Thread by @ZiadFazel

COVID19AB Balanced Scorecard
Wed 22 Sep

Publishing my 3 main graphs right away, then I will add analysis on each metric, going down the card, bit at a time.

Yellow highlights on scorecard = idea stolen from @jvipondmd: today's cases x case rate from

covid-tracker.chi-csm.ca

Just finished watching @PopAlberta special on:
• protecting children too young to vaccinate
• learning that the risk in schools SEEMS to be scientific: #COVIDisAirborne but is ACTUALLY political
• Learn how to address this at home, school & your MLAs.

@PopAlberta R

Some people were surprised last night to hear Premier Kenney say R in Calgary & Edmonton was below 1.0.

True per GoA stats, but no thanks to Premier Health Minister, CMOH or SAG.

#yyccc & #yegcc enacted Mask Bylaws at the beginning of September.

That's why they have R<1.0

@PopAlberta In fact, when the province enacted their Crochet Chinstrap of a Mask Mandate:
• full of holes
• doesn't cover the risks like schools and places of worship

The cities had to scramble to enable enforcement

globalnews.ca/news/8167070/c…

@PopAlberta Edmonton tried on 30 August to get provincial support for a mask mandate, but the Minister of Health's spokesperson refused, saying vaccination was the only way of fighting Covid-19 they supported.

That arrogance is killing 20 Albertans a day.

cbc.ca/news/canada/ed…

Last November, the province reneged on providing R.

Then they begrudgingly started providing it, but cut to biweekly in June when Endemic blah-blah.

globalnews.ca/news/7489224/a…

So it was amusing to see Premier Kenney cherry-pick R, when he's been dismantling surveillance.

Thankfully, Ontario biostatistician @imgrund picked up Alberta in November to help us out, and Canadians now check his feed *every morning* for his excellent thread.

It's like checking the weather.

My friend @Mrhockey1231 graphs Ryan's work for BC/AB.

https://twitter.com/Mrhockey1231/status/1440671400377733126?s=20

You know after long hot/cold/rainy spell, your local weather analyst reviews that past week with statistics on record temps, or mm of precipitation?

Imagine using that review as your daily weather forecast for the next 2 weeks.

That's AB Health's R.

alberta.ca/covid-19-alber…

Where is Alberta Health's biweekly R useful? Checking if AB Health's intervention was effective, using their own stats.

@ByMatthewBlack graphs:
• Calgary & Edmonton mask bylaws <1.0
• falling
• Rest of Alberta provincial mandate 1.15
• rising

edmonton.ctvnews.ca/infographics-c…

@ByMatthewBlack @GosiaGasperoPhD @DruhFarrell @JyotiGondek @gccarra @ChahalGeorge @doniveson @joececiyyc @Adam_Toy @cbcjanjohnston @nenshi You're thinking "Ziad! 7 tweets on R, you Nerd?"

To which I'd reply "I'm a Mathlete" and ask whether you see the foundation I am subtly building.

#COVID19AB is diverging between cites and small-town/rural. You can see it in stat after stat.

Test Positivity.

Good news: going down overall.

Bad news: City Mouse, I mean, Zone; Country Zone.
• Calgary 7.31%
• Edmonton 8.51%
• Central 16.4%
• North 19.28%
• South 14.15%

Epidemiologists call this heterogenous, I think. I'm not that nerdy.

alberta.ca/stats/covid-19…

Daily New Cases.

Why am I showing you @ucalgaryCHI Test Positivity & Daily Volume Graph for this? Because Daily New Cases depends on Test Volume, and where you Test.

AB is averaging ~15,600 tests/day. In previous waves we were around ~20K tests/day

health-infobase.canada.ca/covid-19/epide…

We interrupt this thread for a brief request for donations. (Not for me).

All of us on @PopAlberta are putting in our time for free, but we do have out of pocket costs to keep our broadcasts accessible, and bilingual.

gofundme.com/f/popab

@PopAlberta Back to the science.

Last night the Premier complained that too many Albertans were waiting until the last minute before they acted on their COVID-19 illness, and were blinding the healthcare systems by not seeking care until they were seriously ill.

alberta.ca/release.cfm?xI…

Whose fault is that?
• Premier, Health Minister, CMOH.

On 28 July, announced cuts that took effect NEXT DAY.
• Even if exposed, can't get tested without symptoms
• Delta often doesn't show symptoms until too late
• No contact tracing
• Wastewater?

alberta.ca/covid-19-testi…

Which brings us to Severe Outcomes.

And a strange "ceiling" on ICU which I noticed on Friday 17 Sep, from the Thursday numbers. And has continued since.

It wasn't an anomaly, so I have removed the exponential curve.

At first I though this was some partial limit to ICU capacity.
• Finally pushed staff as far as possible?
• Equipment? Infrastructure?

Then I saw these two threads from two of my teammates on @PopAlberta. Caring, smart people, straight-shooters, great teachers. Life-savers.

From @GermHunterMD, this observation that surge capacity keeps growing in order to keep the patient count in ICU from all causes below 90%.

Why?

