With #COVID19 vaccine supply ramping up, there is lots of discussion about #Ontario's vaccine distribution plan and how individuals are being prioritized.

Ontario's ethical framework is clear that prevention of illness/death is not the only priority: ontario.ca/page/ethical-f…

1/8
These multiple and divergent priorities (reduce illness/death vs. promote economic/social wellbeing) aren't clearly ranked.

e.g., 1.5 million essential workers have similar priority to 3.5 million older adults (who account for 96% of COVID19 deaths): files.ontario.ca/moh-covid-19-v…

2/8
This leads to frustration, anger and fear for older adults who are at highest risk of death and see other vaccination programs like the UK's focus on age and have the singular goal of "prevention of mortality and supporting the [healthcare system]": gov.uk/government/pub…

3/8
Using age to determine vaccine priority (like the U.K.) respects the KISS principle (e.g. "systems should be as simple as possible") and has been used by other countries like Israel to vaccinate as fast as possible to reduce morbidity and mortality: covid19-sciencetable.ca/sciencebrief/l…

4/8
A simple framework also ensures that those who have the hardest time getting vaccinated aren't unintentionally deprioritized—when there are multiple groups within one priority category, the easiest to vaccinate will go first (e.g. those without mobility & cognitive issues).

5/8
Prioritizing vaccine distribution based on age clearly prevents the most #COVID19 deaths, which I think should be the #1 goal.

Importantly, an age-based approach will require explicit attention to promoting health equity to further reduce mortality: jamanetwork.com/journals/jama/…

6/8
This weekend #Ontario announced that adults ≥80 will be among the next priority groups for vaccines: cbc.ca/news/canada/to…

This is welcome news, but there is remaining uncertainty for other older adults, including those aged 70-79 (18.7% of all Ontario #COVID19 deaths).

7/8
I think most people appreciate that vaccine supply is limited—the current frustration is caused by the multiple unranked priorities of #Ontario's vaccine program, meaning that those at highest risk of #COVID19 death will not always be first in line to receive the vaccine.

8/8

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More from @NathanStall

12 Feb
#Ontario is trying to deploy 385,000 rapid antigen tests per week in #LTC homes for asymptomatic #COVID19 screening: news.ontario.ca/en/release/603…

This is a bad idea for several reasons—not only is this infeasible, but it will be practically impossible for most homes to complete.

1/9
Currently asymptomatic staff undergo weekly PCR testing, much of which is completed on-site at #LTC homes and testing is staggered throughout the week.

Essential family caregivers complete PCR testing off-site at assessment centres or pharmacies (some are done at homes).

2/9
A shifts towards rapid antigen testing will require testing 2-3x/week (in Yellow/Orange/Red/Grey high prevalence zones) or 1x/week (in Green zones): health.gov.on.ca/en/pro/program…

The high frequency of testing compensates for the test's poor sensitivity: bmj.com/content/372/bm…

3/9
Read 9 tweets
18 Nov 20
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
Read 8 tweets
16 Nov 20
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 20
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 20
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 20
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

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