Big news on Canadian expert policy advice Wednesday morning that seems to have slipped under the radar. Per the attached, Royal Society (RSC) & Academy of Health Sci (CAHS) have given notice to leave the Council of Canadian Academies (CCA). Some personal reflections follow 🧵n=7 1. CCA created to notionally link the RSC, CAHS & engineering/CAE). Got rolling in 2006. Its assessments entail volunteer experts working w/ a fine staff of ~25 to distill evidence relevant to public issues. Topics framed mostly by federal gov't. Budget about $3M/yr.

🧵Oscar (masked dog): There's some rumbling that all these restrictions are pointless -- Omicron is everywhere. We should just do vaccines & live with the spread.

Old Fart: Yep. So, imagine this is a big fire, scattering embers and sparks widely. 1/6 Oscar: OK. And?

OF: You can pour gasoline on the embers & burn everything fast, maximum damage.

Oscar: No, thanks. 2/6

Anti-vax sentiments are being fueled by Vax vs no-Vax stats without proportions. Yes, denominators vary by age, regions, etc. But here's a crude adjustment worth keeping in mind. 1/4 Kids <11 y/o currently vax ineligible. So take 1000 Canucks aged 12+ per bit.ly/3n7hD35: V2/V1/V0 proportions 772, 74, 154. If you see a denominator-less tally for V2 vs V0, multiply the V0 count x 5. For V2 vs V0+V1, multiply the V0+V1 count X 3.4 2/4

On Friday Premier Ford said "I've never shied away from telling you the brutal, honest truth." OK, here's a sampling of private responses from MDs afterwards: “This is literally f**king insane...I feel ill…What an absolute travesty…" Expect other HC workers felt the same. We are in an unprecedented healthcare crisis. And we have to fight to keep playgrounds open? Meanwhile other outdoor activities are still limited. Yellow tape those spaces=more families indoors=more spread. And what happens to families w/ no backyards?

Oscar (masked dog): So you didn't wait until the Premier let you get your hair cut on the way to the pharmacy. You got a jab?
Old Fart: Yes. AstraZeneca.
Oscar: OMG. You're too old for that!
OF: Nonsense. Very happy. I'd say there's more issues for younger people.

1/n Oscar: OK, explain. That vaccine has sure been messy so far.
OF: No kidding. Everything imaginable. Have to focus on the data.
Oscar: Go.
OF: Strong immunogenicity: true for antibodies & cell-mediated immunity. Not much age wobble.

Oscar (masked dog): The PM says we’ll have good vaccine coverage by September.
Old Fart [OF]: Very likely true based on numbers ordered. But we can’t just focus on the finish line and ignore the toll that will be taken if there’s a delayed start. 1/n Oscar: Will there be a delay? The Moderna chair said on @PnP that Canada moved fast and “is not at the back of the line”. bit.ly/2JpUmHT
OF: Yes, so far, so good. But figuring out where we are in the line is complicated. 2/n

Thread...
Oscar (masked dog): Why did the PM talk about vaccine manufacturing?
Old Fart: Beats me. Maybe anticipating that the US and UK will get vaccines first, and wanting to avoid blowback.
1/9 Oscar: Why would they go first?
OF: Three vaccines with Phase 3 data are Astra Zeneca [AZ] = big operations & HQ in the UK, and Pfizer and Moderna = based in the US. 2/9

Last gasps re: the Opposition COVID-19 motion. Yes, I understand Parliament’s job is to hold the government to account. A fractious week in politics – proposed WE inquiry, confidence motion, election brinksmanship – and now some payback. So it goes. 1/6 The scope & timing of this motion still troubles me. Read it: bit.ly/3owKn3M This isn’t focused. It’s sweeping. Not just about access to documents. It’s a comprehensive review of the epidemic response w/ specific timelines in the middle of a cresting 2nd wave. 2/6

Mask redux - 7 part thread. First: Politicization: Masks are not a Right-Left issue. Wearing a mask in a grocery store or on public transit helps protect you and others. Good sense, good citizenship. Second, Equity. Key issue. Someone can't afford a mask, or is rushing to do gig work to support a family struggling on a low income, forgets to mask, & is barred from going on public transit. Logical Rx: Key service providers mandated to keep stock of disposable masks on hand.

Oscar: Doc, no joking, now. Some real thoughts for Meds 2T0...
Me: I was privileged to graduate w/ Meds 7T8. I had amazing profs & classmates. And 42 yrs later, I'm still deeply grateful to be a medical doctor. 1/7 Oscar: What about this crew?
Me: Meds 2T0 classmates will be special. They'll have a deep bond forged by the shared experience of finishing their degrees during a global pandemic, & lasting inspiration from the courage & commitment of front-line HCWs from all disciplines. 2/7

Oscar: Strong article & editorial on public health in Hill Times today.
Me: Yes.
Oscar: It said "David Naylor’s report has been frequently cited as an authoritative guide for evaluating Canada’s ongoing response to the novel coronavirus."
Me: Wrong on 2 counts. Oscar: Why wrong x 2?
Me: First, group effort. Look at panelists' names. Many serious public health experts. I was the scribe. Plus huge list of contributors at the front & in appendix 1.
Oscar: And second?
Me: It's about misfires and machinery. It's not a pandemic plan.

Oscar: Doc, what's ahead?
Me: An even bigger surge of COVID-19 pts arriving at hospitals.
Oscar: Sounds awful. Could a lot of people die?
Me: Yes, Oscar. Sorry to say it. The number of deaths is likely to climb dramatically. Oscar: Is this ever going to end?
Me: Yes. And the surge will peak and fall faster if we keep up physical distancing, & further intensify testing & tracing. Personal precautions also help.

Oscar: Doc, some tweeps say there's "blind growth" & we should lock everything down.
Me: A spike from many returning travelers is not "blind growth". But it can become blind growth when there is so-called 'efficient' testing and insufficient tracing. Oscar: But there's lots of community cases!
Me: Oscar, see earlier tweets. Have to separate them to make a decision on escalation incl degree/type. How many clear-cut clusters vs scattered outbreaks vs coalescing regional outbreaks.