Thread by @MoriartyLab

OK. Have finally found age-specific vax rates for Ontario PHUs that more closely resemble national data for ON than those reported provincially.

This really changes our understanding of which Cdn regions are at greatest risk of future deaths, ICU admissions, hospitalizations.
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https://twitter.com/MoriartyLab/status/1459270570915340291

The most recent age-specific vaccination data from @GovCanHealth indicated the Canadian regions with the highest risk for future ICU admissions, deaths and hospitalizations are, in order, AB, ON, NWT, YK, SK, BC, NB, QC, NS, MB, NL, NUV, PEI.

SK 1st dose vax has really sped up.

@GovCanHealth However, even though ON is now a major concern due to slow vaccination in people 50+, I couldn't figure out how to identify the ON regions at greatest risk because provincially reported vaccination rates are so much higher than national rates, especially in older age groups.

@GovCanHealth Today, thanks to conversations about this with @karloskar17 @alan_page_ca @corntea_kw and someone who was talking about Algoma data (sorry! I can't find your comment), I found the link to the ICES age-specific vax rates by PHU and forward sortation area for Ontario.

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw These data are in fact highly consistent with nationally reported age-specific vaccination rates for Ontario. In addition, they use timely population estimates based on the number of people in the OHIP database as of late September, 2021 (unlike pops province uses).

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw I calculated the average vaccination rates for all FSAs in each age group and each PHU and plugged these into the spreadsheet where I estimate numbers of possible deaths, ICU admissions and hospitalizations among people who were completely unvaccinated as of Oct 31.

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw Tab "Death hosp ICU projections" on spreadsheet here. Methods, sources, formulas are available on other tabs.
docs.google.com/spreadsheets/d…

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw Based on this, here are the highest priority regions in Canada for vaccine outreach. These are the regions that are likely to experience the highest per capita ICU admissions, deaths and hospitalizations unless vaccination rates increase, especially among those 50 and older.

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw Highest to lowest residual (remaining) risk Canadian regions (ranked by ICU admissions/100,000 people):

1. SK, South West: 76 deaths, 91 ICU admissions, 350 hospitalizations

2. ON, Timiskaming: 75 deaths, 63 ICU admissions, 288 hospitalizations

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw 3. On, Northwestern: 168 deaths, 166 ICU admissions, 682 hospitalizations

4. AB, South: 303 deaths, 553 ICU admissions, 2,215 hospitalizations

5. SK, Far North West: 29 deaths, 56 ICU admissions, 210 hospitalizations

@GovCanHealth @KarlOskar17 @alan_page_ca @Corntea_kw 6. SK, South East: 80 deaths, 167 ICU admissions, 576 hospitalizations

