Dr. Alexander Wong Profile picture
Feb 22 11 tweets 6 min read
Saskatchewan #COVID19 wastewater data released today for 4 #SK communities.

Both Saskatoon & Regina showing significant INCREASES in viral load week over week. Discouraging.

Reasons for increase unclear at this time. BA.2 driven?

Brief 🧵 to review #SK wastewater data. /1
Let's start with Regina.

@UofRegina wastewater analysis shows rebounding viral load levels week-over-week, suggestive of ongoing high rates of viral transmission in community.

BA.1 remains dominant but 18% BA.2 reported too. We expect BA.2 to dominate in coming days. /2 Image
Also, note that @UofRegina plot is time-lagged by 13 days, as the most recent analysis comes from the time period b/w Feb 6-12 inclusive.

So presumably proportion of BA.2 in Regina is higher now, just don't know how much higher. /3
Not much better in Saskatoon. @usask_water analysis for week ending Feb 16 shows 98.1% INCREASE in viral load burden compared to week prior.

No breakdown of proportion of BA.1 vs BA.2 included that I could find. "All Omicron". /4 Image
Levels of wastewater viral load in Saskatoon are now the HIGHEST they have ever been throughout the course of the pandemic.

In summary, NO clear signal that Omicron has peaked in either Saskatoon or Regina.

I am guessing that BA.2 is driving more transmission, but not sure. /5 Image
Things are different in 'rural' Saskatchewan. Prince Albert shows week-over-week DECREASE of nearly 64%. That's good.

However, rural #SK has lagged the major cities w/ Omicron, so guessing that BA.2 hasn't quite 'arrived' in smaller Saskatchewan cities quite yet. /6 Image
You can see the significant decrease in viral load burden in Prince Albert week over week. We'll see whether BA.2 plays a potential role in increasing viral load burdens in the coming days. /7 Image
However, what's unclear is that only 77% of viral load burden is being driven by Omicron. Delta is now "undetectable".

What's the remaining 23%? Is this potentially BA.2?

Would depend on the gene targets used for sequencing, but would be helpful to get clarification. /8 Image
North Battleford's week-over-week virall load burden is also increasing, up nearly 40%. This represents the highest viral load burden North Battleford has ever seen, and ~86% is Omicron. Delta undetectable. Is remaining 14% BA.2? /9 ImageImageImage
Summary:

- Omicron continues to surge across ALL of Saskatchewan
- Removal of protections (e.g. indoor masking) will prolong Omicron wave in Saskatchewan
- BA.2 will dominate in #SK 'soon'
- With no publicly available data, impossible to know where we're at

Be safe, all.

/end
FYI: links to source data for reference.

University of Regina data: facebook.com/UniversityofRe…

University of Saskatchewan data:
water.usask.ca/covid-19/index…

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More from @awong37

Feb 20
"Hi Alex, what's BA.2? Is it a little bad or is it REALLY bad?"

BA.2 is a sub-lineage of Omicron. The 'original' lineage of Omicron is designated as BA.1 & remains the dominant strain circulating in most parts of Canada currently.

A brief 🧵 of what we know thus far. /1
BA.1 & BA.2 are both classified by @WHO as Omicron, but are distinct viruses. See the phylogenetic diagram below (thx @kallmemeg).

BA.2 has over 25 mutations that differentiate it vs BA.1.

Many questions still exist around how similar BA.1 & BA.2 are clinically. /2
Danish pre-print data comparing transmission of BA.1 vs BA.2 in household settings suggests BA.2 IS more transmissible than BA.1.

BA.2 also LIKELY possess more immune-evasive properties vs BA.1 that could reduce vaccine efficacy. /3

medrxiv.org/content/10.110…
Read 20 tweets
Feb 11
Great @SaskHealth Town Hall last PM re: #COVID19 in Saskatchewan. Key points:

- Community MAY have peaked w/ Omicron.
- Non-ICU/ICU numbers STILL rising
- #SK non-ICU system capacity MAXED OUT.
- Relaxed public health measures in #SK = LONGER & MORE SEVERE Omicron wave

🧵 /1
Let's start w/ cases, non-ICU & ICU COVID patients, & deaths.

