So I created an entire med school using AI. It started out as a joke with my friends, but just grew and grew into something that still astonishes me in its depth and breadth. I call it the Hibbert School of Medicine. Check it out at hibbertmed.com

I have a feeling that, when all the living and dead are accounted for, this will likely be one of the greatest crimes in history.

My own annual Christmas tradition: working a shift in the ER so that those who celebrate can be home with their families. Merry Christmas everyone! #teamHinduJewishMuslim's got this tonight!

My holiday tradition: working Christmas in the ER so colleagues who celebrate don't have to. This is my 15th Christmas in a row! Today its team #MuslimJewishHindu's time to shine. Merry Christmas and Happy Holidays everyone!

If you're an adult without kids and don't think this hospital crisis affects you, think again. In the ER, if we had to choose between an adult with a heart attack, or a 6 month old struggling to breathe for our last critical care bed, the baby will get that bed every single time

It seems a lot of American can't conceive why Canadians are not so eager to join the union. I'll give you a few reasons: - We love our country, just you like you love yours. Things can always be better, but this will always be our home and native land. - The climate sucks, but we're used to it, and it can be quite beautiful at times. We have warm homes with warm people, winter sports, and lots of sunshine. - None of my kids have had to do active shooter drills, unlike their cousins across the border. Our cities are the safest big cities in North America. - There is no role for religion in politics. No one cares. - We never have to worry about health insurance. Granted the system can be improved, but there are no co-pays, no monthly contributions, few worries. - There's no corporate donations in politics, it was banned 20 years ago. Billionaires can't own the political system. - The media (what's left of it) is not allowed to broadcast false or misleading news. - There's no corrupt geriatric supreme court that can ruin your life. Here judges have mandatory retirement, and few Canadians can name even one of them. - Abortion has been permitted for 35 years and is a non-issue politically - There's no senate or electoral college that can keep unpopular parties in power. - Higher education is good, cheap and accessible. Few are crushed by student debt like in America. There's a million small things too, but overall, this will never stop being the most beautiful place in the world to me:

Masks are the norm in Mexico, as any recent visitor to that country will tell you. They didn't make it a political issue, they didn't throw an extended tantrum like we did in the West. There isn't even an official mandate in place... wbur.org/hereandnow/2022/11/…

There's this awful cold going around...

The world's elite at the Davos forum are enjoying every possible protection from Covid, including PCR testing, air filtration, UVGI light. Why isn't this being offered to everyone else? Every school, every workplace should have the same protections as the rich and powerful.

This is amazing, France is going to require clean air in classrooms, aiming at CO2 levels of 800 ppm. Other countries should quickly follow suit. Aside from limiting Covid, just the benefits of lowering common respiratory viruses makes this worth it alone, as any parent knows.

The fastest man in the world was cheated out of a gold medal today. I don't blame Noah Lyles for running (and later collapsing) while sick with Covid. What failed him is the system around him that should have protected him and all the other Olympic athletes. Lyles even wore a mask earlier to protect himself, but there's only so much you can do as an individual... did anyone check the ventilation in Olympic venues? Was there any rapid testing to quarantine positive cases? Was there any direction to isolate when sick? How many other athletes were similarly cheated? Why are so few records being broken this year? And most importantly, what are we going to do about it for next time?

Why remove them from health care spaces in the first place?

Celebrating a whole school year where kiddo did not get Covid even once. School is so well ventilated, you feel a chill from the airflow from all the filters. As a result, we didn't get sick, we didn't miss a day of work, we didn't get Long Covid, we kept older family members safe. Ventilation is 90% of the battle. Fight and make sure your kids' classrooms have excellent ventilation this September.

What's crazy is Canada had the merit-based immigration system that the US tech-right wants for America. It was a model for the world. Just enough to grow the economy, not enough to cause social unrest. Trudeau wrecked it by inviting 3m people all at once. This is one of the big reasons his party is going to be absolutely crushed in the coming elections. Immigrants will be the first to line up to vote against him, for ruining a system that brought prosperity to all, created loyal new citizens, and worked well for five decades.

