A few points to clarify vaccine distribution in Ontario.

1. We get ~400K doses of Pfizer weekly. It shows up like clockwork. It gets distributed throughout the province in ~1-2 days & there is very little at the end of the week. This is administered at mass vaccine clinics.
2. We get several hundred thousand doses of Moderna every 2 weeks. Also rapidly shipped to locations in the province. For various reasons, Moderna shipments are occasionally delayed. There is very little Moderna in freezers at the end of the 2 weeks.
3. We have infrequent large boluses of AstraZeneca. This is administered by primary care in 6 Public Health Units, and by ~1400 pharmacies throughout the province.

It is available to anyone 55 years of age and older.
4. On the day of vaccines delivery, for a brief period of time there are a lot of vaccines. Kind of makes sense.

Throughout the week they are quickly administered.

It looks like most of the provinces are comparable in terms of their ratio of delivered:administered @jm_mcgrath
5. So what is the deal with so many "in the freezer"?

Well at the beginning of the week there is plenty of Pfizer/Moderna but that quickly get administered. We then wait for the next shipment.

There is ~2 day supply for wiggle room if there are supply chain issues.

6. What's left in the freezer?


A lot of it.

It's not exactly flying off the shelves for the 55+ crowd unfortunately.
7. Even with ~1400 pharmacies & PHUs administering AstraZeneca, it moves SLOWLY in many areas.

Expanding primary care's role and outreach would help, but perhaps may not solve this issue.

See below:

8. It's pretty clear why the uptake of AZ is slow. There have been some preventable & perhaps less preventable communication (& policy?) issues at various levels.

@picardonhealth has a great article today that is relevant here:

9. We could probably administer significantly more AstraZenca vaccine through some combination of:

1) transparent & effective communication
2) lowering age cutoff below 55
3) expanding role of primary care
4) other/etc.
10. There are several of areas for improvement on the vaccine rollout , like improving access in high-burden neighbourhoods, sorting out confusing sign-up systems, communicating ever-changing guidance, lowering barriers, etc.

BUT having said all that...👇
11. Ontario is administering >100000 vaccines on most days.

While I am grateful for the increased supply of Pfizer & Moderna (this really kicked in on March 22nd), we truly don't have enough to vaccinate everyone is Phase 2 now, and still have to triage.
12. But we are making significant headway.

A few examples of lowering barriers in communities most in need:

1. bit.ly/32fzwRR
2. bit.ly/3mMSyIG
3. bit.ly/3dZyMWk

There are more examples & this will expand with growing supply.
13. I appreciate how this particular topic of distribution & freezers can get politicized & can be rather polarizing.

I really try my best to avoid all that & get to the actual issues at hand.

I hope this clarifies a few points.
14. There are obvious areas for improvement on the vaccine rollout (see above), but somethings are still going rather well.

We have to quickly address the issues & continue to work toward a rapid & equitable #COVID19 vaccination program.
Last point: Reading through some of the comments - I wouldn't attribute hesitancy as the sole contributor to slow AstraZeneca rollout, but it cannot be ignored either.
Really the last point:

To sum up...

Burn rate for Pfizer: Fast
Burn rate for Moderna: Fast
Burn rate for AstraZenca: Slower (for various reasons)

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More from @BogochIsaac

11 Apr
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.
Read 7 tweets
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

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