1) On Sunday, out of the blue, Premier François Legault tweeted the latest ICU COVID numbers for Quebec and Ontario after insisting for days that making such comparisons was not fair. In this thread, I will try to explain why such an ICU comparison might actually favor Ontario.
2) At first glance, Legault’s tweet would appear to suggest Quebec is handling the 5th wave of the #pandemic much better than Ontario. “Number of COVID patients in intensive care: Quebec: 282 Ontario: 579,” Legault tweeted yesterday. 
3) Almost immediately, Legault’s observation sent journalists scrambling to place the Premier’s tweet into context, pointing out correctly that Ontario’s population is a lot bigger, 14.7 million, while Quebec’s stands at 8.6 million.
4) Former Senator André Pratte took to Twitter to denounce Legault’s comparison. “This is not a hockey game here where we will declare the winner of the ‘Covid cup.’” @apratte wrote. “In all provinces, the situation is tragic.”
5) But what if there were more to Legault’s tweet than meets the eye? What if Legault inadvertently touched on something that might help explain why Quebec’s #COVID deaths are now far outpacing Ontario’s? This thread is an attempt to answer that question.
6) Long before Legault’s ICU tweet Sunday, I observed that throughout the #pandemic, Ontario was consistently reporting proportionally slightly more #COVID ICU hospitalizations than Quebec. Did this suggest — as Legault’s tweet implied — Quebec was managing better than Ontario?
7) In fact, I later learned that it might be the opposite. I interviewed the chief of intensive care at a Montreal hospital who also had worked in Ontario ICUs for five years. This ICU chief told me that Ontario ICUs have more resources than those in Quebec.
8) The ICU chief added that from his experience, Ontario has relatively more staffed ICU beds than Quebec. The implication here is that Ontario doctors may sometimes be quicker to admit #COVID patients to an ICU than Quebec because of greater capacity in Ontario.
9) If true, this might help explain, in part, why Quebec’s #COVID deaths are now outpacing Ontario’s mortality rate. Presumably, the sooner a critically-ill #COVID patient can be admitted to an ICU, the better the potential outcome for that patient.
10) “Early referral (to the ICU) is particularly important,” a 1999 British Medical Journal study found. “If referral is delayed until the patient’s life is clearly at risk, the chances of full recovery are jeopardized.”
11) Let me be clear: In no way am I suggesting that Quebec doctors and nurses are even remotely to blame. On the contrary, they are doing truly heroic work — have been for two years now — saving lives in a hospital system that has buckled under the weight of the #pandemic.
12) Furthermore, does Ontario indeed have more staffed ICU beds per capita than Quebec? The non-partisan Canadian Institute for Health Information collects relevant statistics on hospitals across the country. It's so done so for this #pandemic. But Quebec chooses not to part.
13) Thus, it’s hard to objectively determine whether Quebec’s ICU capacity is lower than Ontario’s. What we do know is until recently, Quebec’s ICU capacity for #COVID patients was 319. That capacity has now, incredibly, been boosted to 520 despite a massive shortage of staff.
14) In contrast, the Ontario Health Ministry announced Jan. 11 that the province has 2,436 adult ICU beds. “Approximately 600 ICU beds remain available today, with the ability to add nearly 500 additional beds if required,” the Ministry added.
15) On Monday, Quebec declared 286 COVID ICU patients, up by four. In contrast, Ontario reported 578 such patients, down by one. Please see the Ontario chart below on that province’s ICU picture, much more detailed than anything available in Quebec.
16) But André Pratte is right. This is not a hockey game with the provinces competing for the COVID cup. Comparisons should only be made if they are accurate, consistent and can guide us to making better decisions. Plus, they must be fair. End of thread.
17)ADDENDUM: My heart goes out to the family of the 4-year-old girl whose death was confirmed by the CHU de Québec-Université Laval on Monday afternoon. The hospital linked her death to #COVID19. May she rest in peace, along with 12,364 other Quebecers who’ve perished to date.
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