Testing positive for COVID, even after full vaccination, is not unique to the delta variant. We saw this in the third wave as well with B117. Oftentimes it was in the context of an outbreak investigation. 1/
Fully vaccinated people who tested positive for COVID were overwhelmingly mild cases or completely asymptomatic. 2/
I am seeing the term "breakthrough infection" being used in context of delta variant a lot lately. People testing positive as part of outbreaks (even if fully vaccinated) is not necessarily a bad thing 3/
Two things to consider: oftentimes these individuals are picked up as part of a larger outbreak investigation. If they weren't working or living in a high risk setting, they'd have minimal (or no) symptoms, not get tested, not be a risk to anyone, and be none the wiser 4/
Secondly, the key is to look at the clinical picture. Are the people with full (or partial) vaccination getting sick enough to be hospitalized, or just mild symptoms like a fever/sore throat? The majority of "breakthroughs" are in the mild category 5/
That said, there are (and will be) people with partial and full vaccination who will get sick with COVID and require hospitalization. Certainly this needs to be monitored. Thankfully this has not been a huge issue. 6/
I propose some further precision on breakthrough infections by coining the phrase "Breakthrough infection of concern" (BIOC). In other words, people fully vaccinated or >2w post 1st vaccine dose, who are getting sick enough with COVID to be hospitalized 7/
With delta, we do know there are more BIOCs with people having only received 1 dose, but numbers are still absolutely small. The answer is still vaccinating. 8/8

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More from @TorontoIDDoc

2 Jun
Agree with Mayor Brown. Where the delta variant will affect people is no mystery, as it will be the same areas that were affected with B.1.1.7.

Important to note that one dose of vaccine still offers significant protection--this 33% figure does not tell the whole story. 1/
There will undoubtedly be more cases because of the delta, but let's remember we are in an entirely different situation compared to even 3 months ago. One vaccine dose still provides protection. A 4th wave will look much less severe most notably because... 2/
...hospitalizations will be significantly less. I sound like a broken record on this, but the objective of restricting the community is to prevent overwhelming of hospitals. With hospitalizations being markedly reduced with vaccination.... 3/
Read 6 tweets
14 Apr
Anecdotal observations from COVID in hosp:
1. Notable absence of LTC admissions (vaccines work!)
2. Not many community dwelling people >70y (vaccines work!)
3. No doubt that average age is younger
4. Younger people are almost all essential workers or their family members.
5. Younger people admitted have a history of not just exposure but heavy, prolonged exposure.
6. Obesity and/or metabolic syndrome are common themes (including in younger pop'n)
7. A few older people with 1 dose vaccine. Most within 2w. Over 2w, seem not to be as sick
8. Younger individuals do turn around faster, and less needing ICU
9. But those who need ICU are often there for a long time.
10. All have indoor exposure
11. Yet to see someone who went to HomeSense....
Read 4 tweets
28 Feb
With respect to COVID, many of us have been on about hospitalizations and death, and how the vaccines relate. This is very important because it takes us back to why we are doing all of this in the first place THREAD: 1/
At the present time, SARSCOV2 is spreading in a pandemic fashion all over the world. It's a respiratory virus, but that has significant differences than others (e.g. influenza etc.) my goal here is not to dwell on these differences 2/
As we saw in Northern Italy and NYC, the big problem with COVID and unchecked community spread, is that you get a massive expansion of cases and from those, a large number of hospitalizations all at the same time. 3/
Read 21 tweets
24 Feb
There was a lot of concern over a video of a lineup at HomeSense last weekend. Truth be told, I think the risk of people lining up in a large building for a fleeting time with masks, is not risk-free, but it's low risk. @zchagla @BogochIsaac @DocDominik @MikeHaddadMD 1/
These "viral" videos are obviously visible and garner a reaction, but take attention away from the much higher risk and (much) less visible high risk settings where COVID is spreading (i.e. the essential workplace - household transmission chain). 2/
We should continue to focus efforts on risk mitigation, and not forget the tried and true infection prevention principles which work whether high or low risk setting...whether variant or not. 3/
Read 4 tweets
10 Jan
I've been wanting to write this thread for a while. It has been inspired by hearing a common thought: why can't people just "listen"? If people just followed the rules, we wouldn't be in this mess. I think this is oversimplification of the problem with COVID: 1/
It is true, there are people who haven't been following guidelines (by definition that happened a LOT at Christmas/NYE in my region), but even before, we know transmission in private gatherings happens. 2/
These private gatherings are pictured to be big raucous parties, but in reality, even before lockdown, this is just people having dinner, watching TV, doing things we did before on a daily basis. These little ripples when added across the country make a big wave.. 3/
Read 20 tweets
15 Nov 20
The South Asian community I am part of has a number of overlapping risk factors that increases the risk of both acquisition of COVID and also at risk for having a more severe outcome 1/
First many work in ESSENTIAL, public-facing jobs (including in health care) as well as crowded workplaces where it is difficult to physically distance (e.g. factories, food processing plants etc.) 2/
We are more likely to live in a multigenerational home (especially in the hotspots across Canada and the world), with an average of 6-8 people. This is a prime situation for amplification of a single infection brought in to the household. 3/
Read 10 tweets

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