This is what I've been waiting for. It could finally give us a real ending to the pandemic. No more waves of illness, no more rushing for tests and antivirals if you're elderly or vulnerable. Hope this comes out soon!

Hmmm.. do today's winners of the Nobel prize know something, perhaps about something floating in the air, that most of our leaders don't? I wonder what it could be...

When the top two world experts on immunology and Long Covid are wearing masks on stage, should give you a hint they probably know something most others don't!

So much truth in this one graphic. True story, on a recent shift, I had to run and help a patient who had collapsed on our waiting room floor, short of breath. Hypoxemic. The family was diligent, and tested before coming, and lo-and-behold, they were positive. With some help, got her on a stretcher, I rolled her the acute zone myself, and we got to work stabilizing her. Triple vaccinated, in late middle age, no serious medical conditions, and this thing still got them sick enough to come to us. Another anecdote, right in the middle of summer when these things are not supposed to happen, where I can only say to myself, “what a curse on humankind this virus is” “Shouldn’t she be in an isolation room?” someone asked. Good question. “What’s the point. Isn’t our hospital mask mandate ending soon?” someone else said. Ah, now we get to the point. If we were actually following the science, we would have screened her to a separate zone, away from the other patients in the waiting room. She could have infected any number of children, chemo patients, pregnant patients. Instead, we and every patient are now expected to make our own decisions on how to protect ourselves. You could roll into a cancer clinic and cough on every single patient in the waiting room, and not violate policy now. While many are eager, even celebrating the end of mask requirements in our hospital, they still don’t want to be anywhere near an infected patient outside of an isolation room, of course. I don’t get it. Now I’m not about to go on some hopeless career-ending crusade to fight this, when most people don’t even want to think about it anymore... people have moved on, and that is that, I'm repeatedly told. ... but it is profoundly sad to see all the preventable suffering around you, to personally see the public get sicker over time, to see the young people with inexplicable blood clots and strokes, to see the life expectancy numbers continue to plummet, knowing that the only people who will come out of these troubled times relatively unscathed are the tiny minority who are wealthy, well-informed or well-connected. It is, sadly, almost a certainty that I'll be seeing more patients like the poor woman I had to lift off the floor that night.

A great way to explain the relative risks of the AZ vaccine with patients. In short, get what you can as quickly as you can! Thanks to @NourKhatibMD for translating from the original Spanish.

Not really a mystery if you remember what we all just went through...

Love this restaurant’s creative way of getting around Florida’s fine on asking for vaccine status. ctvnews.ca/health/coronaviru…

If you’re a physician and you’re not seeing the effects of Long Covid regularly, you’re probably not in active clinical practice. It is stunning the amount of disability out there, and how few tools we have to address it.

Why indeed...

Entire cities are being wiped off the face of this planet due to climate change related events. Last week it was Lahaina, today it's Yellowknife, the capital of the Northwest Territories in Canada's north. You can't keep ignoring this and pretending it's someone else's problem.

Narrowly missed getting exposed this week at a family dinner. My elderly parents had the good sense to test when they had symptoms, and sent this to me a couple of hours before we were to meet. They are very medically vulnerable and thankfully they were able to start antiviral treatment quickly. Despite boosters, it hit them hard... and I worry about the post-infectious issues like clots, cognitive impairment, GI, renal, respiratory, and cardiac issues. One step at a time though. They are true survivors, having lived through civil wars, terrorist attacks, the stresses of immigrating, etc. God willing they will get through this trial as well.

10 shifts in a row completed, 80+ Omicron patients seen, N95 and goggles the whole time, great ventilation in the hospital, meals and breaks in the car… and the result is… NOT Covid pregnant! Hopefully my luck holds up. God help us all.