7. ON, Windsor-Essex: 717 deaths, 799 ICU admissions, 3,194 hospitalizations

8. MB, Southern: 262 deaths, 381 ICU admissions, 1,519 hospitalizations

9. ON, Eastern Ontario: 335 deaths, 393 ICU admissions, 1,556 hospitalizations

10. ON, Algoma: 198 deaths, 213 ICU admissions, 852 hospitalizations

11. BC, Interior: 1,026 deaths, 1,487 ICU admissions, 5,415 hospitalizations

12. ON, Niagara: 812 deaths, 856 ICU admissions, 3,451 hospitalizations

13. SK, Central East: 116 deaths, 173 ICU admissions, 626 hospitalizations

14. ON, Toronto: 5,659 deaths, 5,247 ICU admissions, 22,216 hospitalizations

15. ON, Chatham-Kent: 163 deaths, 187 ICU admissions, 741 hospitalizations

16. BC, Northern: 305 deaths, 489 ICU admissions, 1,818 hospitalizations

17. ON, Peel: 2,566 deaths, 2,658 ICU admissions, 10,852 hospitalizations

18. ON, North Bay-Parry Sound: 180 deaths, 217 ICU admissions, 845 hospitalizations

19. ON, Renfrew: 138 deaths, 181 ICU admissions, 708 hospitalizations

20. ON, Haldimand-Norfolk: 155 deaths, 200 ICU admissions, 779 hospitalizations

21. ON, Grey-Bruce: 258 deaths, 291 ICU admissions, 1,150 hospitalizations

22. ON, Hastings-Prince Edward: 253 deaths, 283 ICU admissions, 1,125 hospitalizations

23. ON, Lambton-Sarnia: 185 deaths, 217 ICU admissions, 846 hospitalizations

24. SK, Central West: 28 deaths, 60 ICU admissions, 207 hospitalizations

25. ON, Brant: 222 deaths, 249 ICU admissions, 1,017 hospitalizations

26. ON, Haliburton: 263 deaths, 310 ICU admissions, 1,194 hospitalizations

27. ON, Hamilton: 989 deaths, 943 ICU admissions, 3,834 hospitalizations

28. ON, Simcoe Muskoka: 766 deaths, 976 ICU admissions, 3,832 hospitalizations

29. ON, York: 2,152 deaths, 1,927 ICU admissions, 8,200 hospitalizations

30. SK, North East: 46 deaths, 66 ICU admissions, 237 hospitalizations

31. SK, South Central: 58 deaths, 95 ICU admissions, 342 hospitalizations

32. AB, Central: 758 deaths, 1,244 ICU admissions, 4,848 hospitalizations

33. ON, Porcupine: 117 deaths, 132 ICU admissions, 528 hospitalizations

34. ON, Southwestern: 289 deaths, 336 ICU admissions, 1,347 hospitalizations

35. ON, Sudbury: 249 deaths, 304 ICU admissions, 1,193 hospitalizations

36. ON, Thunder Bay: 212 deaths, 226 ICU admissions, 905 hospitalizations

37. ON, Middlesex-London: 654 deaths, 713 ICU admissions, 2,856 hospitalizations

38. ON, Waterloo: 760 deaths, 844 ICU admissions, 3,378 hospitalizations

39. AB, Edmonton: 1,007 deaths, 1,333 ICU admissions, 5,642 hospitalizations

40. ON, Durham: 911 deaths, 965 ICU admissions, 3,961 hospitalizations

41. SK, North Central: 58 deaths, 118 ICU admissions, 409 hospitalizations

42. ON, Peterborough: 185 deaths, 197 ICU admissions, 789 hospitalizations

43. SK, Saskatoon: 362 deaths, 441 ICU admissions, 1,770 hospitalizations

44. NWT, entire territory: 16 deaths, 59 ICU admissions, 190 hospitalizations

45. ON, Leeds Grenville Lanark: 206 deaths, 233 ICU admissions, 926 hospitalizations

46. ON, Ottawa: 1,303 deaths, 1,341 ICU admissions, 5,541 hospitalizations

47. ON, Halton: 738 deaths, 783 ICU admissions, 3,229 hospitalizations

48. YK, entire territory: 37 deaths, 54 ICU admissions, 189 hospitalizations

49. ON, Wellington: 356 deaths, 386 ICU admissions, 1,564 hospitalizations

50. ON, KFLA: 229 deaths, 257 ICU admissions, 1,035 hospitalizations

51. BC, Vancouver Island: 673 deaths, 1,034 ICU admissions, 3,667 hospitalizations

52. ON, Huron Perth: 159 deaths, 176 ICU admissions, 714 hospitalizations

53. BC, Vancouver Coastal: 1,102 deaths, 1,408 ICU admissions, 5,049 hospitalizations

54. AB, North: 655 deaths, 1,071 ICU admissions, 4,219 hospitalizations

All other Canadian regions, provinces and territories are at or below the national average for expected future ICU admissions.

Finally, for those who are new to these threads, which I post ~1X weekly, when new national data are out, these are an attempt to come up with estimates of the numbers of future COVID-19 deaths, ICU admissions and hospitalizations that may still occur over the next 1-2 yrs.

I do these estimates in an attempt to prioritize high intensity one-on-one vaccine outreach. We can't reach everyone unvaccinated to provide support, so we have to prioritize efforts.

Yes, the vaccines reduce transmission, and vaccinating kids 5-11 will help slow spread.

But basically, herd immunity is likely out of reach, at least in the way many of us slip into thinking about it (a situation where getting seriously ill and dying from COVID-19 is a rare event).

In this situation, a major priority, in addition to slowing spread using all the measures we need, is to get the people vaccinated who are most at risk of serious illness and death.

This is important not only to protect these individuals, but also the healthcare system.

Something it's really important to remember is that maybe about 15% of the Canadian population has been exposed to SARS-CoV-2 to date. It might be a bit more, but not much. Before vaccines, maybe 10% of us were exposed, if that.

