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UPDATE on #COVID19 in #Canada for September 29. (1/42) What it means and what you can do. Mega-thread below.
(2/42) We are now well into the second wave of COVID-19 in Canada. 
Geographically, recent cases have been concentrated in Canada’s four largest provinces, particularly in and around #Montreal and the #GTA. But cases have been growing at an alarming rate across the country.
Geographically, recent cases have been concentrated in Canada’s four largest provinces, particularly in and around #Montreal and the #GTA. But cases have been growing at an alarming rate across the country.
(3/42) % change in 7-day rolling average of cases compared to one week ago:
MB: +95.6%
(22.7/day 
44.4/day)
QC: +57.8% (409.4/day 646.1/day)
ON: +37.2% (357.6/day 490.7/day)
MB: +95.6%
(22.7/day 44.4/day)QC: +57.8%
(409.4/day 646.1/day)ON: +37.2%
(357.6/day 490.7/day)
(4/42) This was predictable. We know from seroprevalence studies that the vast majority of the population has not yet been infected by the virus. When restrictions ease, behaviour relaxes, and outbreaks are not quickly extinguished, the result is exponential growth.
(5/42) At least three provinces are undergoing obvious exponential growth: #Ontario, #Quebec, and #Manitoba. Recall that a straight line on a log scale indicates exponential growth: daily cases are growing by a constant percentage (i.e., by a growing absolute number) each day.
(6/42) Manitoba has been growing exponentially for at least two weeks. In fact, Ontario and Manitoba are adding approximately the same number of cases per 100,000 each day. #Winnipeg is a hotspot, but some of the more rural regions are also seeing growth.
(7/42) % change in 7-day roll. avg. comp. to 1 week ago:
Interlake-Eastern: +180.0% (1.4/day 4.0/day)
Winnipeg: +93.5% (17.7/day 34.3/day)
Southern Health: +91.7% (1.7/day 3.3/day)
Prairie Mountain: -30.8%
(1.9/day 1.3/day)
Northern: 0/day 1.6/day
Interlake-Eastern: +180.0%
(1.4/day 4.0/day)Winnipeg: +93.5%
(17.7/day 34.3/day)Southern Health: +91.7%
(1.7/day 3.3/day)Prairie Mountain: -30.8%
(1.9/day 1.3/day)Northern: 0/day
1.6/day
(8/42) In Ontario, the GTA and #Ottawa are seeing rapid growth.
Toronto: +57.4% (119.9/day 188.7/day)
Ottawa: +37.8% (49.1/day 67.7/day)
York: +35.9% (31.4/day 42.7/day)
Peel: +14.3% (79.7/day 91.1/day)
Toronto: +57.4%
(119.9/day 188.7/day)Ottawa: +37.8%
(49.1/day 67.7/day)York: +35.9%
(31.4/day 42.7/day)Peel: +14.3%
(79.7/day 91.1/day)
(8/42) In Ontario, the GTA and #Ottawa are seeing rapid growth.
Toronto: +57.4% (119.9/day 188.7/day)
Ottawa: +37.8% (49.1/day 67.7/day)
York: +35.9% (31.4/day 42.7/day)
Peel: +14.3% (79.7/day 91.1/day)
Toronto: +57.4%
(119.9/day 188.7/day)Ottawa: +37.8%
(49.1/day 67.7/day)York: +35.9%
(31.4/day 42.7/day)Peel: +14.3%
(79.7/day 91.1/day)
(8/42) In Ontario, the GTA and #Ottawa are seeing rapid growth.
Toronto: +57.4% (119.9/day 188.7/day)
Ottawa: +37.8% (49.1/day 67.7/day)
York: +35.9% (31.4/day 42.7/day)
Peel: +14.3% (79.7/day 91.1/day)
Toronto: +57.4%
(119.9/day 188.7/day)Ottawa: +37.8%
(49.1/day 67.7/day)York: +35.9%
(31.4/day 42.7/day)Peel: +14.3%
(79.7/day 91.1/day)
(9/42) The number of outbreaks in long-term care, retirement homes, and schools in Ottawa is particularly alarming.
