Thread by @Matthew_Froese

I used to work with a guy who talked about the difference between strategy and tactics. I think a lot of our COVID talk has tended to focus on tactics; what are we doing now, what are we doing next, what works, and what doesn't.

I don't think we talk about strategy that much. Talk of herd immunity has fallen off, and our summer re-opening turned out to be too optimistic.

Today we heard another really excellent call to action - to get boosters to as many people as possible as soon as we can. It's a good call, it's based strongly in the data, and I support it. Go get your shot!

That said...

I didn't hear anything today about how this tactic - speeding up boosters - fits into our current strategy. And I'm not honestly sure what our strategy is at a broader political level. I haven't heard anyone talk about it, I don't think.

Sometimes you can reverse-engineer an unspoken strategy from the tactics in use. We're facing a variant with incredibly rapid transmission; we have no new measures to meaningfully reduce transmission.

When facing a crisis, you have 3 options. You can prevent damage, you can mitigate or reduce the magnitude of the damage, and you can recover from the damage. Often we pick a mix of all 3.

Some people always wanted purely option 1 - complete prevention via global elimination. No one in power appears to be suggesting this is on the table at the moment.

Some people always wanted purely option 3 - the Barrington declaration folks wanted everyone to just get sick and get it over with. Don't mention the mutations and the long covid...

And I think by default now we're settling mostly on option 2 - mitigating harm. It's not an idealistic strategy. Mitigating harm means there's always still some harm.

If we aren't committing to the tightest lockdown yet, we're implicitly committing to rapid spread of this variant. It's incredibly quick. We could close a lot of stuff and still have this move faster than any previous wave.

But there's no sign of lockdown to limit transmission in Ontario, which seems a bit ahead of us. There's no signalling from the feds that it's what they expect provincial leaders to do. With a virus that doubles every 2-3 days, it's not *if* each of us get exposed, it's *when*.

So I think it's time for some reframing. What's next isn't to imagine we're avoiding getting exposed, but to work out the practical steps in limiting how hard it hits.

So go get your next shot - whether your 1st, 2nd, 3rd, whatever - to improve your odds of a mild illness.

Keep up on masking, ventilation, filtration, and distancing whenever you can. Lower exposure is always better than high exposure.

Exposure to a lower dose of virus may make for fewer or milder symptoms: ncbi.nlm.nih.gov/pmc/articles/P…

But most of all, I think it's time for a lot of us to adjust our expectations. Some of what we've relied on - testing & tracing, for example - likely won't scale to match peak demand in this wave.

I think it's reasonable to expect testing capacity might be rationed for those with severe symptoms.

We've never even doubled our current rate of testing (green line), and if new cases double every 2-3 days, it just won't be able to keep up.

Similarly for contact tracing - every system has it's limits. I think we're likely to see less accurate data, slower followup, and reassignment of resources to where they can make the most impact.

I think we'll likely also see that when lots of people get exposed at the same time, it's impractical to ask essential workers, especially healthcare workers, to isolate after exposure. Isolation rules may change quickly.

One thing I think I'll have a contrarian view on - I'm not sure canceling a lot of Christmas events will matter very much, at least not among people at low risk of severe outcomes. If everyone's getting exposed relatively soon, it doesn't much matter where it happens.

Risk mitigation still means that smaller gatherings with only fully vaccinated people, maximizing ventilation, and accessing rapid testing if you can are great ideas.

But if you cancel Christmas and get sick a week later anyway, that's going to seem like a bad trade.

I think the next few months will be a scary time for people at higher risk. I don't know what to tell you about that. I wish I did.

I know thoughts and prayers are usually somewhere between a joke and a curse on here, but you can DM if a prayer would be meaningful to you. This will be a difficult time.

I remain hopeful that Manitobans know how to face a crisis - we sandbag when it floods, we dig our way out of blizzards, we look after each other when tragedy hits. We'll do this, too.