Nova Scotia is giving everyone a masterclass on how to crush an outbreak. With a test positive rate of just 1% they are - closing schools, non-essential businesses - limiting essential retail to 25% capacity - rapid testing 2% of the population daily - a huge undertaking

What I imagine a chief public health officer would write, but can't: “Dear citizens, I write to explain some difficult realities. We are tired of fighting Covid-19. Our strategy was entirely based on vaccines, and though they are amazing, their benefits are proving fleeting...

My 🇨🇦 friends: Mexico is cheaper and has better food Costa Rica is safe and has the nicest people, ditto DR Cuba is cheap and beautiful No need to spend your money in a state that takes it for granted.

If this were true, we would not be at wave 7 of this pandemic. We should all have developed durable immunity in the first 2 Omicron waves, and Long Covid wouldn’t exist. The public needs to hear from different experts who can explain what is actually happening in the real world.

Up until the early 2000s, it was normal to go to a restaurant or nightclub and get your lungs and clothes saturated with cigarette smoke. Health effects were well known, but nothing was done. It was considered too difficult, too inconvenient. Remind you of another health threat?

What are these guys even mad about anymore?

I'm not sure how anyone can push the idea that Covid is equivalent to Flu. Risk is much higher across every age group, and especially higher as you get older.

Mask mandates should not end. We are going to sacrifice the lives and good health of a large portion of the population for a temporary election-driven 'feel-good' moment. Covid is still a danger, even to young healthy people and I will outline why in this thread:

Feeling great today on my ER shift: - hardly any new critically ill COVID cases - almost every patient I’ve seen is vaccinated with at least one shot And the good news keeps coming:

Yesterday on my ER shift, I saw almost as many patients with Long Covid symptoms as those with acute Covid. The public has no idea what’s waiting for them.

Believe it or not, people used to fight against sanitation, and against clean water free of feces and cholera, saying it was their right to get sick... that people even died from a 'good washing' Remind you of anyone? H/T: @fluids_guru

Jarring to be intubating Covid pneumonia again. In a triple vaccinated patient, 60s-ish person no less. It was a failure on many levels: - no public awareness the threat still exists - Antivirals weren't offered when diagnosed a week ago - Did not get/wasn't aware of boosters

