#COVID19AB Balanced Scorecard
Stats reported Fri 24 Sep

This weekend feels like seeing a Cat 5 hurricane bearing down on a remote island on Fri evening, knowing we won't hear for some days until power & telecom are back, praying for few deaths & devastation when they're out. ImageImageImage
Except we're not a remote island in open ocean. We're in Alberta, supposedly a modern society.

The hurricane has not passed. We've just had outer bands pass through. Rain, wind, storm surge, etc.

The 250 km/h eyewall is still coming. Major casualties. Hail & Devastation. Image
Modern society? Let's compare AB to City of Chicago

AB 4.4m
Chi 2.7m City (9.6m Metro)

Daily Cases:
AB 1554
Chi 412

Test Pos:
AB 10.11%
Chi 2.9%

AB 1061
Chi 25

Avg Daily Deaths
AB 14.1
Chi 3.57

Fully Vax
AB 62.4%
Chi 57.4%

chicago.gov/city/en/sites/… ImageImage
Calgary Wastewater Sampling and R

See Virus levels jump from beginning of September?
• School started

What reversed them a week into September?
• Mask Mandates by City & School Boards

Why aren't they still going down?
• Momentum of active cases

covid-tracker.chi-csm.ca ImageImageImage
Alberta R

@Mrhockey1231 and I just finished upgrading these graphs.
• North, Edmonton & Central Zones
• Central, Calgary & South Zones

So we can see the city mice, country mice, how central mice correlate to YYC or YEG, and City-Country divergence.

Test Positivity

There are really 2 Albertas hidden in my 1 Scorecard.

Overall, the province looks like the worst is over, because the heavily-populated Calgary & Edmonton Zones dominate the stats.

North, Central, South Zones. Big trouble. Choppy.

alberta.ca/stats/covid-19… ImageImage
Drat, lost the thread. Let's pick it up.

Above, Test Positivity, which is like 2 canoes on a roller coaster. Cities going down, Rural & Small Town going up.

This lost tweet is Active Cases by Geography & Vax.

Then I'll continue with Hospitalization.

OK? Back to the main thread. Where was I?

Oh yes: R, test positivity and cases showing 2 Albertas. Cities going down, Zones going up.

Problem: we all need the same Hospitals. Whether we come from the upper 3 curves, or the lower 2 curves.

Shown with/without Alberta Avg. ImageImage
We have record Hospitalization, in every way:
• ICU Surge Capacity
• non-ICU Wards like Internal Medicine taking COVID-level ICU patients to save lives
• transporting patients from one Zone to another to use every last bit of capacity

HCW breaking, to slow AB dying. Image
Weeks ago, I was critical of Alberta Health showing Surge Capacity growing, thinking it was unachievable because you can't just clone record numbers of:
• Respiratory Therapists
• Critical Care Nurses
• ICU Docs
• Pharmacists
• Anaesthetists, etc.

like it's a video game. ImageImageImage
I'm one of the many voices saying you can't keep stressing healthcare workers to deal with this kind of workload.

But our CMOH, Health Minister du jour, and Premier keep doing it.

I work with many of these people in @PopAlberta. Under huge stress, they are innovating too.
@PopAlberta One innovation? Putting ICU-level COVID-19 patients in non-ICU Wards like internal medicine.

I relayed @NeejaB work with a team of devoted people, which is happening in every major hospital.

But cancelling surgeries doesn't magically clone ICU staff.

I'm an engineer/project manager with background in electronics manufacturing.
• New product introduction, starting from zero, to pilot, to ramp up. All the problems you face as you grow.
• Bringing on other plants to add capacity/enter new markets. The stress of transferring.
These amazing people are doing it all simultaneously:
• from 80 people on 24 July
• to 1061 on 24 September
• 13.3x in 2 months
• using multiple sites
• try raising capacity of any manufacturing or organization process that fast

Imagine rush hour traffic 13.3x in 2 months. ImageImage
These are human beings in our hospitals, not wireless telecom in a factory. They're about as fragile and perishable as a "product" can get.

And we're still not seeing how complex this picture.

Last week AHS CEO Dr Verna Yiu said deaths were making room for new admissions.
At the same time, I was working with a skilled "data wrangler" in Edmonton, who uses Tableau to illustrate complex concepts simply.

@jkparker taught me how to show the daily admissions, average daily deaths, and running count of patients in ICU.

So, looking at her Tableau, you can see:
• the running count at end of day understates the problem
• our Healthcare workers have to handle 50+ admissions PER DAY
• and absorb a rising AVERAGE of 11 deaths per day
• daily admissions fluctuate widely
• one day 53; next day 17 Image
Last Friday, you got to see me cry on YouTube.

This Friday I got to watch my dear new friends, who are doing laudable work to save lives in Alberta, artful innovation and brute force pushing themselves.

Some were crying. Some numb. Some stoic. Some ??.

You can't do this to people. It's grotesque & sadistic.

@jvipondmd calls this the #IntentionallyCruelWave
• Not just to people dying.
• HCW breaking to stop it
• Family & friends of people in Hospital
• People whose surgeries were cancelled AGAIN to make room for COVID-19 ImageImage
@jvipondmd Kids age 5-11:
• started school in Sep
• too young to be vaccinated
• rooms with inadequate ventilation or filtration
• inadequate masks, if at all

Look how "Best Summer Ever" changed once school started.

