"Hi Alex, how do I keep my holiday gatherings safe? Do I have to cancel everything?"

Depends on your risk tolerance. If your bubble has persons who are medically vulnerable, elderly, maybe reconsider.

Otherwise, use ALL measures to keep things safe as able.

Brief 🧵. (1/n)
We all know that seeing & reconnecting with friends & loved ones over the holidays is SO critically important. But with the transmissibility of #Omicron, the risk-benefit calculus has changed dramatically again. What do we do now? (2/n)
For starters, MINIMIZE indoor group gatherings where persons are unmasked. At holiday gatherings everyone will be eating & drinking, so keeping these bubbles tight as possible is optimal. Like 5-10 persons max, if you're able. (3/n)
Groups will decide how to address vaccine status. Having as many as possible fully vaccinated is optimal. DO NOT attend group gatherings if you're symptomatic. Stay home and ideally, get tested if possible. (4/n)
To add another layer of protection to the gathering, if you have access to rapid antigen testing, have everyone perform one when they arrive or immediately before hand. Negative tests for all attendees isn't perfect, but it helps. (5/n)
Optimize your ventilation indoors. As able, open all windows that you can, use ceiling fans and indoor fans to help circulate the air. When you're NOT eating or drinking, consider wearing a mask if you're inclined. Do what you're able to OUTSIDE, which is much safer. (6/n)
Think about your bubble. Are there persons with medical vulnerabilities, for example? If so, reconsider your risk-benefit calculation. If everyone is healthy, asymptomatic, and fully vaccinated, the overall risk is likely low for most/everyone involved. (7/n)
Encourage everyone around you to optimize their protection against #COVID19 by getting 2-3 doses of vaccine ASAP, if they haven't already. Maximize your protection to protect yourself and all those around you. (8/n)
Think about what's happening in your community. If Delta & Omicron are causing huge case surges, then every type of unmasked indoor activity becomes much higher risk. Canada's a big place, every jurisdiction will experience Omicron differently. (9/n)
Last piece of advice. Treat the 'risk' of indoor unmasked gatherings as capital. Spend it wisely with the people who matter most to you in your life. Please try to be responsible to yourself and to the health of others. Be safe, everyone. (/end)

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More from @awong37

15 Dec
"Hi Alex. With #Omicron in Canada, what's the optimal 2nd dose interval for kids b/w 5-11 who have 1 dose?"

VERY different space w/ Omicron now vs 4 weeks ago when NACI guidance was released.

We'll try for 3-4 wk interval in #SK for our 5 year-old, NOT 8. Here's why. (1/n)
Let's start by acknowledging that we have no real clinical data in this space right now. We don't know HOW protected kids b/w 5-11 are with 1 dose vs different variants like Delta or Omicron.

Kids immune systems are ++ robust, so 1 dose definitely confers some protection. (2/n)
That said, NACI guidance on 8 week interval was developed before we knew about Omicron. Extending dose intervals makes 100% sense to optimize long-term protection and minimize risk of heart inflammation events, etc. (3/n)
Read 7 tweets
23 Nov
"Hi Alex. My (5 to 11) year old just got their 1st #COVID19 vaccine dose. Yay! Should we wait 8 weeks for the 2nd dose as recommended, or should we just get a 2nd dose ASAP at 3 weeks?"

No clear answer, but my wife & I WILL WAIT 8 WEEKS for our 5 year-old son.

Brief 🧵. (1/9)
A longer duration between 1st and 2nd doses of Pfizer-BioNTech vaccine has been shown to increase antibody levels and makes COMPLETE SENSE from the immunological perspective given our experience with all other vaccines in both kids and adults. (2/9)

cell.com/cell/fulltext/…
Lots of clinical data now available suggesting extended-interval dosing for #COVID19 vaccines improves overall protection against COVID-19 infection versus shorter manufacturer recommended dosing intervals. Here's an example from Quebec. (3/9)

cbc.ca/news/canada/mo…
Read 9 tweets
8 Nov
"Hi Alex. What is this Western Canadian variant? Is it something to be worried about?"

Yes, there's a new Canadian AY.25 clade which originated from Idaho. This AY sublineage appears to have become dominant in Alberta and Saskatchewan. (1/9)

#COVID19AB
#COVID19SK
This is a bit technical, but as you can see in the phylogenetic analysis below, the strain appears to have originated from Idaho and then spread quickly throughout all of Western Canada. (2/9)

#COVID19AB
#COVID19SK
The same phylogenetic analysis is now color coded by province, so you can see how the strain has spread widely through BC (sea green), Alberta (yellow), and Saskatchewan (lime green). There's smatterings of cases in Ontario, too. (3/9)

#COVID19AB
#COVID19SK
Read 9 tweets
7 Nov
"Hi Alex. My 11 year-old is ready to get vaccinated. BUT, he/she turns 12 in less than a month. Should I wait and get the higher 30 μg dose of vaccine at age 12, or just go ahead & give the lower 10 μg dose right away?"

Answer: DON'T wait, go right away.

🧵 below. (1/7)
The appropriate dosing of vaccine ISN'T dependent on weight, but rather their age. The immune system of a 'small' 11 year-old is functionally the same as a 'large' 11 year-old. The immune response isn't weight-dependent, per se. (2/7)
Younger children in general have very active immune systems, another reason why lower dosing makes sense and leads them to produce the same degree of antibody response as those ages 16-25 who received a higher dose of vaccine. (3/7)
Read 7 tweets
27 Oct
"Hi Alex. If vaccinated folks can transmit #COVID19 like unvaccinated folks, why get vaccinated? Negative testing is good enough!"

Fully vaxxed persons transmit #COVID19 at FAR LOWER LEVELS than unvaxxed persons. Rapid antigen testing has limitations.

🧵 below to explain

(1/7)
If you're fully vaccinated, your chances of getting #COVID19 infection are MUCH lower, so your chances of transmitting are ALSO much lower too.

If you're fully vaccinated but still get #COVID19, you clear the virus MORE quickly, so you're less contagious overall.

(2/7)
This is why being fully vaccinated & PREVENTING #COVID19 infection is BETTER than just doing negative lateral flow testing (LFT, "rapid" tests).

Persons who are fully vaccinated protect themselves from infection as well as those around them MUCH BETTER.

(3/7)
Read 7 tweets
27 Oct
"Hi Alex. Do #COVID19 vaccines affect fertility? Should I get it if I'm pregnant?"

There's SO MUCH misinformation about how COVID-19 vaccines aren't safe in pregnancy or can affect fertility. THIS IS NOT TRUE.

Excellent link 👇 & short 🧵.

(1/4)

pregnancyinfo.ca/covid/
All the information we have with billions of doses of #COVID19 vaccine given is that there's NO EVIDENCE that COVID-19 vaccines affect fertility at all.

Every person, whether actively trying to conceive or just thinking about conceiving, SHOULD be vaccinated.

(2/4)
Acquiring #COVID19 while pregnant means a woman is at HIGHER RISK of needing hospitalization & ICU care versus not being pregnant. Being very sick with #COVID19 could be dangerous for baby.

All pregnant woman SHOULD be vaccinated to prevent serious illness from #COVID19.

(3/4)
Read 4 tweets

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