Probably the most important article you'll read all year, by @omeraziz12 in the @globeandmail Canada is in serious trouble, and Aziz hits the nail on the head on the causes: - Deep incompetence by politicians, who resort to PR management over making decisions. Parliament is deeply dysfunctional, with Question Period a joke, and committee hearings a farce. Trudeau but also the provincial premiers have much to answer for. Many of our leaders come from legacy wealthy backgrounds and have absolutely no idea how difficult they've made life for Canadians. "What I realized soon thereafter was that this country was witnessing a systemic political failure, a complete inability of politicians to get change done in ways that manifested at the dinner table. An extreme form of PR and image-management had begun to take over delivering on policy in concrete ways − and the entire country was noticing. Nor was this an accident, the unfortunate consequence of polarization or inequality, but the deliberate result of multiple policy failures − as well as failures of will." "Normally, in a democracy, social ills can be addressed by public officials. But Canada’s own political institutions have been riven by corruption and personal ambition. And now also potentially by foreign influence. Each controversy and scandal leads people away from crucial time and policy attention that could have been spent on fixing the country’s major issues. At the parliamentary level, most members of Parliament are so frightened of speaking for themselves that they are rendered powerless. This defies the very essence of the British parliamentary system, upon which Canada’s system is based, which empowers MPs to speak on behalf of their constituents and represent their true voice in the people’s chamber." - Inattention to rising crime, especially rampant car thefts, a revolving door criminal justice system, neglect of the opioid crisis. We have the laxest justice system in the Western world. Causing someone's death will get you a 6 month sentence in one prominent example. America had mass incarceration, we have mass leniency. "At some point, one would think that the deaths of so many innocent and vulnerable people would elicit outrage − yet life goes on as normal. Each life is precious, and when violent criminals get off easy, or without punishment at all, they learn the terrible lesson that this country does not take its own laws seriously, so why should they? When the law loses its power to deter crime, either because of prosecutors not moving forward with cases, or because of a general laissez-faire attitude toward violent crime happening in other neighbourhoods, it is the marginalized who are harmed most." - Rising housing costs that has made nearly everyone, including me, to paraphrase A Bittersweet Symphony, a slave to massive mortgages until they die, or they are perennial renters. "For many Canadians, the cost of living has become unaffordable. The average price of a house in the GTA is $1.1-million, and Metro Vancouver is around the same. There are certainly cheaper places to live, but the average cost of a rental in Canada has reached record highs − more than $2,100 a month. According to one major study, Canada needs to build an additional 3.5 million homes by the end of the decade and is currently only building around 200,000 a year." - Violation of the social contract on immigration. "In Canada, the social contract for years allowed more immigration to grow the economy, but this came with stringent criteria for who should be admitted. Today, there are more than 900,000 international students in Canada, a 170-per-cent increase over the past decade. Some of these students have been scammed by for-profit colleges. Others have been affiliated with fake schools, using their student visas as loopholes in the immigration system. The social system was unprepared for such an influx, though certain institutions benefited: colleges and universities got more fees; politicians touted rising immigration numbers; the landlord class got an endless supply of perpetual renters. Without any housing available, this has left the country unprepared to deal with multiple, overlapping economic and social crises." Aziz asks What is the Canadian dream? "It was a promise − less individualistic and gun-friendly than the American version, but no less ambitious. To me, the dream promised that every person here could have a decent shot at life, one that was better than that of their parents. There was emphasis on community and a strong focus on order and good government. The compact included the payment of higher taxes, and in exchange, the existence of world-class social institutions delivering for ordinary people. The immigration system worked because the same contract existed with immigrants − that they would work hard, play by the rules, become part of Canadian society through legal means, and in return, would become citizens of a highly functioning democracy where a good life was, if not guaranteed, then within reach. The dream was based on fairness, on merit, on policies that worked. It promised breathable air and the bountiful resources of the second-largest country on Earth. It promised the principle of equality of opportunity, promised safety and peace and responsibility. It promised leaders who put the national and long-term interests of the country above their own partisan needs. The dream now feels like it’s on life support." Amen

I'm making rapid test 5-packs for my clinic patients. Also throwing in a KN95 mask to protect them from day-to-day airborne exposures. I figure if governments won't do it, it's up to all of us to jump in and protect each other this holiday season from Omicron.

What in the world possessed you to think bringing in nearly 3m people in just the last two years was a good idea? Immigration was actually popular in Canada, until you wrecked a system that was the envy of the world.

All negative, all set for a safe Thanksgiving dinner with the rest of the family, who are all testing themselves as well. Rapid tests could have been a game changer, and they still can be. Every Canadian household should have free and easy access to these tests.

We in 🇨🇦 will eat grass if we have to, but we will never accept being bullied or absorbed by the US.

Diagnosis: Mastoiditis, infection of the mastoid bone behind the ear, and a rare complication of an ear infection. I told my colleague to take her straight to hospital. Kiddo needed hospital admission, IV antibiotics and surgical drainage, was admitted for a few days, and did well. Group A strep was suspected. Delay could have led to widespread infection including meningitis and brain abscess, with high risk of death. I shudder to think what would have happened if my colleague had hesitated in getting advice. THIS is why ER and primary care should be easily accessible at all times, every day, every night.

So proud of my city. Giving these truckers the welcome they deserve:

Why isn’t the pandemic over yet? Why did we require boosters? Authorities including the CDC are finally acknowledging that our vaccines provide protection for only 3-4 months at a time. I interview @fitterhappieraj to go over possible reasons why. piped.video/jCWfytQXpEs

The cruelty of these people is incredible. What if he has cancer and is getting chemo? Or has a sick loved one at home?

