Trends w/ Omicron & RAPID INCREASES in hospitalizations are now clear.

'Leading indicator' jurisdictions w/ advanced Omicron waves (e.g. Ontario, Quebec, NYC, UK) are ALL showing BIG increases in adult hospitalizations.

All are strained further by HCW shortages. Brief 🧵 (1/n)
Let's start with the UK. Hospitalizations are rising quickly, as evidenced by the graph below.

Yes, not as bad as January surge w/ Alpha - yet. But additional challenges including system & HCW burnout, significant staff absences due to COVID, etc. (2/n)
Excellent description of pressures that National Health Service (NHS) currently faces via @ChrisCEOHopson.

Hospitalization challenges now DIFFERENT w/ Omicron. It's a "sheer numbers" issue of persons needing ward/medicine beds, less ICU capacity. (3/n)

Omicron seems to cause less severe illness & death (yay!), but large numbers of hospitalized patients will impact hospital "flow".

Elective procedures & surgeries that need a hospital bed won't have one. Nowhere for patients in ERs & ICUs to go. (4/n)

How about Quebec, where significant measures have been imposed and educational institutions are closed to in-person learning till Jan 17?

Hospitalizations are soaring. Almost vertical curve. Thanks to @MoriartyLab for this graph. (5/n)
Ontario? Hospitalizations beginning to steeply rise there too.

Thanks to @jkwan_md for this graphic plotting Ontario's cases (VERY underreported) vs. hospitalizations.

That hospitalization curve is going vertical, which is worrisome. (6/n)
New York City is America's Omicron epicenter, just as it was back in March 2020. Amazing numbers there - nearly 50,000 daily cases (underreported), test positivity of 22.7%.

Hospitalizations are soaring. (7/n)

Some people trying to "minimize" hospitalization impact of Omicron by implying many persons in hospital for reasons other than COVID, and "incidentally" found to have Omicron on admission screening.

This is false. See below via @deonandan & @bruce_arthur. (8/n)
The near-vertical hospitalization curves we're seeing now in Quebec and Ontario are WAY TOO STEEP to be explained only by "incidental" cases of COVID being found in hospital.

In the end, without (staffed) beds, a hospital's flow of patients grinds to a halt. (9/n)
In summary, RAPID #Omicron spread is leading to BIG spikes in hospitalizations across USA, UK, and Canada.

Decision-makers, don't say you didn't see it coming. IT'S COMING.

Slow transmission via targeted means. Maximize boosters. Please, give our hospitals & HCWs a chance. /fin

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More from @awong37

1 Jan
Many #SK families are worried re: return to school Jan 3. How safe are our kids & school staff?

Omicron in Regina and Saskatoon is surging. We'll continue to see record case numbers for weeks.

@SKGov, what's your plan? We NEED to know.

A 🧵 on safe schools, below. (1/n)
Let's begin with other provinces who are RIGHT in the storm of their Omicron surges. Quebec has delayed opening of 'everything' to Jan 17. Ontario has delayed opening till Jan 5 to try to distribute HEPA filters & N95s for staff (not students). (2/n)

cbc.ca/news/canada/to…
A respected colleague in Toronto, @drmwarner, reasonably argues for a 1-2 week delay IF a delay will increase booster doses for school/daycare staff, improve vaccine uptake for ages 5-11, & solidify distribution of HEPA/N95s/RATs in schools. (3/n)

Read 18 tweets
21 Dec 21
Modelling released by @SKGov predicts DRAMATIC rise in cases, hospitalizations, & ICU admits w/ #Omicron if no additional measures to reduce contacts (i.e. gathering & capacity limits).

Briefing today: NO measures to be implemented at present. Wait and see.

1/ #COVID19SK
Here is ICU / non-ICU modelling data. Not great, as you can see. Also not being taken into account - scores of HCWs taken out of circulation as a result of widespread community transmission.

Who will look after all the patients? Many HCWs have already moved on.

2/ #COVID19SK
Once again, there is an appeal to personal responsibility for #SK citizens to make good choices, do the right thing.

No surprises here. Get vaccinated, improve ventilation, use your best mask, etc.

3/ #COVID19SK
Read 6 tweets
15 Dec 21
"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
15 Dec 21
"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)
Read 10 tweets
23 Nov 21
"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 21
"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

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