Dr. Alexander Wong Profile picture
Feb 24 15 tweets 6 min read
Weekly Saskatchewan COVID-19 data for Feb 13-19.

KEY POINTS:
- 37 deaths over 7 days. 1 b/w 20-39, all others >= 40
- Hospitalizations & ICU admissions decreasing (phew)
- Weekly test positivity 14.4% (last wk ~20%)
- ALL Omicron (no breakdown of BA.1 vs BA.2)

Brief 🧵 /1
Let's start with key data around hospitalizations & ICU admissions.

Week-by-week hospitalizations down 9% to 372, ICU down 18% to 27. Slowly coming down, thankfully.

Of those with known COVID status, 42% in hospital/ICU "due to COVID", 58% "incidental". /2
We can see that overall hospital admissions per day definitely decreasing now across all regions of Saskatchewan, but it's a relatively slow decrease, likely driven by limited protections we have in place provincially.

Still, this is reassuring and encouraging. /3
Different way to visualize overall hospital census numbers. Again, we're seeing slow decreases, but hopefully we've reached and moved past our peak re: hospitalizations / ICU admissions.

Wish we could see that curve come down faster, though. /4
ICU admissions coming down as well.

We see 2 peaks, one from the initial Omicron surge, and then a second as our #SK hospitals filled up. However, things look definitely like they're on the downswing with critically ill patients too. /5
Here's PCR testing data & test positivity information by regions in #SK.

Overall test positivity in Saskatchewan has decreased to 14.4% from 20.2% week over week. Again, encouraging.

Hard to interpret region-by-region data as PCR testing limited now, so won't even bother. /6
This graph just illustrates the time period for which Omicron took over from Delta in Saskatchewan.

Essentially by mid-January, everything was Omicron.

Important to understand BA.1 vs BA.2 breakdown for Saskatchewan but that was not made available in this data report. /7
Deaths week-by-week DID come down, but rates are still very high. 37 deaths over 7 days, compared to 42 the previous week.

One person b/w 20-39 died. All others over 60. Most over 80. 😢

Rate of death in Saskatchewan equivalent to 65 persons dead per day in Ontario. 😢😢😢 /8
Vaccine uptake in #SK has stalled.

For ages 5+:

- Only 0.1% increase in first doses given
- Only 0.2% increase in 2nd doses given
- Only 0.4% increase in 3rd doses given

ONLY Regina reports over 80% of eligible population fully vaccinated (2+ doses). /9
So in summary, #SK doing a bit better in hospitals and ICUs as Omicron slowly begins to crest & fade.

Wastewater data from Regina and Saskatoon was concerning this week, hopefully this will not translate to more hospital / ICU pressure.

Impact of BA.2 is unknown right now. /10
Death rates have remained high for the 2nd week in a row, including an individual under 40.

#SK's death rate from COVID-19 remains high, tragic, and likely under-reported.

Let's hope that deaths peak and come down quickly soon. /11
As protections end across Saskatchewan come March 1 (e.g. indoor masking), the outcome will be slower-than-ideal decreases in our hospitalization / ICU admission numbers, but we DO appear to be past this peak now.

Hopefully BA.2 will not cause a resurgence. /12
Vaccine uptake in Saskatchewan has slowed to almost nothing now. Not surprising and predictable especially with the end of our proof-of-vaccine certificates.

Only one place in Saskatchewan, Regina, has a vaccine uptake rate of greater than 80% for those ages 5+. /13
All #SK hospitals definitely remain under massive pressure. #SK ICUs, less so.

In an ideal world, we would be removing protections when our hospitals & ICUs decant even further than they are right now.

Not to be, however. /14
Omicron remains very much present in Saskatchewan.

Minimal protections means our wave will be prolonged compared to other jurisdictions. It is what it is.

Good news? Hospital/ICU admits have hopefully peaked for this wave. Fingers crossed this continues.

Be safe, all.

/end

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More from @awong37

Feb 22
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
Read 11 tweets
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

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