Noticing a lot of your relatives are just not the same, health wise? Relatives dying after surgeries that were relatively low risk a few years ago? Today, this report from insurance giant @SwissRe puts numbers on the ongoing excess death toll attributable to Covid-19. From the report: "Fluctuations in excess mortality tend to be short-term, reflecting developments such as a large-scale medical breakthrough or the negative impact of a large epidemic. However, as society absorbs these events, excess mortality should revert to the baseline. With COVID-19 this has not been the case and all-cause excess mortality is still above the pre-pandemic baseline. In 2021, excess mortality spiked to 23% above the 2019 baseline in the US, and 11% in the UK. As Swiss Re Institute's report estimates, in 2023, it remained significantly elevated in the range of 3–7% for the US, and 5–8% for the UK. If the underlying drivers of current excess mortality continue, Swiss Re Institute's analysis estimates that excess mortality may remain as high as 3% for the US and 2.5% for the UK by 2033." What does the percentage increase in deaths mean in real numbers? Roughly 3 million people die in the US every year of various causes (cancer, heart disease, accidents, etc). The 3-7% increase in 2023 represents a 3-7% increase in that 3m number, so roughly 90-210k more deaths. This places Covid-19 solidly among the top five killers in the US, with heart disease (700k), cancer (600k), accidents (200k) and strokes (150k), and it continues to stay there 3 years after mass vaccinations, and countless waves and variants since. While not the killer of millions and the destroyer of health systems it was in 2020-2021, it is a leading cause of death that we must continue to respect, and take active measures to prevent in especially the elderly and vulnerable. It continues to be a leading cause of disability in the form of Long Covid.

In just a few days: - Auto parts tariffs quietly dropped - Olive branches extended to opposition parties - Alberta resource development concerns addressed - Actually talks to the media and answers questions like a normal human. We voted for an adult, and by God, we got him.

Simple tips for as a new wave (possibly) picks up steam in the US and Europe, as well as the possibility of a new variant outside of the Omicron family that may challenge our collective immunity (BA.2.86). Main points: 1) Be ready to identify (with rapid tests), and then treat the infection with antivirals. This will lower the likelihood of hospitalization and long-term symptoms, especially for higher risk folks (elderly, comorbid, very young children, women). If you live in a place with a paternalistic medical establishment that restricts access to these tools, make noise, contact your local media and advocate hard. It's how we won access to them in Ontario. 2) Be proactive about the quality of the ventilation in your workplace or school. The science is solid, public health agencies (finally) endorse it, and the main HVAC engineering society (ASHRAE) now mandates this. I can foresee legal and financial penalties for building owners that refuse to do the right thing and protect their patrons. Anecdotally, we managed to avoid infection all year partly because of a well ventilated school for our kiddo (on top of vaccines, masks during waves etc). You can use the Raven Clean Air Map to help mark buildings with cleaner indoor air: ravenapp.org/cleanair XTwitter: @theRavenApp 3) Wear a mask in crowded indoor spaces. This includes airplanes, crowded buses or subway cars, and high risk areas like health care settings. I went to buy a new TV at a nearly empty Best Buy with great ventilation (a CO2 of 500-600), I didn't wear a mask on that occasion. In hospital and clinic, definitely. On a recent plane trip, full 3M Aura N95 the whole time. Restaurants; take-out and patios for me for the foreseeable future. Social gatherings - try to do them outdoors, or indoors with a few people we trust to be honest about symptoms. The peer pressure not to mask is a real thing. It is especially difficult when social norms are being used to push something when the scientific facts are fairly unanimous that this thing is fairly bad for you. For me, I help many patients, and many friends manage the long term effects of infection, and need no reminder just how much luck plays a role in how well we all fare with this thing. Also growing up often being the only visible minority with a funny name in a given setting makes me sort of immune to what people think lol. 4) Boosters - they are due to be released in the US in mid-September, targeting the XBB.1.5 variant, which hopefully will provide protecting to similar variants that are circulating. Not sure if it will work with the BA.2.86 variant that appears concerning, but if you follow steps 1-3 that hopefully will be less of a concern. 5) WFH where possible. I know this is getting a bad rap from some managers, but hybrid work where employees visit a well ventilated office a few times a week is probably the ideal long-term solution to minimize sickness and absenteeism from illness. There are powerful interests that want to prop up a flagging commercial real estate market that are trying to portray WFH as unsafe and unproductive. If you have it already and your employers are trying to claw it back, stick to your guns and keep it going as long as possible. I'm fairly certain that with just a few simple preventative steps, you can live a fairly normal, healthy life. You sidestep the question of whether repeated infections are dangerous by avoiding them altogether, or at least, keeping your overall infection count as low as possible. Best of luck to you all out there!

