Thread by @KashPrime

The new updates in Ontario seem grim, and a new harsher lockdown is coming, but here's a few things I think can help get us bck on track. Many of my colleagues are either in despair or resigned to a brutal Spring in the hospitals, but it doesn't have to be this way...

1) Rapid testing strips are sitting by the millions on shelves. They are not being released to municipalities to use in hot spots. I spoke with one mayor who needs them STAT. Other countries have shown the way, and more tests are available now:

https://twitter.com/KashPrime/status/1328794677655592961?s=20

2) Several new therapies have been developed, including monoclonal antibodies like Bamlanivimab and Regeneron, which can be used on older, at-risk populations, potentially averting prolonged ICU admissions and death. These give passive immunity. One possible criteria:

They have to be given within a few days of the start of mild symptoms when the virus is replicating the most, if you wait until a patient gets sicker or needs ICU, its already too late. There's only phase 2 trial data, and benefit is not certain, but not much evidence of harm

For hospitalized patients new results from the REMAP-CAP study show much improved survival in ICU patients with Tocilizumab and Sarilumab (both IL-6 inhibitors). They also have to be given at just the right time to make a difference in mortality

nytimes.com/2021/01/08/hea…

Moving medical practice can often take too long, months and years even, and many ICUs are still giving Remdesivir, originally designed to fight Ebola and with fairly shaky evidence behind it. Some of these tensions are covered in this excellent piece: nytimes.com/2020/08/05/mag…

3) Ventilation is finally being addressed by authorities in Canada following the publishing of our open letter, signed by hundreds of top authorities in engineering and public health.

https://twitter.com/DavidElfstrom/status/1348751036694061063?s=20

Here is a link to the original letter and discussion around it:

https://twitter.com/KashPrime/status/1346093097093128194?s=20

Practical steps you can take now:
- Evaluate air quality in your space, use CO2 monitors if you can't get engineers to help
- Use HEPA filters in smaller rooms (like clinic rooms or classrooms) if you can't ensure at least 3 air changes per hour
- Assess central air filters

4) Small classes - its becoming increasingly clear that kids are a major vector of covid spread, with their test positivity as high as 20%. Class sizes need to be kept to a minimum, and masks required from kindergarten onwards

cbc.ca/news/canada/to…

5) Paid sick days - Many folks work in essential jobs and can't distance or have no say on workplace safety measures. Losing one days income can be a huge blow to many; seamless, easy to access sick benefits would be a boon even after the pandemic:

https://twitter.com/SabiVM/status/1348802670782509056?s=20

To conclude: I hope some of these measures are adopted, it would certainly alleviate suffering and possible deaths and prevent economic damage, but given how slowly and ineffectively we move in this country, I am not optimistic. Prove me wrong Canada!

Looks like the province is moving to get the private sector to test workers. This will be huge if it can be done properly!