1/ Eventually we will see a decoupling of new #COVID19 cases from hospitalizations as population-level immunity grows (through vaccination & recovery from natural infection), especially among those at greatest risk for more severe infections.
2/ But with variants of concern driving more explosive outbreaks, causing more significant symptoms & impacting younger people, this decoupling of new cases from hospitalization will require more widespread population-level immunity.
3/ No fear mongering or 'sky-is-falling' rhetoric here, but a 4th wave is certainly possible if we rapidly & prematurely re-open as we exit wave 3, especially if we don't have a significant degree of population-level immunity at that time.
4/ This infection rips through non-immune populations like shit through a goose, especially when there are no/few measures to control transmission.
The impact of any potential 4th wave on our healthcare system will depend on who is vaccinated & how widespread vaccination is.
5/ Want to end this 3rd wave & avoid a potential 4th wave? Need equitable & rapid vaccination based on risk of severe outcomes & risk of getting infected (e.g. essential workers/high burden neighbourhoods) coupled with sound public health policy to get us through spring.
Addendum: so people haven't heard that goose expression? Must be a Western Canadian thing.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
1. Those at risk of having a severe outcome from infection (e.g. age, medical comorbidity).
2. Those at risk of getting infected (e.g. essential workers, shelters).
3. Communities disproportionately impacted.
2/ That is a lot of people in Phase 2. While vaccines are pouring into the country & the province, it is still not enough to flip a switch and prioritize everyone at once in this Phase.
Still, it has started and will gear up substantially given the recent large shipment.
3/ I am hesitant to put in the slide with the tentative dates of each part of Phase 2, as there is an important caveat at the bottom that often gets missed:
"All timelines subject to supply availability"
We now have more availability so this will be moving faster.
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.
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
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.
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.
3/
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?