💯 I see about 150-200 patients a week, many of them with hoarking coughs, right in my face. And I didn't catch a single thing from them. Masks in health care settings is just common sense.

Putting the top 3 killers of adults in perspective, and things you can do to prevent falling victim to them. We have @HeartandStroke We have @cancersociety We probably need something for the new kid on the block... it's not going anywhere, that's for sure.

They might as well have said this. Simpler too.

Novavax should be the default option for future vaccinations for Covid. Longer lasting immunity (65% at 1y), fewer side effects.

Found @MarkJCarney to be surprisingly quite charming and funny on last night's show with Jon Stewart. Rolled with the jokes, and came off quite sincere and capable. A huge contrast to the nasty social media swamp creature that the Conservatives are running with.

This is thread of cases to get the point across that variant Covid is brutalizing young people. Please post your own cases in the replies. 35 year old teacher with no medical problems got severe Covid from a student. 65% sat on room air, went straight to our ICU. UK variant.

Talk about mixed messaging. On one hand, the WHO sends the biggest possible signal to stop worrying, and then later says we still need to worry! This is very typical of an agency that has repeatedly failed to rise up to these challenges. When this all started, they could have rallied the world to counter the disease with real airborne precautions, stuff we’ve known since SARS1, focusing on the quality of indoor air. And people would have listened… we could have avoided lockdowns, people could have seen their relatives safely in hospital, businesses could have stayed safely open, and trillions of dollars in economic output saved, and we would have had enduring protection against future respiratory pandemics. Instead, a few entrenched figures with careers to protect, kept any action from being taken and here we are today. Instead of ventilation upgrades we got ‘6 foot distancing’ Plexiglas and millions of gallons of hand sanitizer. This outdated guidance is still pushed by some authorities even to this day! Except for a few Asian countries, no one has been about to spell out exactly how to live this new reality, between absolute panic, and absolute denial. The topic has become taboo, that even mentioning the word here will get this post off the algorithmic feed. Now we have the worst of all worlds; we watch our life expectancy numbers plummet, our elderly and vulnerable facing a good chance of disability or death literally every time they get infected, and everyone else facing a decent chance at disability each time, and all we have is an antiviral which is hard to get, and a vaccine that barely works to prevent infection. This sh*t needs to be made into a movie.

Just lovely to see people blaming the Covid vaccine... Less than 1% of the <5 year olds are fully vaccinated, <6% even got one shot. And admissions in that age group are going off the scale. There's one thing ~80% of them did get in the last year though: Covid-19

I stand with many experts and believe that with Covid/SARS2: - Don't get infected - If you do get infected, get infected as few times as possible, while as vaccinated as possible Our leaders are telling us we're on our own, so here's some advice to navigate this crazy time. 🧵

This is outrageous. First Avian flu case in Canada, the teen affected went to the ICU. But they aren't using airborne precautions. So this could spread to any number of health care workers on that unit, and further beyond. We have learned absolutely nothing.