10% of us being exposed to SARS-CoV-2 over nearly 2 years brought us and our healthcare system and communities almost to our knees.

Now, ask yourself how much of the Canadian population remains completely unvaccinated--it's about 15%.

For those who look at estimates of future deaths and think reflexively that they're impossible, remember that there are currently roughly as many people completely unvaccinated as the number of people exposed to SARS-CoV-2 in Canada to date.

On top of this, we WILL have serious illness and deaths due to breakthrough infections in fully vaccinated people. Even if this is 90-95% lower than in unvaccinated people, it can still be a big number--maybe one third of what we've seen since February 2020.

On top of serious illness and death in unvaccinated people, this can be an enormous societal and medical burden that will continue to suffocate our healthcare system and so many parts of our society.

So, we really, really need to reach the unvaccinated people most likely to develop serious illness and possibly die.

In general, this is anyone 40 and older, especially those 50 and older.

These threads I do are NOT a prediction of the future. They're a rough, but reasonable, estimate of the future burden of COVID-19 in all our communities, big and small.

Sure, Toronto may still experience the largest number of deaths, ICU admissions, hospitalizations in the country, but per capita, rural parts of SK, AB, ON and BC will be harder hit.

How can South West Saskatchewan handle 91 ICU admissions, especially if the virus spreads fast?

My final plea--every community and region needs to have a reasonably accurate idea of what the future impact of COVID-19 may be. They can't do this without good data, and it really doesn't help if there are major discrepancies between provincial and local public reporting.

I would bet a lot that the fast, recent uptake of vaccination we finally saw in Saskatchewan (and Alberta) has had a lot to do with people living in these provinces understanding the seriousness of COVID and the importance of vaccination.

I don't think it's an accident that Quebec and Manitoba, which appear to have been the only provinces to accurately and completely report COVID-19 deaths, also have some of the highest vaccination rates among people 50 and older in the country.

On this note, I have some pretty frustrated thoughts about COVID death reporting in many provinces, including recent news that helps explain why/how Ontario has been under-reporting, but I'll leave that for another day.

My final plea is to medical colleague, coroners and decision makers who have not reported deaths of people with COVID as COVID deaths if they had other, serious health conditions.

Not only is this what PHAC and WHO explicitly say NOT to do for COVID death reporting.

It also makes it hard to understand the cause of Canada's excess deaths in the epidemic (outside QC and MB).

And by far the most important....

Massaging COVID death and hospitalization and ICU admission reporting so that numbers look better than they are has a profoundly important effect on people's sense of personal risk.

The small numbers of studies that have been done in the past on pandemic fatigue found that people's compliance with public health and self-protective measures wasn't so much because they got tired of them. People adjusted their behaviours based on their sense of personal risk.

If we don't talk clearly and without euphemisms and waffling about how many people will likely still die and/or become seriously ill in Canada from COVID-19, how can we expect people to understand why they need to get vaccinated to protect themselves. Especially people 40+.

Everyone wants to know when this will be over. Everyone wants to have a sense of what endemic might look like. If we can roughly estimate numbers of future deaths, ICU admissions, hospitalizations as all of us are exposed, then maybe we can talk about these decisions.

By this point in the epidemic, with the amount of data we have worldwide, we really can estimate the minimum expected deaths etc, assuming vaccines provide perfect, lasting protection etc.

If we tell people what this looks like, what it REALLY looks like, without sugarcoating, then maybe some will understand why they need to protect themselves. Some won't, but some will. They deserve this truth, truth that isn't obscured by spin.

So much of what we're doing with all our protective measures (which are ALL important, not just vaccines) is buying time and slowing spread so that all those future serious illnesses and deaths don't happen all at once.

And we're buying time for more people to get vaccinated.

The recent acceleration in vaccination of people 40+ in Alberta and especially Saskatchewan strongly suggest that people will get vaccinated if the risk of remaining unvaccinated is vivid, clear and immediate.

We must speak clearly, honestly, and compassionately about risk.

Although it is awful to watch the growing wave in Ontario, part of me also hopes this shakes us out of our complacency and encourages us to refocus our efforts on prioritizing and supporting the urgent vaccination of people 50+ across the province.

Especially people 80+. FFS.