regaining any kind of clientele until warmer weather.

EPI-BASED TARGETING OF RESTRICTIONS
This is what @brianlilley and some others keep calling for—so-called "evidence-based restrictions". It is elegant (go to where the outbreaks are), but suffers from "squeezing the balloon" (a term from #antimicrobialstewardship):

Today's banquet hall, is tomorrow's private home; today's house of worship is tomorrow's enclosed tent; today's restaurant is tomorrow 4-walled patio; today's workplace outbreak is tomorrow's apartment outbreak.

Today's visible problem is tomorrow's (temporarily) invisible one.

Everyone wants a public- and business-friendly, painless solution, but there is none. Sadly, there is no painless solution

WHAT WILL WORK
a) go really hard on COVID-19 now, and do everything possible to protect vulnerable, and financially support businesses (calling @cafreeland)

b) buffer up testing capacity and contact tracing
c) focus on isolation and quarantining with HEAVY SUPPORT (for those who can't otherwise) AND FULL WEIGHT OF LAW (for those who won't otherwise)
d) pursue what we know to optimize masking, distancing, crowding, and ventilation

I know political decisions are being made, but I am trying to separate these out as much as possible. I also believe that the Premier and his govt are doing what they feel is right. It isn't.

There is no "balanced" approach to this that averts the misery ahead.

Deep down I know that nothing will happen until the front page of the newspaper shows an overwhelmed hospital, or patients getting O2 outside the hospital, or a triage "tent" gets built, or a healthcare worker crying.

But maybe, just maybe...