(10/42) As reported by the always reliable @Aaron_Derfel, several regions in Quebec have been put on red alert. It isn’t hard to see why when you look at the explosion in cases across the province. https://twitter.com/Aaron_Derfel/status/1310758017063882753?s=20
(11/42)
Laval: +102.5% (23.3/day 47.1/day)
Montérégie: +77.3% (42.7/day 75.7/day)
Mauricie : +72.9% (10.0/day 17.3/day)
Lanaudière : +70.6% (12.1/day 20.7/day)
Laurentides : +64.2% (17.1/day 28.1/day)
Laval: +102.5%
(23.3/day 47.1/day)Montérégie: +77.3%
(42.7/day 75.7/day)Mauricie : +72.9%
(10.0/day 17.3/day)Lanaudière : +70.6%
(12.1/day 20.7/day)Laurentides : +64.2%
(17.1/day 28.1/day)
(12/42)
Chaudière-Appalaches : +59.6% (25.4/day 40.6/day)
Montréal : +57.3% (150.4/day 236.6/day)
Capitale-Nationale : +55.5% (71.0/day 110.4/day)
Estrie : +22.6% (17.7/day 21.7/day)
Chaudière-Appalaches : +59.6%
(25.4/day 40.6/day)Montréal : +57.3%
(150.4/day 236.6/day)Capitale-Nationale : +55.5%
(71.0/day 110.4/day)Estrie : +22.6%
(17.7/day 21.7/day)
(13/42) According to @CovidEcoles, about 20% of schools in Quebec have at least one confirmed case. https://www.covidecolesquebec.org/liste-alphabtique
(14/42) How about Alberta and BC?
AB: +11.5% (129.4/day 144.3/day)
BC: -24.7% (132.7/day 100.0/day)
AB: +11.5%
(129.4/day 144.3/day)BC: -24.7%
(132.7/day 100.0/day)
(15/42) Good news: BC is trending down despite increased testing. Alberta looked to have plateaued, but seems to be ticking up again.
(16/42) The rest of Canada? #NovaScotia has active cases once more. But overall, the Atlantic bubble appears to be working. https://atlantic.ctvnews.ca/support-for-atlantic-bubble-remains-strong-as-canada-wide-case-numbers-surge-1.5122350
(17/42) Yukon detected a case in a non-resident. But otherwise, the Territories are keeping the virus out. https://www.whitehorsestar.com/News/non-resident-hospitalized-with-covid-19
(18/42) And now for the questions on everyone’s minds. What about the hospitalizations? What about the deaths? How does this compare to the early pandemic? Isn’t the second wave just a “casedemic” among younger people, who have a very low probability of severe outcomes?
(19/42) Infections lag cases. The cases reported today were acquired a week or more ago. Hospitalizations lag cases by weeks due to the time it takes for severe illness to develop, and deaths lag hospitalizations for the same reason.
(20/42) But hospitalizations have been going up, steadily, for weeks now. ICU numbers are rising too. (See the below plot by @wanghoaneng) Invariably, the deaths will follow soon. https://twitter.com/wanghoaneng/status/1310587920793960456
(21/42) This isn’t the same epidemic as we saw in March and April. It’s being driven by young people, but this is changing fast. In Ontario, the percentage of cases in those under 40 have dropped from 70% to 60% in only 10 days. https://twitter.com/NjalRollinson/status/1310599538219122688
(22/42) This is what uncontrolled community spread looks like. It starts with the young and then spreads to other age groups. Look at @jkwan_md’s daily #Ontario charts: about half of cases have no known epidemiological link. https://twitter.com/jkwan_md/status/1310587148186333187
(23/42) We have some advantages going into the second wave. We have a lot more testing, with more hopefully on the way. We know more about how to treat this disease and how to keep vulnerable settings (long-term care, hospitals, etc.) safe.
(24/42) Another critical advantage: widespread mask use. As @NathanStall reminds us, the best way to keep cases out of long-term care (and schools, workplaces, etc.) is to keep cases low in the community. This is the first line of defence. https://twitter.com/NathanStall/status/1307061741306687489?s=20
(25/42) Premier @fordnation said the second wave will come at us harder than the first one. In some ways, this is true. I’m not going to sugar-coat it: this will be a tough fall and winter. Here are a few of the challenges we will be facing...
(26/42)
- Colder temperatures means more time spent indoors, where the virus spreads much more easily.
- Cold/flu season means more respiratory symptoms and thus more demand for COVID testing.
- School is back in session, which will intensify uncontrolled community transmission.
- Colder temperatures means more time spent indoors, where the virus spreads much more easily.
- Cold/flu season means more respiratory symptoms and thus more demand for COVID testing.
- School is back in session, which will intensify uncontrolled community transmission.
(27/42) Finally, burnout. Burnout among healthcare professionals of all stripes. And burnout among the public who have had to make major sacrifices to fight this pandemic together.
