One population I fear is being overlooked (yet again) during #Ontario's 3rd wave is community-dwelling older adults.

There is no doubt that the new variants of concern make #COVID19 a different disease, with increased risk for younger populations: covid19-sciencetable.ca/sciencebrief/c…

1/8
With this changing disease come more tragedies of younger adults—especially essential workers—being hospitalized and dying from #COVID19.

These stories must be told and Ontario must enact supports like paid sick leave.

But sometimes missing are the stories of older adults.

2/8
In #Ontario, 21.1% of people 60+ and 77.2% of people 80+ have received at least 1 dose of a #CovidVaccine: publichealthontario.ca/-/media/docume…

Yet in the last 14 days, older adults still accounted for 76/85 (89%) of deaths and 715/1171 (61%) of hospitalizations: publichealthontario.ca/en/data-and-an…

3/8
Why are we not hearing many stories about older adults during the third wave?

Perhaps it's because they are no longer dying en masse in #LTC homes.

But it also likely reflects our "identifiable lives bias"—we respond more to lives we identify with: jamanetwork.com/journals/jama/…

4/8
I am in no way minimizing the illness and death of younger people—especially essential workers and those living in #COVID19 hotspots.

I am making the point that we also need to remain focused on older adults who are also disproportionately impacted by the #COVID19 pandemic.

5/8
As #Ontario appropriately adapts its vaccination strategy to better protect essential workers, it must also adapt to better protect older adults.

This includes mobile on-site vaccination of NORCs (covid19-sciencetable.ca/sciencebrief/m…) and homebound older adults: covid19-sciencetable.ca/sciencebrief/m…

6/8
We also need to shorten the vaccine second dose interval for the very oldest, who have less response to 1 dose: medrxiv.org/content/10.110…

#Ontario only shortened the interval for (younger) immunocompromised people, once again overlooking older adults: toronto.citynews.ca/2021/03/29/ont…

7/8
During the #COVID19 pandemic, we have often neglected and abandoned our older adult population:
cbc.ca/radio/ideas/fe…

As the 3rd wave intensifies in #Ontario, we most focus on supporting and protecting all vulnerable populations, including the oldest members of society.

8/8

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More from @NathanStall

8 Apr
ICMYI—Dr. @iPreetBrar on why the Canada Recovery Sickness Benefit (CRSB) is NOT paid sick leave: thestar.com/opinion/contri…

#CRSB is limited to those workers who miss at least 50% of their work week because they are unwell or isolating from #COVID19: canada.ca/en/revenue-age…

1/5
This means that #CRSB doesn't cover shorter absences, thereby excluding:

-Worker time off to get tested or vaccinated

-Workers who stay home due to symptoms or exposure, subsequently test negative for #COVID19, and are cleared for return to work within <50% of a work week.

2/5
#CRSB is limited to a 1-week period, is not renewable and can only be used 4 times/year.

This may not be enough for workers in high exposure occupations.

These limitations may discourage testing and isolation of workers, thereby hindering mitigation of workplace outbreaks.

3/5
Read 5 tweets
16 Feb
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
Read 8 tweets
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

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