Critical Care Triage Protocol. Which would affect even babies & toddlers in Pediatric ICU.

Nightmare.

https://twitter.com/drsaminaali/status/1440421113947848707?s=20

Before that, this heartfelt thread from @NeejaB about non-ICU Wards.

TBH, I had to chat with her to understand it better, and she generously explained. Read it carefully.

If there is any error in paraphrasing, or drawing inferences, the error is mine.

https://twitter.com/NeejaB/status/1439804286183960576?s=20

She used a term "Optiflow" which I understand partly from being an engineer (not a doctor). Hope this explanation helps.

healthcare.uiowa.edu/ncec/ned/n0067…

It allows an adjustable mix of O2/air, humidified & heated, to be delivered to the patient through the nose.

No intubation.

Some other terms you need to know from Goals of Care (GoC) and Goals of Care Designation Order (GCD).

This is the form itself

albertahealthservices.ca/frm-103547.pdf

But you should really read the whole Advanced Care Planning guide. Bookmark it; print it, read it.

myhealth.alberta.ca/Alberta/Albert…

Why are we talking about this again?

Oh yes, that invisible ceiling in ICU at 90% of surge capacity patients from all causes, Covid, heart attacks & strokes, car accidents...

Dr Bakshi apologized for having a 17-tweet thread...

We still have cases growing exponentially, many coming from lower vax regions, eg Northern Alberta into Edmonton's big hospitals.

And all those ICU-level sick people need to go somewhere. Because the alternatives, Triage & Transport aren't great.

So those ICU-level sick people go to non-ICU, where the teams are not staffed for ICU-level care & COVID-19 unpredictability.

With ICU, we can see the surge capacity added and the overload.

Non-ICU just looks like a pretty flat-topped birthday cake.

alberta.ca/stats/covid-19…

But when you change the view, you can see the non-ICU wards are overloaded worse than in the 2nd or 3rd Wave.

3rd Wave, ICU added that surge capacity, so non-ICU was not impacted so badly.

Even worse than 2nd Wave, when so many of our older Albertans died.

Dr Bakshi was kind enough to share with me some system-level numbers to illustrate.
• non-ICU teams handle 17-25 patients
• the large Royal Alexandra Hospital has 8 teams for baseline 168 patients, which looks a lot like AB-wide ICU capacity

In Wave 2 they got stretched.

In Wave 2 they had to add 5 covid teams, to baseline 8 teams (17-25 patients each).

They they had an outbreak in one base team, so they converted it to covid.

7 base + 6 covid = 13.

Providing ICU-level care, without staff ratio.

Needing Respiratory Therapists (RTs) like ICU.

But the problem is not just volume of patients coming in. It is also the mix of patients.

Please read that Advance Care Planning document again before proceeding. This is tough sledding.

myhealth.alberta.ca/Alberta/Albert…

Don't proceed until you've read it.

In 2nd Wave, before vaccines were approved, or when global quantities were still tiny, many of the seniors needing hospital or ICU chose to modify their Goals of Care.

From R1 or R2, to M1 or lower. Depending on their health & preferences, with family & doctor advice.

It is best to think about these things in advance, and do your Green Sleeve & Personal Directive, because Delta makes people sick so fast, and you can't sit beside your relative in COVID-19 ICU or Ward to go over it.

Please discuss this in advance with family and your doctor.

So here we are in 4th Wave, worse in every way, in every part of the hospital.

It is intentionally cruel to patients, to family, to every kind of healthcare worker.

The mix of patients is younger, including children.

How do you do their GoC?

aryntoombs.github.io/schools/

So in non-ICU wards, they are having to take care of younger people who have chosen R1.

And internal medicine wards lcan handle R1, with Optiflex, and RTs.

(I don't know about ventilators)

So they are basically being ICU, without the team make-up and size.

We don't know this.

Let's change the view again.

25 July
• Covid: 60 patients or 1%
• Empty bed: 656 or 11%

19 Sep
• Covid: 760 patients or 13%
• Empty: 690 or 11.6%

Ratio changed from 1:11, to 13:12.

Imagine the work.

There are people like me trying show this workload, to help Albertans understand.

eg. in ICU, the daily totals you see are Net after all admissions, discharges, and sadly deaths.

It's like closing stock price on a share that has been active all day.

public.tableau.com/app/profile/ed…

But do not interpret this to deny yourself care if you are sick, for whatever reason. You won't be judged even if you are unvaccinated.

There is still room for you in ER, in non-ICU (690 beds at last count), even ICU.

Don't stay home & suffer.

cbc.ca/player/play/19…

I checked this video in advance with a couple of doctors, and PBS Newshour is a high-quality, in depth news program.

As you go through the Advance Planning Document, with your doctor and advisor, think also of quality of life after long stay in ICU.

pbs.org/newshour/show/…

I was going to go through the remaining metrics on my scorecard, like Deaths or Vaccinations, but I'm exhausted.

I reckon I have left you with lots to think about.

Get everyone you know vaccinated.

And remember, if you need hospital, go to hospital. They will help you.

@threadreaderapp unroll please