Thread by @Lidsville

I'm going to live-tweet tonight's panel, "Charting the Strategic Path Out of COVID-19: A Public Panel Discussion," sponsored by @SFU_Science & moderated by @a_longhurst. It seems to be sold out but I believe the video will be available later. #covid19BC eventbrite.ca/e/charting-the…

The hashtags for tonight's panel will be
#COVID19BC
#CovidZeroBC
and #COVIDisAirborne, #bcpoli and #cdnpoli where applicable.
"Charting the Strategic Path Out of COVID-19: A Public Panel Discussion"
eventbrite.ca/e/charting-the…

One of the topics tonight will be an "elimination" strategy to #Covid19 which is aggressive suppression of transmission (#CovidZero) like NZ. This isn't eradication but strong policy. Vs the mitigation approach we see in BC/Canada. #COVID19BC
#CovidZeroBC

Then there's the "Canadian Shield" approach devised by a number of experts - broadly similar to elimination approach, but some have asked if it gives all the benefits of elimination. #COVID19BC
#CovidZeroBC
#cdnpoli

Acc to a Lancet review, elimination countries perform better on economics and civil liberties - slides: #COVID19BC
#CovidZeroBC

Intros - going too fast to cover but again, check the panel info. eventbrite.ca/e/charting-the…

First speaker is Dr. Carolyn Colijn, Canada 150 chair in Math, SFU. The next few months are critical. Finally we have a shiny new tool in the toolkit (vaccines). We haven't been using prior tools (rapid testing) but now we have vaccines to reduce transmission...

Carolyn Colijn: So far, with our mitigation strategy in BC, our only real tools have been social distancing.

Mathematical modelling is helpful because we can't afford to wait for data...

Carolyn Colijn: the bad news is that vaccines are not a silver bullet - we can't entirely return to normal even once everyone eligible has had their first shot. Modelling will help us to determine what we can safely do...

Dr. Amy Tan: @AmyTanMD Has worked as a physician in both AB and BC during the pandemic. West of Quebec we had the most warnings signs for the 3rd wave (looking at Europe). There was covid fatigue but the virus doesn't get fatigued & with increasingly transmissable variants...

Dr Tan: even with less contact we are still seeing a lot of transmission. When we talk about ICU capacity, it's not just bed and ventilator, it's specifically skilled staff req'd to fulfill a variety of functions - that is the concern re: rapid increase in ICU admissions

Dr. Tan: when ICUs are overstretched it affects all conditions, not just #covid19BC. We are lucky that we have very dedicated health workers in many diff roles, but w/ outbreaks there are no backups. We are now seeing this in Ontario. "I'm concerned BC isn't far behind" #bcpoli

Now restauranteur Nick Diamond: talking about the difficulty of dealing with patrons not abiding by #covid19BC rules. Describing one night where they decided they didn't want to fight with the public so they closed the restaurant, Saturday night & the weekend...

Nick Diamond - talking about the alleviation of stress to just shut down. He waited a day, made a comment on his personal FB page which was popular, got picked up by media & went viral. Gave him insight into the anti-mask camp...He won a lot of support but found it overwhelming..

Dr. Lisa Barrett in N.S. @LisaBarrettID, infectious disease doctor, talking about a powerful relationship between govt and non-gov bodies and the community. She says no one's calling it an elimination strategy but it resembles that. "Why wouldn't you try to eliminate it?"..

Dr. Barrett also works on another disease where the goal is elimination. Talking about how quickly they shut down in NS when they experienced even a small wave, but were able to open up to cultural activity. People were going to restaurants.. but they still kept Atlantic bubble

With the Atlantic bubble they have a strict 14-day quarantine. People were able to have a 10 person bubble safely thanks to the elimination-like strategy. But then variants appeared. if you don't test when cases are low, you don't know what's entering province, you don't know..

So NS used both rapid testing and PCR testing on asymptomatic people. "negative for the night" was a big slogan. They didn't use health resources for rapid tests - could use volunteers and didn't need a lab. There are risks if you make people overconfident but it was OK

They opened up, but then went to a double digit day, workers reentering the province. And within a few days the govt just shut things down again. Very proactive. Went up to 90 cases, then back down to 70, and they're in a circuit breaker. Schools had a lot of the cases.

Dr. Barrett: we've had businesses shut down voluntarily including Irish bars on St Patrick's day. They just said "we know what's going to happen here." We're now testing 20,000 people daily, including volunteers doing rapid tests, for several days now.

Dr. Barrett - noting the testing is finding #COVID19 in "incredibly asymptomatic people." "Our neighbours will really go down by next week. /

Dr. Kelley Lee: @profplum8. Despite claims by WHO and parts of our govt, travel is a major source of onward transmission. #Covid19BC #Bcpoli @adriandix Border mgmt, tight travel restrictions and phsyical distancing are critical...

Dr. Kelley Lee: @profplum8 Canada keeps claiming it has tight travel/border restrictions but we all know that's not true. What would a gold standard look like? Policy makers like to dismiss travel/border restrictions, slam them as oppressive, but that's not what it is..

Dr. Kelley Lee: @profplum8: think of it as not "closed" borders but proper border mgmt. It doesn't slam a door.

