In the last few days and following the emergence of #COVIDzero, I've noticed an unsettling fissuring within the academic community.

As @IrfanDhalla says, people on both sides likely agree more than they disagree, but the divisiveness is unproductive: thestar.com/life/health_we…

1/8
The #COVIDzero approach recognizes that there is a disjointed approach to #COVID19 in Canada that is causing uncertainty, unnecessary suffering, economic hardship, and preventable deaths.

#COVIDzero is based on a goal of 0 cases with 0 tolerance for community transmission.

2/8
The "moderate" or "balanced" camp scoffs at this aspirational strategy, minimizing it to "hashtags and platitudes...on social media", highlighting its impossibility, and contends that we need to focus on "improving our ability to live with #COVID19": nationalpost.com/opinion/opinio…

3/8
The "live with COVID19" approach also argues to "focus on preventing transmission amongst our most vulnerable and within congregate living settings", despite the known failings and questionable ethics of "shielding" or "focused protection" strategies:

4/8
If we're honest, the current Canadian approach to #COVID19 (outside of the Atlantic) is failing.

Hospitalizations, #LTC outbreaks and deaths are increasing, small businesses are struggling with uncertain futures, and the public is fatigued.

The status quo is unsustainable.

5/8
As it stands, the goal posts keep moving and the roadmap gets redrawn on a seemingly daily basis.

In May, @IrfanDhalla emphasized the need for a "clear objective", and that "elimination, not adaptation, is the courageous #COVID19 choice for Canada": theglobeandmail.com/opinion/articl…

6/8
Most proponents of a #COVIDzero strategy understand that absolute elimination of #COVID19 is an aspirational strategy, but we also understand the need for a common objective to reinvigorate Canada's pandemic response.

As @DFisman says "don’t put the goal ahead of the task".

7/8
Remarkably, many of the core strategies underpinning a #COVIDzero and a "balanced" approach are similar:

Ultimately, healthy (and public) debate on this topic is needed, but an academic pissing match is not—this distracts from what needs to get done.

8/8

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More from @NathanStall

16 Nov
New @medrxivpreprint (not yet peer-reviewed) with @KevinAnBrown and colleagues examining temporal variations in the intensity of care provided to the 2,000 Ontario #LTC home residents who died of #COVID19 between March 11th and October 28th, 2020: medrxiv.org/content/10.110…

1/6
While there was no official policy denying hospitalizations media reports (cbc.ca/news/health/co…) & testimony from Ontario's LTC COVID19 commission (ltccommission-commissionsld.ca/transcripts/pd…) suggest that resident transfers to hospital were strongly discouraged at the onset of the pandemic.

2/6
To investigate this, we measured monthly variations in hospitalizations among community and #LTC-dwelling Ontarians who died of #COVID19 between March-October, 2020.

We found that monthly hospitalization rates were relatively stable among community-dwelling individuals.

3/6
Read 6 tweets
9 Nov
Our study led by @KevinAnBrown associating crowding in #Ontario nursing homes (defined as the mean number of residents per bedroom and bathroom) with #COVID19 infection and mortality has now been published in @JAMAInternalMed: jamanetwork.com/journals/jamai…

1/9
We analyzed #COVID19 incidence and mortality data for residents of nearly all of Ontario's 623 nursing homes from March 29-May 20, 2020.

As of March 29th there were 78,607 residents in these homes, with 36.9%, 37.3%, and 25.8% in single, double, and quadruple-bedded rooms.

2/9
As of May 20th, 5218 (6.6%) residents developed #COVID19 infection, and 1452 (1.8%) died of #COVID19 (case fatality rate = 27.8%).

#COVID19 infection was distributed unequally across Ontario's nursing homes, with 4496 infections (86%) occurring in just 63 homes (10%).

3/9
Read 9 tweets
4 Nov
Yesterday, despite rising #COVID19 cases, hospitalizations, and deaths in LTC, Ontario released a framework to "keep the province safe and open": news.ontario.ca/en/release/590…

This is nothing more than an ageist, ableist & unethical "shielding" or "focused protection" strategy.

1/12
A "shielding" or "focused protection" strategy (the latter was popularized by the Great Barrington Declaration: gbdeclaration.org) segments the oldest and most vulnerable to #COVID19, while allowing everyone else to resume life as normal with simple hygiene measures.

2/12
As many have already highlighted, the #Ontario framework establishes a very high threshold for closures and lockdowns: cbc.ca/news/canada/to…

Specifically, the 10% test positivity and incidence rate ≥100/100,000 thresholds for return to a modified stage 2 are very high.

3/12
Read 12 tweets
4 Nov
Manitoba's Health Minister called out the "motivation" of >200 doctors who wrote an open letter calling for stronger action: cbc.ca/news/canada/ma…

Remember @CameronFriesen called care home deaths "unavoidable"—let me explain how when it comes to #LTC he hasn't "got this".

1/9
Let's review the escalating #COVID19 catastrophe in the province's care homes.

There are 14 active #LTC home outbreaks and 38 cumulative resident deaths. Today the @redcrosscanada was called into Parkview Place and Maples, the two hardest hit homes: cbc.ca/news/canada/ma…

2/9
Earlier this year, @LTCcovid published international examples of measures to prevent and manage #COVID19 outbreaks in residential care and nursing home settings: ltccovid.org/wp-content/upl…

#Manitoba is failing miserably on almost every key measure.

3/9
Read 9 tweets
18 Sep
In the last 24 hours, two more Ontario #LTC residents died of #COVID19: ottawacitizen.com/news/local-new…

There remain 22 active Ontario #LTC home outbreaks (see figure).

@ASPphysician has challenged me to say what must be done to get this under control.

Here it is (a thread).

1/8
We need swift action to control community transmission of #COVID19 which is getting out of control.

In our @CMAJ study, the prevalence of #COVID19 in the community surrounding a home was strongly associated with the odds of an outbreak (aOR = 1.91): cmaj.ca/content/192/33…

2/8
Controlling community transmission is imperative, as staff neighborhood characteristics are also significant predictors of outbreaks: medrxiv.org/content/medrxi…

As @DFisman showed, lagged staff infections were associated with death among #LTC residents: jamanetwork.com/journals/jaman…

3/8
Read 8 tweets
18 Jun
The @ONlongtermcare released an FAQ document on the updated directives for visitation in nursing and retirement homes: ltchomes.net/LTCHPORTAL/Con…

The details in this document further highlights the restrictive, onerous and even cruel conditions for visitation.

@picardonhealth

1/8
The nonsensical requirement for potential visitors to test negative for #COVID19 within the previous two weeks holds visitors to a higher testing standard than healthcare workers!

As @drlesleybarron writes "I'm a HCW but my first #COVID19 test will be so I can visit my mom"

2/8
The biweekly testing requirement for a weekly visit is ridiculously onerous.

Many visitors will themselves be frail older adults with mobility issues, they're being asked to travel to and from #COVID19 assessment centres, often standing outside in the heat to await testing.

3/8
Read 8 tweets

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