CASES (blue line) are falling. This may be artificial to degree given limited PCR testing in #SK.

HOSPITALIZED (non-ICU) patients (light green 'shade') are at HIGHEST LEVELS of pandemic, now exceeding Delta. /2
ICU patients (dark green 'shade') are rising but nowhere near levels seen w/ Delta when #SK had to fly patients to Ontario.

DEATHS (red line) are rising gradually with Omicron but remain considerably lower than #SK's Delta peak. /3
Read 21 tweets
Feb 1
Yesterday, Premier Moe said #COVID19 cases in Saskatchewan are more frequent in the vaccinated vs. those who aren't.

THUS, vaccines DON'T prevent infection with or transmission of Omicron.

The Premier's conclusions are INCORRECT. But why?

It's complicated. Here we go.

🧵 /1
The Premier's incorrect conclusion stems from a simplistic interpretation of the data. 'Base rate fallacy' is one problem, but there are MANY other factors at play.

We explained 'base rate fallacy' with cases & vax status back in August. See below. /2

For 'base rate fallacy' & #COVID19 & hospitalizations, this is the diagram EVERYONE uses (thx @MarcRummy).

MANY more people are fully vaccinated now, so even though a small proportion of them go to hospital, the absolute numbers are the same as those unvaccinated. See below. /3
Read 25 tweets
Jan 30
"Hi Alex. I have #COVID19 infection. Should I try to get Paxlovid? What is it? Will it help me?"

Short answer: YES, you should.

BUT, there's LOT of things to know about it, and your eligibility for it will depend on where you live + many other things, too.

Explainer 🧵. /1
Paxlovid's generic name is nermatrelvir/ritonavir. It's a combination of 3 pills taken twice daily for 5 days.

Nermatrelvir is a "protease inhibitor". It works by blocking an enzyme ("protease") that the virus needs to manufacture new copies of itself. /2
In this situation, Ritonavir acts as what we call a "booster drug".

It inactivates an enzyme in our bodies called CYP3A4 that plays an important role in metabolizing and removing many medications from our bodies.

This allows nermatrelvir to exist longer in our bodies. /3
Read 15 tweets
Jan 29
Earlier today, @PremierScottMoe posted a letter. In it, he stated:

- Being vaccinated DOES NOT prevent one from contracting #COVID19
- Vaccines are NOT reducing transmission of #COVID19

Both statements are FALSE & should be corrected ASAP for the record. Thank you.

🧵 (/1) ImageImage
Many studies show 3 doses of mRNA vaccine (Pfizer or Moderna) provides 60-70% protection (vaccine effectiveness, VE) vs Omicron infection.

If you don't get infected, then you don't transmit the virus. Simple.

So being vaccinated, esp. w/ 3 doses, makes a HUGE difference. (/2)
Here is a recent pre-print from Moderna showing ~68% VE against Omicron infection with 3 doses of vaccine.

Also, VE to prevent hospitalization w/ Omicron following 3 doses was >99%. That's HUGE. (/3)

medrxiv.org/content/10.110…
Read 13 tweets
Jan 21
On January 18, @PremierScottMoe posted a graphic comparing "real-time" QC / ON / MB hospitalizations / ICU admissions vs. SK.

Problem: SK is ~3 weeks behind those provinces w/ our Omicron surge.

We MUST be careful interpreting this data. We're NOT OK, Saskatchewan.

🧵👇 (1/n)
A more reasonable and appropriate comparison would be to look at where MB/QC/ON were at ~3 weeks from Jan 18 to create a more fair "apples vs apples" graphic.

For those 3 provinces, that would take us to about Dec 28. Let's see what the data shows us. (2/n)
We have #QC data from Dec 28 & Jan 18 in the graphics below courtesy @sante_qc:

Dec 28: 804 in hospital (including ICU), 128 in ICU
Jan 18: 3425 in hospital (including ICU), 285 in ICU

(3/n)
Read 11 tweets

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