On the advice of the CMOH, yesterday the Ford government lifted Ontario’s proof of #COVID19 vaccination requirements effective March 1st.

While some have simply dismissed this as capitulation to the "Freedom Convoy," it's actually much more complex.

1/10
thestar.com/politics/provi… In evaluating their decision, we must 1st consider whether a 2-dose vaccine certificate remains justified by a compelling purpose.

In July 2021 when Delta was dominant, our @COVIDSciOntario brief outlined key considerations for vaccine certificates.

2/10
covid19-sciencetable.ca/sciencebrief/c…

To date, 23.5-million Canadians (71%) aged ≥12 years have received 1 dose of a #COVID19 vaccine and 3-million (9%) are fully vaccinated.

Incredibly, we still don't have guidance for the fully vaccinated.

Us Canadians seem to be experiencing Fear of Normalization (FONO).

1/10 The @CDCgov released its first guidance for the fully immunized on March 8.

@RobynUrback wrote about the need for similar Canadian guidance on April 16: theglobeandmail.com/opinion/articl…

Months later, all Canadians are still given the same guidance regardless of vaccination status.

2/10

The final report of #Ontario’s Long-Term Care #COVID19 Commission is now available: ltccommission-commissionsld.ca/report/pdf/Ont…

The 322 page report released today details 85 recommendations focusing on:

1. Pandemic Preparedness

2. Addressing the Aftermath of COVID-19 for Residents and Staff

1/4 3. Infection Prevention and Control

4. Strengthen Health Care System Integration

5. Improve Resident-Focused Care and Quality of Life

6. French-Language Services

7. Address the Human Resources Challenges

8. Operational and #LTC Home Development Funding

2/4

From some reason, this @BusinessInsider article from Feb 23rd is making the rounds today on social media: businessinsider.com/new-data-calls…

The sensationalist headline "Scotland's vaccine rollout suggests delaying the 2nd #COVID19 shot is a bad idea" requires some serious nuance.

1/6 The news article references a Feb 19th pre-print: papers.ssrn.com/sol3/papers.cf…

This means that the study was neither peer-reviewed nor finalized when posted.

The pre-print reported a combined 58% vaccine effectiveness for #Pfizer and #AstraZeneca starting 42 days after 1 dose.

2/6

Today #Ontario enacted a new emergency measure providing hospitals with the authority to transfer patients who no longer require acute care (so-called "alternate level of care" or ALC patients) to #LTC and retirement homes without their consent.

news.ontario.ca/en/release/100…

1/15 This action is being taken to create additional room in #Ontario's acute care sector for the 3rd wave of #COVID19.

There are currently 4,288 ALC patients in hospital, and 1,854 are waiting for #LTC beds.

There are also 5,401 vacant #LTC beds available for new admissions.

2/15

Today #Ontario's Auditor General released a scathing report on pandemic readiness and response in long-term care: auditor.on.ca/en/content/spe…

The report details the many factors resulting in 3,919 residents dying of #COVID19 and countless others suffering during the pandemic.

1/7 1. Residents were living in rooms with 3 or 4 occupants

2. The transfer of patients designated as alternate level of care (ALC) from hospitals to #LTC homes contributed to crowding in homes

3. #LTC homes had insufficient staff and staff training to provide appropriate care

2/7

One population I fear is being overlooked (yet again) during #Ontario's 3rd wave is community-dwelling older adults.

There is no doubt that the new variants of concern make #COVID19 a different disease, with increased risk for younger populations: covid19-sciencetable.ca/sciencebrief/c…

1/8 With this changing disease come more tragedies of younger adults—especially essential workers—being hospitalized and dying from #COVID19.

These stories must be told and Ontario must enact supports like paid sick leave.

But sometimes missing are the stories of older adults.

2/8

ICMYI—Dr. @iPreetBrar on why the Canada Recovery Sickness Benefit (CRSB) is NOT paid sick leave: thestar.com/opinion/contri…

#CRSB is limited to those workers who miss at least 50% of their work week because they are unwell or isolating from #COVID19: canada.ca/en/revenue-age…

1/5 This means that #CRSB doesn't cover shorter absences, thereby excluding:

-Worker time off to get tested or vaccinated

-Workers who stay home due to symptoms or exposure, subsequently test negative for #COVID19, and are cleared for return to work within <50% of a work week.

2/5

With #COVID19 vaccine supply ramping up, there is lots of discussion about #Ontario's vaccine distribution plan and how individuals are being prioritized.

Ontario's ethical framework is clear that prevention of illness/death is not the only priority: ontario.ca/page/ethical-f…

1/8 These multiple and divergent priorities (reduce illness/death vs. promote economic/social wellbeing) aren't clearly ranked.

e.g., 1.5 million essential workers have similar priority to 3.5 million older adults (who account for 96% of COVID19 deaths): files.ontario.ca/moh-covid-19-v…

2/8

#Ontario is trying to deploy 385,000 rapid antigen tests per week in #LTC homes for asymptomatic #COVID19 screening: news.ontario.ca/en/release/603…

This is a bad idea for several reasons—not only is this infeasible, but it will be practically impossible for most homes to complete.

