Thread by @ASPphysician

I have received messages, texts, and reply-tweets regarding my stance on COVID management in ON (and elsewhere). As a strong early proponent of a #COVIDzero approach for a variety of reasons which, I believe, will show merit historically, I have never minimized COVID. However ...

1. I continue to have uncertainty regarding the severity of Omicron. I believe we will establish considerably more certainty in days ahead. Certainly, some evidence is emerging of a lesser severity—both mechanistically & epidemiologically—but I remain uncertain and thus cautious.

2. I don't accept the experience of the UK, Denmark, or anywhere else right now because they are at roughly the same time period in Omicron as we are—very early. The reasons why we cannot generalize from Gauteng are well documented, including in my weekly newsletter from Dec. 18.

3. From the outset of Omicron I asserted that almost everyone will become infected with it. This isn't hyperbole, it is facing reality. I said this to journalists over 2 weeks ago, and pointed out that testing capacity and worker illness were the 2 major vulnerabilities.

4. Because of this—and the risk to the healthcare system—we must ensure that the healthcare system isn't at risk of becoming overwhelmed. See 1. above. But immunity from vaccinations (and, for a small percentage) prior infections will lessen the healthcare burden.

5. The degree of contagiousness is so great that this wave will likely be palindromic: a quick rise and a rather quick decline. Lots of people sick. If many end up in hospital, this can be catastrophic. See 1. Because of that, we should not "let 'er rip" right now and boost +++.

6. For many children, their risk of illness (i.e. severe acute and long COVID) remains very low. That isn't zero. But it will never be zero. It can be lowered substantially with 2 doses of vaccine. If eligible, they should get ASAP.

If not eligible for vaccination, parent anxiety should not be amplified.

Many who are castigating school measures now were speaking rather laudingly back in Sept when numbers were good. Omicron is what changed, not any policies, and immune evasion + rapid replication is potent.

7. I cannot say if we are heading towards endemicity—i.e. a situation where most people have a fair amount of protection from severe disease because of immunity—because COVID is a nasty devil that has always fooled those on hopium.(If you don't follow me: I don't consume hopium.)

However, at the end of this wave, the overwhelming majority will have a fair bit of immunity and, hopefully, not too much sickness. Some will get sick—most will be the unvaxed. Some will be the undervaxed or immunocompromised. We need to try and protect them as much as possible.

8. But there seems to be little more we will be able to offer in the near future to reduce important infection risks: those who have yet to get vaccinated by choice will continue to choose against. Those who cannot respond to vaccines, will continue to be at risk.
For now: boost!

9. I, for one, will be happy to see endemicity emerge with many infected and very little illness—ideally with massive vaccination. I'd rather we reached it with few infected with massive vaccination, but that just won't happen.

Even Australia and China cannot seem to control it.

10. So I say: let's try and keep cases as low as possible now until we know more, and then act accordingly. We do that with good masking, ventilation/filtration, avoiding crowding, and getting 1st, 2nd, 3rd, and even 4th doses into arms ASAP.

11. I don't know what this means for getting kids back to school immediately, because so much depends on 1. and 2. above. I hope we can get them back very quickly, because they have all lost so much. Parents deserve to hear a government plan now.

It is unreasonable to make rapid testing for school safety a condition of return: we would need ~1-2M tests almost daily—it just ain't going to happen d/t supplies and logistics.

We SHOULD expect better air quality and safety in schools and workplaces moving forward regardless.

12. Finally: I expect some will agree with this thread, some will attack this (and me), and some will say "of course, we've been saying it is nothing but a cold and will be endemic" right from the start. Feel free to keep those beliefs.

Vaccines were a huge, earlier-than-expected game changer that has likely saved millions of lives already, and Omicron is a totally unexpected game changer that necessitates a changed strategy.

I have always tried to guide my thoughts by the available science.

Special thanks to @BallouxFrancois who I've never engaged with on Twitter, often silently disagreed with but respected, but whose post today prompted me to write this.