Some highlights of Ontario's #COVID19 rollout:

1. Centralized online and telephone booking to start in mid-March.

2. Mass vaccine clinics & community centers will be a major focus for vaccinations.

3. Pharmacies will administer 10-20% of vaccines, and scale up further.
4. Each Public Health Unit expected to vaccinate a minimum of 10K people per day.

5. Larger Public Health Units will vaccinate significantly more. E.g. Toronto expected to vaccinate 400K per week when things get rolling, through 9 mass vaccine sites.
6. Details of the prioritization within Phase 2 (e.g. underlying medical conditions, etc) will come out shortly.

The task force has submitted their recommendations to Cabinet. This will be publicly released asap when approved.
7. (my editorialization): We need an all hands on deck approach...families, community-based organizations, caregivers, etc. will need to identify and support community-dwelling elderly to 1) sign up for vaccines, 2) mobilize to vaccine centers closest to them.
8. Also mentioned today - area codes disproportionately impacted by #COVID19 (e.g. racialized & low income neighbourhoods) will have strategically located mass vaccine centers, mobile vaccine centers, community centers, different (lower) age cutoffs for vaccination.
9. Primary care is actively involved. They will be administering vaccination in mass clinics for now.

When more stable vaccines available (AZ, J+J, etc) they will be able to vaccinate in their clinics.
10: *Approximate* timelines as per General Hillier today:

*Mid March: 80+ years
*April 15: 75+
*May 1st: 70+
*June 1st: 65+
*July: 60+

*see #8 above -> age cutoffs may be lower in several regions more heavily impacted.
*Access to more vaccines = earlier timelines.

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More from @BogochIsaac

17 Feb
1/ @nature asked over 100 scientists if they felt that #COVID19 was going to become endemic & circulate on earth for years to come. ~90% felt this was a likely or very likely scenario.

2/ Why will #COVID19 be around for a while? A few reasons....

*It is very contagious
*Mild-to-no symptoms in many (harder to identify cases)
*Significant pre-symptomatic transmission
*Non-animal reservoirs of the virus
*People can get re-infected

...more below...
3/ cont....

*Vaccines reduce the risk of infection but do not prevent infection all the time

*Vaccines may reduce risk of transmission but likely not all the time

*Slow/inequitable global vaccine rollout

*I'm sure there are many other reasons...

Read 8 tweets
11 Feb
1/ Tocilizumab appears to reduce the risk of death in those hospitalized with severe #COVID19 infection, with results from the RECOVERY trial available today.

This is an anti-inflammatory/immunosuppressive medication, used in rheumatic diseases.


2022 patients were randomized to receive tocilizumab; 2094 to receive standard care. 80% of the participants were using dexamethasone.

596 (29%) in the tocilizumab group died within 28 days VS 694 (33%) in the usual care group.

"Tocilizumab also increased the probability of discharge alive within 28 days from 47% to 54% (rate ratio 1.23, [95% CI 1.12 to 1.34], p<0.0001)."

"This means that for every 25 patients treated with tocilizumab, one additional life would be saved."
Read 6 tweets
31 Jan
1/ Many are talking about gradually lifting public health measures as #COVID19 cases are dropping in Canadian settings.

What is needed to avoid undoing our collective efforts & sacrifices as we reopen? And how do we account for more transmissible variants (eg B.1.1.7)? 👇👇👇
2/ We often hear people say that because of the more transmissible variants we need to "double down" on control efforts & vaccinate.

What exactly does doubling down mean?

It most likely means keeping R at (or preferably below) 0.8 to account for greater transmissibility.
Maintaining R at/below 0.8 would likely allow for a continued decline in cases as we see more B.1.1.7 circulate.

So what questions do we need to address to gradually & safely reopen in the context of community #COVID19 transmission & growing burden of B.1.1.7?

A few Q's👇
Read 11 tweets
30 Jan
1/ What is the #COVID19 situation like in Canada now?

Cases are down & the situation is improving in much of the country, but we still have a long way to go.

A few additional thoughts below...
2/ Most of the country has recovered from peaks in December or from a post-Christmas peak.

A few examples below Nationally & in AB, ON, QC.

Despite outbreaks in Eastern Provinces, cases still remain low there.

3/ Long Term Care - a significant black eye for Canada, is also improving. We failed to protect our most vulnerable (twice!), but cases are rapidly declining, perhaps mirroring reduced community transmission, widespread vaccination, or both.

Read 13 tweets
29 Jan
1/ Johnson & Johnson #COVID19 vaccine results are out.

As per press release, preventing both moderate & severe illness 28 days after vaccination:

-66% Overall
-72% USA
-66% Latin America
-57% in South Africa
2/ Important point:

"85% effective overall in preventing severe disease & demonstrated complete protection against #COVID19 related hospitalization and death as of Day 28"

If this can keep people from getting very sick/prevent hospitalization/death then this is an obvious win.
3/ This is a single dose vaccine, requires conventional refrigeration for storage & would be much easier to administer to populations.

Canada has access to this vaccine.
Read 4 tweets
29 Jan
The Novavax vaccine has excellent efficacy (~90%) against symptomatic #COVID19, where ~50% of cases were from the variant discovered in the UK (B117).

But it only had ~60% efficacy in the variant discovered in South Africa (B1351).

A good explanation👇
60% efficacy against B1351 is decent, but not amazing.
Important to point out that the numbers are still very small in this trial & this could change with more data. Also if the vaccine prevents severe #COVID19 disease (which it likely does), it would still be extremely helpful.
Just to clarify, in the South Africa study, efficacy is ~60% in those who were HIV negative, ~50% in entire trial including HIV+ individuals.

Still, no severe disease seen in #COVID19 cases confirmed to have B1351 (variant discovered from South Africa) in those vaccinated.
Read 4 tweets

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