Good morning, all. Before going in this AM, wanted to share some high-level thoughts re: #SK situation with #COVID19. Will try to go into more detail as time allows, but these are some immediate thoughts. My opinion only, please remember. 🧵 begins... (1/n) #COVID19SK
#YQR curve and R0 seem for now to have peaked and are coming down. Hospitalizations & ICU admissions have stabilized. #YQR ICUs still running with ~180% capacity but more beds available now, critical elective surgeries proceeding, etc. (2/n) #COVID19SK
Still widespread community transmission throughout southern SK but has seemed to mostly peak at this point and some places like Moose Jaw are decreasing steadily too. (3/n) #COVID19SK
Opposite dynamic in #YXE & NW SK, where cases & R0 are steadily increasing, along with proportion of cases caused by VoCs. #YXE in similar "pre-surge" state as #YQR around early-to-mid March, for perspective. #YQR just now flattening & decreasing, ~6-7 wks later. (4/n) #COVID19SK
All data & evidence points to significant surge in #YXE, perhaps attenuated to some degree by the fact that more of population has received 1st dose vaccine as of May 1 compared to #YQR as of early/mid March. Surges expected across rest of #SK including NW, etc. (5/n) #COVID19SK
Based on #YQR peak, expect #YXE surge to peak next 4-6 weeks, then hopefully flatten again. Other regions yet unaffected will follow suit but timelines may be slightly different to when surge begins. (6/n) #COVID19SK
Mandated restrictions & measures from mid-March in #YQR, though modest, helped in terms of flattening curve in the city. Similar mandated measures in #YXE instituted immediately would help attenuate anticipated curve & save lives & prevent suffering in the city. (7/n) #COVID19SK
Some key points IMO.

#SK is right in midst of 3rd wave, but most useful to consider different parts of the province separately instead of province as whole. Different parts of province are in different stages of pandemic curve.

(8/n) #COVID19SK
When looking at data & numbers, focus your attention on what is happening in different parts of the province rather than overall numbers if you want to interpret the data in the most accurate way possible.

(9/n) #COVID19SK
Secondly, b/c #YQR seems to have peaked & #YXE is about to surge, the fact that our two major cities are experiencing surge at different time points means it is less likely our overall provincial critical care capacity will be completely overrun.

(10/n) #COVID19SK
If both #YQR & #YXR had surged at the same time, we would have been in huge trouble, similar to #ON. But likely b/c of our population density being way less than #ON along with measures to reduce spread of VoCs in #SK from #YQR, we have "spread the surges" out.

(11/n) #COVID19SK
It is still 100% critical to follow public health guidance, vaccinate ASAP, and make best decisions every day. The limited mandated restrictions mean our #SK curves will come down more slowly than if more aggressive measures were in place, unfortunately.

(12/n) #COVID19SK
That said, I am cautiously optimistic that the very worst is over in #YQR. Other parts of #SK will feel similar pain, peak, and then it will end again. When complete, the 2nd & 3rd waves in #SK will have taken many #SK lives unnecessarily. It has been tragic.

(end) #COVID19SK

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More from @awong37

17 Apr
My colleagues Lori & Jeff explain the SUPER BAD situation in #YQR ICUs. 2 COVID+ pts / room to maximize nursing & RTs. All ICU beds full in #YQR, city now on ICU/CCU bypass (including cardiac pts). Staff @ breaking point.😢 (1/4) #COVID19SK

cbc.ca/news/canada/sa…
I have tried to maintain equipoise but feel I need to say this again: we CANNOT vaccinate our way out of this without losing many lives & overwhelming our ICUs, forcing triage. We NEED definitive & immediate mandated measures to help bend our #SK curve quickly. (2/4) #COVID19SK
We are vaccinating 'easy' folks quickly in #SK. Soon, we will hit road blocks: persons who need improved access & hesitant persons who will need their concerns addressed / questions answered. Nobody can be left behind if we are going to achieve herd protection. (3/4) #COVID19SK
Read 4 tweets
9 Apr
Hi everyone. I thought I would try to explain what all these 'variants' of COVID-19 are, and are they really that bad? I feel this has relevance to #SK & Canada because we are seeing growth of all three key VoCs at once. Start w/ graphic below. (1/n) #COVID19SK
All viruses mutate (change) over time. Most of these mutations are meaningless, but sometimes the virus changes in ways that allow it infect cells or reproduce itself more effectively. This confers a "fitness advantage", and over time more "fit" viruses become dominant. (2/n)
When certain mutations confer advantages such that the virus can grow and spread within populations & infect people more quickly and/or make people sicker, these are termed "variants of concern". Several are well-described now. We'll focus on the 3 relevant in Canada. (3/n)
Read 14 tweets
8 Apr
We don't think guidance around AZ vaccine will change soon, if at all. Evidence is mounting to suggest association b/w AZ vaccine & VIPIT is real. VIPIT occurs mostly in younger persons. It is rare but often fatal - it can't be ignored. (1/n) #covid19sk

leaderpost.com/news/saskatche…
The risk-benefit calculation of administering AZ vaccine still strongly favors its use in older persons, because such persons are far more likely to die from COVID-19 infection. We need to administer it as much as possible in populations who remain eligible. (2/n)
Even with VoCs circulating which are more dangerous, the risk-benefit calculation of AZ vaccine in younger persons remains unclear. This is not a decision that Trudeau or Dr. Tam have the jurisdiction or expertise to make on their own. (3/n)
Read 6 tweets
5 Apr
Hi everyone. Coming off 2 weeks of call tomorrow AM. So sorry to be #debbiedowner but holy cats, #YQR hospitals are full of #COVID19 patients either intubated or requiring high-flow O2. Frontline providers are worried, anxious, and scared. (1/n) #COVID19SK
Hypothetically, if 1/3rd of current ward patients in #YQR requiring high-flow O2 deteriorate tomorrow AM and need ICU support, there would not be an obvious place for them to go. ICU beds in #YQR, including surge as of today, would be completely full. Yikes. (2/n)
One challenge we face with these critically ill #COVID19 patients is that they are so sick for so long, there's just no turnover of ICU beds where people improve and can be moved to the wards quickly to make room for new patients. (3/n)
Read 7 tweets

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