Thread by @MoriartyLab

71,000 NEW Canadian deaths is the current Omicron endpoint, if 90% of us are infected. Which is possible in next 4 weeks at current doubling rate.

If that's what you're asking.

Expected annual Canadian flu deaths: 4k

Cdn WWII death toll: <50k

This is what mild actually means

https://twitter.com/TorontoIDDoc/status/1478217579479109634

Here is the daily updated spreadsheet any Canada can use to see estimates of future deaths, ICU admissions and hospitalizations in their regions.

Methods and sources are at bottom.

docs.google.com/spreadsheets/d…

I update it daily with the latest vaccine efficacy data from @COVIDSciOntario, it's been adjusted to reflect Omicron severity estimated in recent @PublicHealthON study.

And yes, I'm expert in demographics of COVID-19 death in Canada. See link here: rsc-src.ca/en/covid-19-po…

@COVIDSciOntario @PublicHealthON I probably think more about this on a daily basis than any other person in the country.

What we most need to do right now is slow spread so that those who do get sick get the best care they can. Otherwise the numbers could be higher.

@COVIDSciOntario @PublicHealthON It's not clear that we have enough stock in the country of the one monoclonal antibody still working against Omicron to get it to people as they get sick. Countries around the world are competing for it, including our large neighbour to the south.

@COVIDSciOntario @PublicHealthON That monoclonal....people need to get it in the first 7 days of symptom onset for it to help prevent hospitalization. We need to slow spread enough that we have a hope in hell of testing and diagnosing those people and getting them into treatment fast enough.

@COVIDSciOntario @PublicHealthON We have don't know when/if Paxlovid will be approved by Health Canada, and if it is, if we can even get it into the country fast enough. For that to work, people have to start treatment within 3 days of symptom onset. So, testing can't be overloaded and has to be FAST.

@COVIDSciOntario @PublicHealthON For hospital and ICU care to work, we can't have 50% of hospital staff out sick with COVID, or in isolation because family members have COVID, or unable to work because schools are closed and/or emergency childcare isn't available....remember most HCWs are women.

@COVIDSciOntario @PublicHealthON All of these things together create a perfect wave of crisis that will drive up deaths above the baseline estimate.

If the doubling time is currently ~7 days and currently ~10% of Canadian population has been infected since Nov 15, in 2 weeks 50% of us may have been infected.

@COVIDSciOntario @PublicHealthON The mildest outcomes are what come first: i.e. hospitalizations that don't necessarily progress to ICU.

This is because:

1) deaths lag ICU, which lag hospitalizations, which lag cases...each by 1-2 weeks

2) people younger than 40 were infected first

@COVIDSciOntario @PublicHealthON Now we're seeing infections of older people, as @EdTubb and @NathanStall have been pointing out in Ontario.

With the possible exception of Newfoundland Labrador and Prince Edward Island, most of the country is in the same boat--maybe lagging at most 1 week behind front-runners.

@COVIDSciOntario @PublicHealthON @EdTubb @NathanStall Tomorrow (Jan 4) we're going to find out just how bad the situation is everywhere in the country, as provinces start reporting officially again.

Given the instability of Canadian COVID reporting over the December holidays, we won't have a complete picture until next week.

@COVIDSciOntario @PublicHealthON @EdTubb @NathanStall By the time we have a clear picture of what happened over the holidays, 25% or more of the country will likely have been infected. If we take another week to decide what to do, 50% may be infected. And any measures we do adopt will take at least 2 weeks to work.

@COVIDSciOntario @PublicHealthON @EdTubb @NathanStall But.....based on Cdn population age structure, Omicron severity, vaccine effectiveness etc 1 thing that is pretty clear right now is that ~1 of every 100 infections in Canada will result in hospitalization.

Every 100 infections we prevent is 1 prevented hospitalization.

@COVIDSciOntario @PublicHealthON @EdTubb @NathanStall Each one of our personal decisions matters. At our current Rt, every infection leads to 1.7 more infections, let's round to 2. 1 becomes 2 three days later. 2 becomes 4 six days later. 4 becomes 8 nine days later. 8 becomes 16 twelve days later.

@COVIDSciOntario @PublicHealthON @EdTubb @NathanStall 16 becomes 32 fifteen days later. 32 becomes 64 eighteen days later. 64 becomes 128 twenty-one days later.

So, you avoiding contracting and spreading infection can prevent 1 hospitalization <3 weeks later.

Our personal decisions matter, even if this seems hopeless.

Finally, I would like to point out that although these medium-large high income Northern hemisphere countries also have Omicron, they're controlling it much better than Canada: South Korea, Taiwan, Japan. It's a choice.

Canada is also only OECD country that restricts testing to symptomatic people in high risk groups. We do 50% less per cap testing than peers. We do 75% less testing per case IDd. We're paying for our failure to scale up testing enough after 1st wave. We had time but not will.

I see some people commenting that this could be 10,000 deaths per day, and that this is not possible. What most people don't realize is that all those deaths will take months to happen. They'll still be happening into the late summer. People don't always die of COVID right away.

Many people die later of a heart attack, or stroke, or kidney failure or a second infection that they might have resisted if their lungs weren't damaged by COVID.

Also, death reporting in Canada is really, really slow. Did you know that there are still COVID deaths from the first wave that weren't provincially reported at the time that are now showing up in the national mortality database.

On average, Canada takes about 2 years to report all its deaths. We still don't have complete reporting for the first wave, and it likely won't be complete until summer 2022.

We won't know what happened in the Omicron wave until the middle of 2024, or possibly later.

As time has gone on, it's become clear that Canada did not detect and/or attribute likely COVID deaths to COVID, at least Canada outside Quebec. The under-detection/under-reporting was about 50% outside QC until the end of 2020.

We simply don't know after that, because death reporting is so incomplete.

We're not alone in this. Most countries have under-detected/under-reported COVID deaths by at least 25-50%. We're not special in this respect--just average.

Finally, I see people saying this just isn't possible and that vaccines work.

Yes! Vaccines work. For the Canadian population age structure the death rate pre-vaccine would have been 1.3%. It's about 0.19% now, without all of us fully vaxxed.

Multiply 0.19% by 38,500,000 people

Also, FYI, to date COVID-19 vaccines have saved an estimated 474,000 lives of people living in Canada.

Can you imagine what Omicron would have done if we didn't have vaccines?

See column Z in spreadsheet here:
docs.google.com/spreadsheets/d…