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#Ontario made the call today to re-implement modified stage 2 restrictions in #Ottawa, #Toronto, and #Peel due to the resurgence in #COVID19 cases and hospitalizations. 
(1/20) Some thoughts on where COVID-19 is going in the province. Thread.
(2/20) This should not be a surprise to anyone. It has been apparent that COVID-19 is once again on an exponential trajectory in Ontario for at least several weeks. https://twitter.com/CBCQueensPark/status/1314625259128197122
(3/20) A confluence of recent eventsâthe testing backlog, the transition to appointment-based testing, the suspension of contact tracingâhave made daily case numbers in the province less reliable, especially in hard-hit areas like Toronto. https://twitter.com/JPSoucy/status/1314012080421429248
(4/20) As reported by @jyangstar, @meganogilvie, and @katecallen, it doesnât seem like the numbers in Toronto (and thus the province) will be getting much more reliable in the near future. https://twitter.com/jyangstar/status/1314548295465865217
(5/20) A depressing take: It is better optics to have people waiting to get a test than people waiting for their tests to be processed, because the latter is easily measurable and the former is not. https://twitter.com/jyangstar/status/1314549129004167171
(6/20) I am confident that publicly reported daily case counts in Ontario have underestimated the trajectory of the epidemic in our province and will continue to do so for at least the near future.
(7/20) I believe a simple exponential curve fit to the daily reported cases from September 1 to October 3 (the day before the 7-day rolling average of cases stopped rising) provides a better approximation of the current epidemic trajectory.
(8/20) By our count, public health units in the province reported 899 new cases today (excluding suspected cases where possible). Note that this is slightly smaller than the number reported by the Ministry or by PHU counts that include suspected cases.
(9/20) This is more in line with the fitted value from the exponential curve (1,033 cases) than what we would expect from the rolling average of daily cases. This comes after several days of conspicuously low case numbers resulted in an abrupt flattening of the rolling average.
(10/20) Torontoâs trajectory looks even more conspicuously muted. The city faces particularly acute challenges with testing, contact tracing (now suspended), and even quickly reaching people who have tested positive.
(11/20) With all this is mind...please exercise caution when interpreting #COVID19 case trends in #Ontario. Things are worse than they look.
(12/20) These circumstances make looking at other metrics, less susceptible to testing issues, all the more important. For example, hospitalizations and long-term care outbreaks.
(13/20) Hospitalizations are mounting rapidly, with a 250% increase over the last 3 weeks. But the signal from hospitalizations lags the signal from cases by several weeks. As @DFisman says, if youâre reacting to hospitalizations, itâs already too late. https://twitter.com/katecallen/status/1314642718589550593
(14/20) Outbreaks in long-term care are multiplying, propelled by the rising force of infection in their surrounding communities. (Follow @NathanStall for the best source of information on this topic) https://twitter.com/NathanStall/status/1314574796999610370
(15/20) These outbreaks are not limited to the big city. Consider the Simcoe Manor outbreak in the small town of Beeton. To date, 4 residents have died and at least 42 staff and residents have been infected. https://www.barrietoday.com/coronavirus-covid-19-local-news/very-serious-situation-worsens-at-simcoe-manor-2778743
(16/20) The only province with a more severe trajectory than Ontario is #Quebec. Starting at the end of September, Quebec began painting the province red with returns to partial lockdown in many hard-hit areas.
https://www.cbc.ca/news/canada/montreal/quebec-city-to-montrela-covid-19-1.5755857
https://www.cbc.ca/news/canada/montreal/quebec-city-to-montrela-covid-19-1.5755857
(17/20) Time will tell how effective these measures are. Here in Ontario, we are just re-implementing restrictions now, so we will have even longer to wait. The questions surrounding the reliability of our case data will make it harder to see these effects clearly.
(18/20) Finally, a call to action: please download and install the COVID Alert app. It is more important than ever that everyone be using this app. Letâs help public health get a lid on this thing. 
https://twitter.com/JPSoucy/status/1310943260383350787
https://twitter.com/JPSoucy/status/1310943260383350787
(19/20) You can find more from me and the COVID-19 Canada Open Data Working Group at our website: https://opencovid.ca/
Our #COVID19 #OpenData:
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
Our #COVID #DataViz:
https://art-bd.shinyapps.io/covid19canada/
Our #COVID19 #OpenData:
https://github.com/ishaberry/Covid19Canada
https://opencovid.ca/api/
Our #COVID #DataViz:
https://art-bd.shinyapps.io/covid19canada/
(20/20) Have a wonderful Thanksgiving, everyone.
