Thread by @ASPphysician

As all of Ontario waits with baited breath to learn how @fordnation has decided to act on what the mostly leaked Science Table shows, I thought it important to explore what "all options on the able" look like.

A 🧵:

First, there are no MUST DOs.

There are places around the world who have kept schools open and seen cases drop, and there are places who have managed to drop without closing borders, restricting travel, or curfews.

But COVID is transmitted by people interacting, usually indoors in prolonged close contact.

The data (and my experience) seems to show that some of this post-holiday surge was related to people behaving as people do. globalnews.ca/news/7555586/p… It appears that we will hear more of this tomorrow.

Although we deserve a fair amount of blame, govt should shoulder much, too...

... as they haven't invested in behaviour change. To get people to change behaviour, it boils down to Capability, Opportunity, and Motivation. Over the holidays, those 3 leaned towards shopping and gathering. Some of those will need to change tomorrow.
bit.ly/3sfyeSs

Then there is the avoidable workplace congregation: non-essential workplaces that are important to the economy but not essential to short-term survival. Those should probably be closed down.

Essential workplaces? Make them safer with paid sick leave, PPE, regulations, testing.

Crowded living? This is a huge issue, and some dent can be made to this, but this government has shown they have zero interest in tackling this important issue. So we can whistle "Sweet Georgia Brown" all we want, but it ain't gonna happen.

Travel? They could probably get dramatically more aggressive about travel, especially about bans, mandatory quarantining, etc, but also consider how to regulate interprovincial & regional travel. Like everything, these are choices, they have been done elsewhere, but they won't.

Test-trace-isolate? It is never too late to get back to this, but we are at a point where doing so is kinda like bailing a boat with a cup. It has a pretty big return on investment, but the order is too tall at present for most PHUs.

Schools? I think no, but it is like everything else, you decide what is most important, and how much R you want to drop things.

The most important thing: we are at a pretty pivotal point in our history, contemplating rationing care, actively moving people around the province.

No easy answers and @fordnation has no easy decision. But interventions have predictable effects, and should be data driven, based on expected reductions in transmission, coupled with economic and social disturbance. cmaj.ca/content/early/…

Right now, interventions should be focused on reductions in transmission. The biggest bangs for the buck:

1. Remove capabilities for discretionary gathering.
2. Support and protetction for those who can't avoid gathering.

This govt. has shown so far that they prioritize

business & personal freedoms over viral transmission and the healthcare system.

Some have understandably said, "no curfew", "don't close schools", "open up small businesses for longer", or "we can't stop travel".

It is all about values.

But if you want to change behaviour, go back to what we know: Capability, Opportunity, and Motivation. If you can't reasonably affect motivation, you need to affect capability or motivation.

Let's see what gets proposed ... they've had a long time to think about this.