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.

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More from @BogochIsaac

7 Apr
ANYBODY in Ontario who lives in a high burden neighbourhood who is 18 years and older will be eligible for #COVID19 vaccination.

This will help essential workers, families, communities, etc.

A very smart move.
Mobile teams to help bring the vaccine to the people. This will happen in workplaces, congregate settings, dense urban areas, etc.

1. More access to vaccine.
2. Lower barriers to vaccination.
This is the part of the Phase 2 Vaccine roll out that prioritizes communities at greater risk.

Link: bit.ly/2R5Ffaj
Read 7 tweets
6 Apr
1/ Ontario's Phase 2 #COVID19 vaccine rollout prioritizes:

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.
Read 8 tweets
24 Feb
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.
Read 7 tweets
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.

Link: go.nature.com/3aquiaw
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

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