Thread by @lymanstoneky

Quebec COVID update: Back when I projected this wave would just never generate the deaths and hospitalizations the government worried about, I made 3 scenarios for ICU cases. One assumed Case-->ICU ratios returned to historic wave ratios. One assumed they flatlined. One fell.

For January 8, the latest data, my low forecast suggested there would be 208 ICU cases. My mid forecast suggested 333 ICU cases. And the high forecast, the one the government is basically treating as "what is going to happen," was 795.

In reality, on January 8, there were 257 ICU cases: between my low and mid scenarios. So it continues to be the case that Quebec's wave is generating far fewer ICU cases per official positive case than prior waves.

Nonetheless, since Quebec "officially" has around 260-270 ICU beds, we are basically "at capacity" now. My mid forecast has always suggested we would go "over" ICU capacity.

So will we have incredibly high death rates?

Probably not.

Here's the rate at which lagged ICU cases generate official COVID deaths. As you can see, the ICU-->Death rate HAS risen somewhat, perhaps pointing to some hospital overcrowding. But even at present "spike" levels, it's 1/2 the rate as last winter.

This suggests that, overall, either the typical ICU case has become less severe, or hospital resources have expanded, or treatments have improved.

I don't think hospital resources have grown. In fact stories about nurse shortages and medical personnel quitting suggest the opposite: hospital resources may have fallen.

That implies hospitalizations occurring at milder thresholds, or improved treatment.

I actually don't think the threshold for hospitalization is likely to have fallen. If anything, fear about hitting hospital capacity and nursing shortages may have led hospitals to have gotten stricter about how they allocate ICU resources.

This implies that the *likeliest* story is improved treatments.

Note that vaccination cannot have a role here. Were talking about *among hospitalized people*. If they're vaccinated, they've already had a severe breakthrough case. Vaccine benefits failed them evidently.

Nor is it likely that this is an "Omicron is milder" story since, again, we are talking about *among people in the ICU*. Omicron may be milder on average, but for people in the ICU, it's not mild! It's by definition severe!

So my suspicion here is just that the medical system has gotten better at treating COVID patients both by finding actual medical treatments and just finding better overall courses of care.

Which is to say, it's very likely that the ICU-->Death rate, even if it could briefly spike higher, will remain generally below the levels seen last winter.

So what does this mean?

Since the Cases-->ICU rate has fallen by about 85%, and the ICU-->Deaths rate has fallen by about 50%, the Cases-->Deaths rate has probably fallen by something like 90-95%.

And indeed, on various lags, it seems like the Deaths/Lagged Cases rate has fallen by something like 85-95% in this wave vs. last winter.

This means to have a comparable amount of concern as last winter, you'd need to see somewhere between 6 and 20 TIMES as many cases.

We are seeing about 5x as many.

Since the current lockdown in Quebec is about as intense and in some ways even more intense than last winter.... this means that even if you use the MOST PESSIMISTIC assumptions about the current wave, Quebec's reaction has been excessive.

We do not need to be shutting down all businesses, imposing curfews, forcing churches to close, etc. These policies are unnecessary and do not match the actual level of risk Quebec is facing.