(28/42) The key here is behaviour change and policy change. Take Toronto as an example. In mid-August, the city had low double-digit daily cases. A week ago, the 7-day rolling average was 120/day. Now it’s more like 190/day and rising.
(29/42) That’s not the result of some crazy mutation of the virus. As @ASPphysician so eloquently put it in his excellent weekly newsletter: “Did the virus change? Nope. It's you. You changed.”
(30/42) Okay, so what can be done? On the policy side:
- EXPAND TESTING.
- EXPAND TESTING.
(31/42) The testing system is buckling in many parts of the province. As @EdTubb pointed out yesterday, only 20% of tests in #Toronto are coming back in 24h, and only 44% are coming back in 48h. This is unacceptable. https://twitter.com/EdTubb/status/1310662378502205440
(32/42)
- TARGETED ROLLBACK OF REOPENING.
In regions with high community spread, we need to re-implement restrictions on high transmission environments. This needs to happen so that other critical establishments (e.g., schools, churches) can remain open.
- TARGETED ROLLBACK OF REOPENING.
In regions with high community spread, we need to re-implement restrictions on high transmission environments. This needs to happen so that other critical establishments (e.g., schools, churches) can remain open.
(33/42) The Ontario Hospital Association is recommending a rollback to stage 2 in the GTA and Ottawa. https://twitter.com/CityCynthia/status/1310619638766673924
(34/42)
- RELEASE THE DATA.
We are asking the public and business owners to make enormous sacrifices in the name of public health. Why is it that we know the number of cases in schools but not bars? We need FULL TRANSPARENCY re: the data used in public health decision-making.
- RELEASE THE DATA.
We are asking the public and business owners to make enormous sacrifices in the name of public health. Why is it that we know the number of cases in schools but not bars? We need FULL TRANSPARENCY re: the data used in public health decision-making.
(35/42)
- APPROVE RAPID TEST KITS.
High frequency rapid testing, even if it’s not as accurate as PCR, could be a key breakthrough in the fight against COVID-19. https://www.ctvnews.ca/health/coronavirus/rapid-testing-becoming-the-new-focus-in-the-fight-against-covid-19-1.5124227
- APPROVE RAPID TEST KITS.
High frequency rapid testing, even if it’s not as accurate as PCR, could be a key breakthrough in the fight against COVID-19. https://www.ctvnews.ca/health/coronavirus/rapid-testing-becoming-the-new-focus-in-the-fight-against-covid-19-1.5124227
(36/42) Things you can do personally:
- Move social gatherings online
- Masks
- Physical distancing
- Spend as much time outdoors as possible
- Please answer the phone if public health calls
- Download the COVID Alert app
- Get your flu shot
- Move social gatherings online
- Masks
- Physical distancing
- Spend as much time outdoors as possible
- Please answer the phone if public health calls
- Download the COVID Alert app
- Get your flu shot
(37/42) 1,000 cases per day in #Ontario is not inevitable. We can still right this ship. But remember, changes made today will take up to two weeks to show up in the data, so don’t despair if cases continue to mount in the near future.
(38/42) I hope this thread has been a useful update on the current situation regarding #COVID19 in #Canada, what it means, and what you can do about it. If it has been, please share it with a friend who might also benefit.
(39/42) You can find more from me and my team, the COVID-19 Canada Open Data Working Group, at our website:
https://opencovid.ca/
https://opencovid.ca/
(40/42) We provide daily #COVID19 #Canada #OpenData here:
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
(40/42) We provide daily #COVID19 #Canada #OpenData here:
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
And a daily #DataViz dashboard here:
https://art-bd.shinyapps.io/covid19canada/
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
And a daily #DataViz dashboard here:
https://art-bd.shinyapps.io/covid19canada/
(41/42) I also provide a daily, automated backup of nearly 100 government COVID-19 data files, including data on schools. 
https://github.com/jeanpaulrsoucy/covid-19-canada-gov-data
https://github.com/jeanpaulrsoucy/covid-19-canada-gov-data
(42/42) If you’ve made it this far, congratulations. Have a safe, fabulous day.
Tagging some people who may be interested... @DFisman @UofT_dlsph @UofT @uoftmedicine @LauraCRosella @ishaberry2 @shelbysturrock @EpiHarris @KateStCyr2 @Bexit90 @zach_bouck @CatharineTC @robyn_s_lee @danialaw @Kutchinbird @emilylmaclean @DevinAbrahami
