In follow up to some of the remarks I made to @CBCIsmaila on @metromorning this am...here's a plot of test positivity in Ontario over time. This is a pretty good reflection of disease activity b/c it adjusts for different testing rates in different age groups.

You can see that positivity is really taking off in older kids, teens, and young adults, probably reflecting factors that @heysciencesam outlined so beautifully in her recent thread. https://twitter.com/threadreaderapp/status/1305758222259814400?s=20

These younger people are overwhelmingly going to be ok, and we don't see a major surge in hospitalizations yet in Ontario. The problem is that hospitalizations are a lagging indicator, and if you're reacting to hospitalizations, you've missed the boat.

That's because of the lags baked into this system...given delay from infection to symptoms, symptoms to testing, testing to test reporting, what we see today likely reflects transmissions from 2 weeks ago.

And those infections in younger people aren't going to stay sealed off from other groups in society (don't @ me, this is my job, it doesn't work that way).

We can see that in this very nice heat map from France:

@GuillaumeRozier has represented this process spatially: https://twitter.com/GuillaumeRozier/status/1304839415160811523?s=20

And of course that's a path that leads to this: https://apnews.com/41c2741ba71ef7457caaaa3183dccd01

None of this is particularly surprising at this point (if you're surprised, you haven't been paying attention!).

The late Babak Pourbohloul used to say: "We model infectious diseases to move from data to understanding, because when we understand we can predict and control"

This is now a predictable process. That's great, because that defines how we're going to control it!

We know this comes from closed-close-crowded-continuous (4 C's) and it's gonna get worse as it gets cold (a 5th C!).

We know that by being proactive and acting in a limited way, we avoid the deaths, health system strain and economic damage that come from being reactive once our ICU's are filling up.

I've made a broad brushstrokes proposal in this regard before: https://twitter.com/UnrollHelper/status/1303820170159423489?s=20

And @cdavidnaylor described this beautifully on @CBCNews last night...the urgency of actually using the tools in the toolbox, rather than wringing our hands and waiting for perfect tools. https://twitter.com/PnPCBC/status/1305627348029575171?s=20

But what can we do now, proactively, in Ontario?

Well, as someone once said: if it keeps on rainin, the levee's gonna break. We have to use the levers at our disposal to surgically but impactfully increase contact rates.

Easy wins: decrease indoor gathering sizes. 50 was never smart. 10 is great, 30 too high.

Take a really hard look at indoor restaurant service, which from multiple data sources (credit card spending, epidemiological data) is a driver of unrecognized spread.

Find ways to support restaurants: outdoor patios, takeout. Compensation if need be...cheaper than a broad lockdown.

Bars, strip clubs, casinos, museums...same.

Does this suck? Yes. Does doing it anyway in a month, when ICU are groaning, suck worse? Yes. Be a grownup.

I've always said schools are the one large gathering that's hard to close. Try to keep them open, as they're hugely beneficial for society as a whole.

But do the work, and stop gaslighting, Mr. Lecce. Spend the money to get those class sizes down. Innovate on outdoor ed.

Cohorts, modified school days, staggered entry.

There's an effing playbook on this now, ffs.

Spend the money the federal government gave you. You're risking a multibillion dollar economy because of your apparent hate-on for public education.

And please start taking the long view.

We need to aggressively start using the tools in our toolbox. If PHO lab can't/won't get up to speed, please partner with private labs that will.

Appoint a CMOH who understands this disease and can communicate.

Etc. Nothing new here...

Have the political courage to do the right thing, even though by doing the right thing nothing will happen and people will say you overreacted.

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