And we need to plug the gaps, close the loopholes, implement a system with fewer exemptions. Countries where ALL travellers, type, port, reason are monitored...

.. those countries are the ones that have been successful with #Covid19. We are not doing this. Quarantine is so important. We only have 3 day quarantine and for air travel only. We've never discussed the wristband method other countries use...

Keeping variants out of the country falls squarely on the fed govt. But some responsibility falls on the provinces. We know people are testing pos after coming in. We don't have enough data on this but we know we need prov measures too, incl intra prov travel..

Dr. Kelley Lee: @profplum8: BC is putting a few measures in but there are too many holes, gaps esp. interprovincial. What keeps her awake at night is how the feds have dropped the ball on border management. #covid19BC #cdnpoli

Now David Alston, N.B., and how the business community has responded there and buy-in with public measures. The Atlantic provs share a lot but their approaches differ slightly. Speaking as a business owner on what it's been like...

David Alston: our population is smaller than most provs. We are 1 degree of separation here in New Brunswick. A very connected society creates a sense of neighbourly concern. It's Canadian too but it's heightened here. If you act in a me-first way you stand out like sore thumb..

David Alston: So perhaps we are more compliant when province asks us to do something. We locked down after our early March break, with only a few cases, and stayed that way for a long time. We reached #covidzero for 3 weeks straight but stayed in lockdown! #covidzerobc

This was an experiment; no other province had done this. Then David Alston and a colleague decided to draft a safe business reopening plan, not criticizing but collaborative with govt. Govt then came out with similar plan, took their time... They have 4 phases in NB

Yellow, orange, red and black (lockdown). Everyone knows what number of cases etc kicks measures into a more restrictive phase. They have 7 health zones in NB and they can be in different phases. Green is back to normal.

David Alston: "I haven't seen a single person not wearing a mask inside. 100% compliance." There were excuses before it became law - but after the law, 100% compliance. Whether you're business owner or not, you want to comply. Alston has a tourism business...

David Alston: found a way to make tourism work despite strong border measures/mgmt. Not many businesses closed; they found a way to make it work (local focus)

David Alston: when northern region, Edmonston went into red zone, but they figured it out it was the city only and they created a new zone. No one crosses the line between zones when they are in different phases from each other. Just essential workers and truck drivers.

David Alston: you can't cross over to go to your summer home. Strict provincial quarantine rules. Way higher level of restrictions than we have in BC. Zone method seems great. We could do some of this in BC - but we're not. Fascinating! /

Recap of all the presentations - lots of focus on border management. Now we go to a conversation among the panelists. Dr. Lee asking David Alston: what do you say to people in BC who say "But we're not like the Atlantic provs, we're exceptional." What would you say to that?

Dr. Lisa Barrett answers: "if I had a dime for every time someone says the Atlantic provs are different" blah blah blah. Water on one side, the culture... She reminds people that you just have to find the unit of community then give clear direction and engage them.

Lisa Barrett (NS) isn't feeling that it's people are just intrinsically compliant and considerate; she feels govt engaged them better. You have to find the right size of community unit to engage with. (I love this point) #CovidZeroBc #Covid19BC

Now David from NB is talking to Nick from Nelson BC and talking about how Nelson might handle it. In NB they have so much local data about where the cases are, they can really engage - it makes them feel more engaged and clear where the risks are

David from NB describing the high level of engagement - he's saying BC should have 30 zones not so few - each zone can work as a team, alongside other teams.. #Covid19BC

Dr. Lee: any travel is a risk. We should start with outer defensive walls, stop people carrying variants in or detect it and safely quarantine them. Then we move down to prov and local levels and stop smaller travel. Until you secure perimeter and get virus within down...

.. then you can think about opening up a bit more. But we have to tink about travel as a whole. So why did we target India not Brazil? Not sure but we can't just look at hotspots because people get here indirectly and so do the variants. Quarantine all - solves the problem.

Carolyn Colijn: now we're immunizing large populations, the virus will be seeing selection in favour of vaccine escape. Maybe escapes won't make ppl v. sick but we don't know that. But one thing that distinguishes mitigation from elimination is the precautionary principle...

That's a pretty stark point. Mitigation strategies are not following the precautionary principle. Colijn: So, what should the approach be to the next stage of this virus, taking vaccines into account. Should we have a national strategy? Should we be ramping up the borders now?

Andy is asking Dr. Colijn to talk about vaccine escape (virus mutating to escape vaccine). We know vaccines are wonderful, great, but we know that their efficacy is not 100% & some people can get sick anyway. These are called breakthrough infections & they can infect others...

A virus in a breakthrough infection can start to mutate. If we reopen, that virus is in a vaccinated individual who doesn't feel sick, and that person goes to work, party, store and spreads that escape mutation. And we barely test so we don't know...

Colijn: are we then bak to where we are today? Pfizer and Moderna etc may be able to update vaccines then, but then we have to redeploy the entire process of the last year all over again. Without more suppression than just vaccines, we could be in this over and over...

I think the thread got broken here - let's hope this mends it:

https://twitter.com/Lidsville/status/1387968740944269312?s=20