1/9 Currently asymptomatic staff undergo weekly PCR testing, much of which is completed on-site at #LTC homes and testing is staggered throughout the week.

Essential family caregivers complete PCR testing off-site at assessment centres or pharmacies (some are done at homes).

2/9

In the last few days and following the emergence of #COVIDzero, I've noticed an unsettling fissuring within the academic community.

As @IrfanDhalla says, people on both sides likely agree more than they disagree, but the divisiveness is unproductive: thestar.com/life/health_we…

1/8 The #COVIDzero approach recognizes that there is a disjointed approach to #COVID19 in Canada that is causing uncertainty, unnecessary suffering, economic hardship, and preventable deaths.

#COVIDzero is based on a goal of 0 cases with 0 tolerance for community transmission.

2/8

New @medrxivpreprint (not yet peer-reviewed) with @KevinAnBrown and colleagues examining temporal variations in the intensity of care provided to the 2,000 Ontario #LTC home residents who died of #COVID19 between March 11th and October 28th, 2020: medrxiv.org/content/10.110…

1/6 While there was no official policy denying hospitalizations media reports (cbc.ca/news/health/co…) & testimony from Ontario's LTC COVID19 commission (ltccommission-commissionsld.ca/transcripts/pd…) suggest that resident transfers to hospital were strongly discouraged at the onset of the pandemic.

2/6

Our study led by @KevinAnBrown associating crowding in #Ontario nursing homes (defined as the mean number of residents per bedroom and bathroom) with #COVID19 infection and mortality has now been published in @JAMAInternalMed: jamanetwork.com/journals/jamai…

1/9 We analyzed #COVID19 incidence and mortality data for residents of nearly all of Ontario's 623 nursing homes from March 29-May 20, 2020.

As of March 29th there were 78,607 residents in these homes, with 36.9%, 37.3%, and 25.8% in single, double, and quadruple-bedded rooms.

2/9

Yesterday, despite rising #COVID19 cases, hospitalizations, and deaths in LTC, Ontario released a framework to "keep the province safe and open": news.ontario.ca/en/release/590…

This is nothing more than an ageist, ableist & unethical "shielding" or "focused protection" strategy.

1/12 A "shielding" or "focused protection" strategy (the latter was popularized by the Great Barrington Declaration: gbdeclaration.org) segments the oldest and most vulnerable to #COVID19, while allowing everyone else to resume life as normal with simple hygiene measures.

2/12

Manitoba's Health Minister called out the "motivation" of >200 doctors who wrote an open letter calling for stronger action: cbc.ca/news/canada/ma…

Remember @CameronFriesen called care home deaths "unavoidable"—let me explain how when it comes to #LTC he hasn't "got this".

1/9

https://twitter.com/WabKinew/status/1323762934586109953

Let's review the escalating #COVID19 catastrophe in the province's care homes.

There are 14 active #LTC home outbreaks and 38 cumulative resident deaths. Today the @redcrosscanada was called into Parkview Place and Maples, the two hardest hit homes: cbc.ca/news/canada/ma…

2/9

In the last 24 hours, two more Ontario #LTC residents died of #COVID19: ottawacitizen.com/news/local-new…

There remain 22 active Ontario #LTC home outbreaks (see figure).

@ASPphysician has challenged me to say what must be done to get this under control.

Here it is (a thread).

1/8 We need swift action to control community transmission of #COVID19 which is getting out of control.

In our @CMAJ study, the prevalence of #COVID19 in the community surrounding a home was strongly associated with the odds of an outbreak (aOR = 1.91): cmaj.ca/content/192/33…

2/8

The @ONlongtermcare released an FAQ document on the updated directives for visitation in nursing and retirement homes: ltchomes.net/LTCHPORTAL/Con…

The details in this document further highlights the restrictive, onerous and even cruel conditions for visitation.

@picardonhealth

1/8 The nonsensical requirement for potential visitors to test negative for #COVID19 within the previous two weeks holds visitors to a higher testing standard than healthcare workers!

As @drlesleybarron writes "I'm a HCW but my first #COVID19 test will be so I can visit my mom"

2/8

The approach to "reopening" nursing and retirement homes in Ontario is 1) misinformed, 2) overly restrictive, 3) prone to abuse, 4) not evidence-based, 5) inequitable, and 6) stinks of ageism.

Let me break down the changes announced by the @ONgov: news.ontario.ca/opo/en/2020/06…

1/7 Misinformed: the reopening policies still fail to recognize that many of these so-called "visitors" are family caregivers, essential partners in care who provide hands-on care and support to residents: medium.com/in-this-time-o…

@MaggieKeresteci @SolidFooting @clairehsnyman

2/7

1/7 What is the max daily number of incident #COVIDー19 cases a healthcare system could manage?

@vasilepi @BreslowDay @mattwrkntn @BogochIsaac and I made an interactive tool modelling the capacity of acute and critical care resources during the pandemic: caic-rt.shinyapps.io/CAIC-RT/?utm_s… 2/7 The tool determines the max daily number of incident #COVIDー19 cases where the rate of #COVIDー19 patients being admitted to acute care, critical care or requiring mechanical ventilation ("patients in") equals the max daily turnover rate of those resources ("patients out").