Latest wastewater data for #SK communities was released earlier today. It's NOT good.

Let's work through what has been going on over the last couple of weeks as BA.2 has taken complete hold across Saskatchewan.

Short 🧵 - here we go. (1/7) Regina & Saskatoon have seen HUGE increases in wastewater viral burden since early April. It's all driven by the more contagious BA.2 Omicron variant.

@LaurenPelley tweeted last week as Saskatoon's viral burden increased an astonishing *742%*. (2/7)

https://twitter.com/LaurenPelley/status/1513542843301875715

Between February 1-26, 143 Saskatchewan citizens have died from #COVID19, despite Omicron being "less severe".

That's an INSANELY high number.

Saskatchewan's most deadly month thus far was October 2021, when 156 people died during our horrific Delta wave. /1 As highlighted by @DrKyle, Saskatchewan's death rate from #COVID19 is more than DOUBLE that of the 2nd highest province, Manitoba.

No province is even remotely close in terms of deaths per capita at this point with Omicron. So embarrassingly bad. /2

Hi, Saskatchewan.

Though @SKGov has now dropped all #COVID19 protections & mandates, sadly, COVID is NOT over.

#SK hospitals & ICUs remain packed.

Patients are being admitted, and dying, tragocally, eacn and every day.

A short 🧵 below for my fellow Saskatchewanians. /1 Please, be mindful of our medically vulnerable, kids under 5 who can't be vaccinated, the elderly & frail. Those who will and already face long COVID.

Respect their health and their right to live their lives as fully as possible in a manner that is safe & low-risk. /2

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

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

"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

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

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

https://twitter.com/awong37/status/1429084212276178951

"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

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) 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)

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)

"Hi Alex, I have 2 doses of vaccine & JUST recovered from COVID. I'm eligible for a 3rd dose. When should I get it?"

Great Q. You assuredly had Omicron, so while you're eligible to get your booster 'right away', I'd personally wait at least 6-8 weeks. Why?

Short 🧵 👇 (1/n) First, getting a 3rd dose even AFTER you've recovered from Omicron makes sense. You're further bolstering your immune response from whatever the 'next' variant will be. *Big sigh.*

Better for your immune system to be ready for whatever this pandemic throws at it next. (2/n)

OK. #SK COVID-19 mega-thread.

NEW #SK Omicron models (via @DennisKendel) Jan 19:

- Measures implemented to SIGNIFICANTLY reduce social mixing, MAYBE we avoid disaster/triage in #SK hospitals.

- Do NOTHING, #SK hospitals crushed, triage ensues.

Get comfy - here we go.

(1/25) Let's begin with history.

@SKGov was provided w/ models from WORLD-CLASS #SK modeler Dr. Nate Osgood in late August 2021 that predicted EXACTLY how #SK ICUs would be overwhelmed w/ Delta in Fall 2021.

Nothing was done. Everything left wide open.

(2/n)

thestarphoenix.com/news/local-new…

NO doubt now. BOTH Quebec & Ontario are in huge pain now w/ #Omicron. The GTA now is being hit hard.

It's a numbers game. Too many patients, not enough staff or beds.

Many HCWs & first responders out, too.

It's ALL bad. Everyone's reality is in plain sight.

🧵 below. (1/n) The number of ICU admissions & ventilated patients in Ontario continues to rise VERTICALLY.

The primary risk for ICU admission remains being unvaccinated, but more elderly persons now with comorbidities & waning immunity also. (2/n)

https://twitter.com/OntHospitalAssn/status/1479798937213091849

Trends w/ Omicron & RAPID INCREASES in hospitalizations are now clear.

'Leading indicator' jurisdictions w/ advanced Omicron waves (e.g. Ontario, Quebec, NYC, UK) are ALL showing BIG increases in adult hospitalizations.

All are strained further by HCW shortages. Brief 🧵 (1/n) Let's start with the UK. Hospitalizations are rising quickly, as evidenced by the graph below.

Yes, not as bad as January surge w/ Alpha - yet. But additional challenges including system & HCW burnout, significant staff absences due to COVID, etc. (2/n)

Many #SK families are worried re: return to school Jan 3. How safe are our kids & school staff?

Omicron in Regina and Saskatoon is surging. We'll continue to see record case numbers for weeks.

@SKGov, what's your plan? We NEED to know.

A 🧵 on safe schools, below. (1/n) Let's begin with other provinces who are RIGHT in the storm of their Omicron surges. Quebec has delayed opening of 'everything' to Jan 17. Ontario has delayed opening till Jan 5 to try to distribute HEPA filters & N95s for staff (not students). (2/n)

cbc.ca/news/canada/to…

Modelling released by @SKGov predicts DRAMATIC rise in cases, hospitalizations, & ICU admits w/ #Omicron if no additional measures to reduce contacts (i.e. gathering & capacity limits).

Briefing today: NO measures to be implemented at present. Wait and see.

1/ #COVID19SK Here is ICU / non-ICU modelling data. Not great, as you can see. Also not being taken into account - scores of HCWs taken out of circulation as a result of widespread community transmission.

Who will look after all the patients? Many HCWs have already moved on.

2/ #COVID19SK

"Hi Alex. With #Omicron in Canada, what's the optimal 2nd dose interval for kids b/w 5-11 who have 1 dose?"

VERY different space w/ Omicron now vs 4 weeks ago when NACI guidance was released.

We'll try for 3-4 wk interval in #SK for our 5 year-old, NOT 8. Here's why. (1/n) Let's start by acknowledging that we have no real clinical data in this space right now. We don't know HOW protected kids b/w 5-11 are with 1 dose vs different variants like Delta or Omicron.

Kids immune systems are ++ robust, so 1 dose definitely confers some protection. (2/n)

"Hi Alex, how do I keep my holiday gatherings safe? Do I have to cancel everything?"

Depends on your risk tolerance. If your bubble has persons who are medically vulnerable, elderly, maybe reconsider.

Otherwise, use ALL measures to keep things safe as able.

Brief 🧵. (1/n) We all know that seeing & reconnecting with friends & loved ones over the holidays is SO critically important. But with the transmissibility of #Omicron, the risk-benefit calculus has changed dramatically again. What do we do now? (2/n)

"Hi Alex. My (5 to 11) year old just got their 1st #COVID19 vaccine dose. Yay! Should we wait 8 weeks for the 2nd dose as recommended, or should we just get a 2nd dose ASAP at 3 weeks?"

No clear answer, but my wife & I WILL WAIT 8 WEEKS for our 5 year-old son.

Brief 🧵. (1/9) A longer duration between 1st and 2nd doses of Pfizer-BioNTech vaccine has been shown to increase antibody levels and makes COMPLETE SENSE from the immunological perspective given our experience with all other vaccines in both kids and adults. (2/9)

cell.com/cell/fulltext/…

"Hi Alex. What is this Western Canadian variant? Is it something to be worried about?"

Yes, there's a new Canadian AY.25 clade which originated from Idaho. This AY sublineage appears to have become dominant in Alberta and Saskatchewan. (1/9)

#COVID19AB
#COVID19SK This is a bit technical, but as you can see in the phylogenetic analysis below, the strain appears to have originated from Idaho and then spread quickly throughout all of Western Canada. (2/9)

#COVID19AB
#COVID19SK