Every other age now 📉

Vulnerable kids 📈

alberta.ca/stats/covid-19… ImageImageImageImage
I didn't get to work with @jkparker on this amazing collection of Outbreaks in K-12 Schools.

@SOSAlberta has to do this, because GoA is not doing contact tracing in schools.

Volunteers & parents doing what AB Health & AB Education should be doing.

I have been procrastinating this all weekend.

These aren't just lines on a graph. They're people, with families.

But we can't ignore the Deaths happening in our province.

See that jump to steeper rate of death at end August? You can see it better compared to a straight line. ImageImageImage
We know, that wave after wave, around world, when you change public health measure, there is a cadence:
• leading indicators change in ~2 wks
• Hospitalization in ~3-4 wks
• Deaths in ~4 wks

So what happened at end July for Deaths to📈~4 wks later?

👉alberta.ca/release.cfm?xI… ImageImageImageImage
@jvipondmd @GosiaGasperoPhD @RajBhardwajMD @TehseenLadha @drdagly @Rea_Booker @kwburak @plasercalgary @NeejaB @PfParks That's all for me this weekend.

Tomorrow, we'll have new ICU stats from AHS.


We should get an update from AB Health.

We'll see the damage from the hurricane @PopAlberta and every HCW in Alberta were fighting.

But that hurricane is still coming in. Image

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More from @ZiadFazel

28 Sep
#COVID19AB Balanced Scorecard
Mon 27 Sep

If you remember my hurricane analogy from yesterday, today we emerged from a weekend without communications from Alberta Health.

There was no sunshine. No respite between bands. Only the 250 km/h eyewall.
@jvipondmd @GosiaGasperoPhD @RajBhardwajMD @TehseenLadha @drdagly @plasercalgary @GermHunterMD @kwburak @PfParks @dupuisj Test Positivity

4th Wave was unusual as Test Positivity was a steep, unhesitating rise.

⬆️not 📈

We have seen that frightening line with Delta all over the world.

Researchers sometimes change their graph to log scale and are shocked to still see it.

When Test Positivity stuttered in September, then peaked in mid-September (urban mask mandates & restrictions) experts with @PopAlberta kept warning of danger.

My analogy then was a 1000-km wide wildfire at 80 km/h.

Because there weren't strong province-wide safety measures.
Read 16 tweets
24 Sep
#COVID19AB Balanced Scorecard
Thu 23 Sep

Sorry for late start on this - was watching today's @PopAlberta broadcast for a third time. So many good shows there 👀

youtube.com/channel/UCXWbl… ImageImageImage
Last night between 4.16pm and 10.12pm, I assembled a monster Balanced Scorecard thread (rope?) of 31 tweets.

I wanted to give extra attention:
• We're becoming 2 different Albertas with COVID-19
• Non-ICU Wards have become ICU to prevent triage


Finished reading ALL of it?

I'm going to build on it a bit. Remember my analogy that covid-19 under bad government is like riding a canoe on a rollercoaster?

We have two canoes now.
• Calgary and Edmonton, leading/front going down
• Rest of Alberta, leading/front going up.
Read 13 tweets
22 Sep
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 ImageImageImageImage
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 Image
Read 38 tweets
14 Sep
Last night @CMOH_Alberta gave a presentation to Alberta family docs, and I got a chance to see it and take screenshots before the video was set to Private.

Whenever a politician wants to give you "Context", be wary of Deceptive Framing.

Have a look at her graphs of BC/AB/SK.
Did you do that yet? No skipping ahead now.

I zoomed in for you.

See it yet?

The axis scales are not the same.
Here are the graphs exactly how they look at


The default shows every province on the same axis for fairness.

See that green "Relative scale". That compares each province to its own peak.

Click it. Gosh - every province looks equally bad now.
Read 8 tweets
13 Sep
#COVID19AB Balanced Scorecard
13 Sep 21

We're all interested in ICU, but I'll stay consistent with giving all metrics, including signals from Leading Metrics which end up in Severe Outcomes.

Test Positivity has paused at an all-time pandemic record just above 3rd Wave Peak.
@jvipondmd @GosiaGasperoPhD @RajBhardwajMD @TehseenLadha @drdagly @shazmamithani @kwburak @plasercalgary @noelgibney @dupuisj Looking at R for Alberta, we can see the "gas pedal" of R has eased up a bit, but still stays above 1.0, which means still accelerating with exponential growth of COVID-19.

The damage was done in July with that steep rise of R > 1.2 during & after Stampede.
I'm sticking with Leading Indicators of the spread of #COVID19AB, because They. Lead. To. Severe. Outcomes, including Death.

You can't grow ICU Capacity to match exponential growth. You have to stop the spread up front to give your healthcare system a chance, Public + Private.
Read 16 tweets
12 Sep
Sadly, today is the day we exceed Alberta's baseline ICU Capacity.

• Blue Exponential Growth Curve = Albertans in ICU with COVID-19
• Red line = Baseline Capacity
• Surge Capacity comes from Cancelling Surgeries & Redeploying Doctors, Nurses, other Healthcare Workers
I don't normally do one graph inset into another, but I wanted to show @GosiaGasperoPhD modelled this exactly, on 24 August.

She's a world-class biologist who could be doing this anywhere in the world, saying "Look what is happening over there in AB."

Instead, she's here in Calgary, volunteering her expertise late at night (eg 12.36am for this tweet) to help our province.

And she's wiping the floor with Alberta Health's CMOH team, even though they have access to internal data and high-end computers.

Read 8 tweets

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