Tara Kiran Profile picture
Jan 22 10 tweets 4 min read
Thanks to the 1000's of people who have powered our 3rd dose effort. We've made amazing progress in a short time—and still have further to go.

A thread on why 3+ doses continues to be important and where we need to focus 🧵 Image
We now have more real world data showing that 3 doses is better than 2 at preventing infection and serious illness with Omicron

These two slides were shared by Dr. Allison McGeer and summarize data on infection and hospitalization with 3 v 2 doses in the UK ImageImage
Older adults are most at risk of COVID complications and thankfully we've done a pretty good job at getting vaccines to those 70+

But some regions are lagging behind. What can we learn from regions where vaccination rates are higher? Image
This slide illustrates that the variation in 3rd dose vaccination rates by public health unit is not about which delivery channels are used—the factors are likely more complex and worth unpacking Image
We need to increase uptake now for those <70

And in particular we need to focus on priority populations

Pregnant people are at high risk of complications if they get COVID, yet only 17% have received a 3rd dose

People who are immunocompromised need 3rd AND 4th doses Image
Who is eligible for a 4th dose?

4th doses can be given 3 months after a 3rd dose for people with very weak immune systems, for example, b/c of dialysis, cancer treatment, or meds that weaken the immune system including high-dose steroids 👇🏽

dfcm.utoronto.ca/sites/default/… Image
3 doses is still important even if you had COVID

Our experience with previous variants tell us that even after infection with COVID, vaccines add stronger and longer lasting protection. This means less chance of re-infection or transmission to others
If you got COVID, when should you get your 3rd dose?

You can receive it as soon as your symptoms are gone but most infectious disease experts recommend waiting 4-8 weeks to get stronger longer-lasting immunity
Finally, either Moderna or Pfizer are good choices for your 3rd dose if you are age 30+. Both are mRNA vaccines and have pretty much the same ingredients. Mixing and matching is just fine.

This is 1-pager from @TOPublicHealth provides more detail
track.upaknee.com/c/443/06c5e9b8… Image
We need continue to use many layers of protection to keep ourselves and more vulnerable people in the community safe and reduce our risk of serious outcomes from COVID-19.

Vaccination with a 1st/2nd/3rd/4th dose is one of the most important layers of protection we have

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More from @tara_kiran

Jan 24
*NEW* Our latest study @AnnFamMed @RickGlazier1 shows that team-based primary care, coupled with payment reform, can improve patient outcomes & reduce ED use

annfammed.org/content/20/1/24

We desperately need to expand team-based primary care in Canada

(a mega 🧵) Image
#Primarycare is the foundation of a high-performing health system. Yet, primary care has been in crisis for the last 2 decades—challenged by an outdated payment model, growing patient need, rapidly growing evidence, and dysfunctional electronic medical record systems
Sharing the care with an interprofessional team has been seen for some time as an antidote to this crisis

Pharmacists, social workers, nurses and others can provide additional expertise and support to patients, particularly those with chronic mental and physical health issues
Read 30 tweets
Jan 13
Are you confused about #COVID?

How do you know when you have it?
Who can get a test?
When to use a RAT?
When to call a doctor?

You're not alone.

We @UofTFamilyMed @OntarioCollege have pulled together answers to common COVID Q's
dfcm.utoronto.ca/confused-about…

Here's a rundown 🧵
1. How do you know you have COVID?

Bottom line: If you have symptoms, assume you have COVID

(Most people don't qualify for a PCR test)

dfcm.utoronto.ca/sites/default/…
2. When should I call my doctor?

i) if you have a pre-existing condition that needs attention
ii) if you might quality for treatment (e.g. very weak immune system, over 60, over 50 + certain medical conditions)
iii) you really are not feeling well!

dfcm.utoronto.ca/sites/default/…
Read 12 tweets
Jan 12
I've been thinking a lot about the patients in my practice who still say no to the COVID vaccine

They are not anti-vaxxers

Most have difficult lives—newcomers, BIPOC, histories of homelessness, trauma, poverty

They (reasonably) mistrust gov't & are victims of misinformation
We should certainly not be taxing these individuals or denying them healthcare

That goes against the principle of healthcare based on need as @picardonhealth @globeandmail so eloquently puts

theglobeandmail.com/canada/article…
I understand why there is anger directed at those who have still chosen not to be vaccinated

I suggest turning that anger constructively towards regulating the amplification of misinformation by social media platforms
Read 4 tweets
Nov 16, 2021
I know some parents are reasonably worried about the risk of myocarditis following COVID-19 vaccination for children 5 to 11

Here's what we know about the risk and why experts think it will be much LOWER in this age group than with teens/adults 🧵
First, it seems that kids have a lower predisposition for myocarditis and pericarditis.

Ontario data show the natural incidence of myocarditis and pericarditis (pre-COVID) was much lower for those <12

(data courtesy @DrJeffKwong via Dr. Upton Allen)
Second, experts believe the risk of myocarditis is dose-related. That's one of the explanations for why we saw higher rates for the Moderna vaccine compared to the Pfizer vaccine

The kids covid vaccine dose is 1/3 that of the teen/adult dose which hopefully means less risk
Read 8 tweets
Sep 30, 2021
Like many parents, I'm struggling to understand why the Ontario government is so strongly against using rapid testing to prevent the spread of #covid in schools.

THREAD 🧵
Is it because the tests are in low supply or too expensive to purchase?

No. My understanding is the feds are purchasing and distributing the rapid tests to provinces
Is it because we don't have the person-power to package/distribute the kits and interpret/action the results?

No. Even if PHUs are stretched, it seems like there are many eager community volunteers
Read 10 tweets
Sep 29, 2021
Let’s prevent a junior-edition of the vaccine “hunger games”

Instead, let take a schools-based approach so every child age 5-11 has a chance at getting the #covidvaccine once approved

New oped @TorontoStar from @SabiVM @NoahIvers and I

thestar.com/opinion/contri… via @torontostar
A schools-based approach would be most EFFECTIVE

Studies estimate that uptake of the HPV vaccine was almost 4 times higher in school-based programs compared to community-based ones

ncbi.nlm.nih.gov/pmc/articles/P…
A schools-based approach is EFFICIENT

No wasted time booking and travelling to appointments. We are bringing vaccines to where kids are already congregating
Read 8 tweets

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