Carrying a CO2 monitor with you can be very eye opening: - high end venue for a social function - CO2 at 550, practically outdoor air - Low cost grocery store - 1200-1300 - not great. This is a consistent, and very sad pattern. The elite are protected, and most of us are not.

So let me get this straight 🔴 More kids are sick now than ever before 🔴 Hospitals and pediatric ICU units are overwhelmed 🔴 There's no children's Tylenol or Advil anywhere 🔴 All common antibiotics are running out And our leader's response is to do nothing? How does that work?

The sheer number of post Covid patients I’m seeing in the ED with lingering symptoms is quite sobering. Maybe 1/4 of my patients on my last shift, many with chest pain and shortness of breath for weeks since the big surge. Not much we can do to help either 😔

Folks we did it, we emptied upstate New York of all their Advil and Tylenol. Good job Canadians, your commitment to not taking any precautions at all and draining the drug supply of your closest friends and neighbours is amazing.

A friend got these CO2 readings in an Uber recently. Hot, sweltering weather outside often means that cars use 'recirculate' mode to keep as much cold air inside with less energy use. This unfortunately means that about 10% of the air you breathe is right out of someone else's mouth when the ventilation is this bad. Very gross. Calculations here: nitter.app/DavidElfstrom/st… You can correct this quickly by opening both rear windows an inch or two. That sets of some cross ventilation and brings these numbers down quickly.

Life expectancy drops for a third year in a row C19 is the third leading cause of death, behind heart disease and cancer, ahead of accidents/trauma. Mortality overall is up 13% across all age groups compared to 2019, and increasing every year This should be a huge scandal!

Canada votes tomorrow, and it is blessed to have one of the most fair, secure and accessible voting systems of any democracy. Here's how: 1) Paper Based: every ballot is paper-based and counted by hand. Each ballot is secured by a signature from the local poll officer, so ballot stuffing is impossible. 2) Open Counting - every candidate can send observers (scrutineers) to watch the count, ensuring that it is accurate. I've volunteered to do this many times. Ballot boxes are opened and the ballots placed on a table, and counted in front of everyone. 3) Voter-ID - Every eligible voter gets a voting card in the mail telling them where to vote. This is based on a central voters list which is automatically compiled and updated based on tax returns and other info. This card serves as their ID. If they don't get a card in the mail, they can get added to the voters list with photo ID and a recent bill showing their address. There's no controversy over 'voter-ID' that there is in the US, and no attempts to keep voters off the list. 4) Accessible and Neutral - No election materials are allowed in or near polling stations. Polling stations are everywhere, well advertised, and often walking distance in towns and cities. 5) Limited Corporate Money - No corporate or union donations are allowed for any candidate. They can only accept personal donations, which are capped at $1750 a year, and parties get a subsidy from the government based on how many votes they got in the last election. 6) No Gerrymandering - Electoral districts are set by a non-partisan committee every 10 years, and are fairly simple geometric shapes, nothing like what we see in the US. Make sure to get out and vote tomorrow!

There is no point returning children to school next week when most will just get exposed and have to isolate at home anyway. The wave will likely peak in mid January anyway, by then we should work on: - HEPA filters - Frequent rapid testing - N95 Masks - A solution for lunchtime

83 children in Samoa paid the ultimate price thanks to this charlatan. Now he gets to do the same to all of America.

Jennifer is a fellow ER doctor and valued colleague severely affected by Long Covid. Many others who are less willing to share their stories publicly are similarly affected. If she, as a doctor, is having trouble navigating health care, treatment and life insurance policies, what chance do average people have? What chance do you think you have?

This guy will make a great Prime Minister one day:

Why not just give these out to people? Mail one to every home? Would be very useful for fall/winter and help guide early treatment with antivirals for lots of higher-risk people.

Exactly the same experience at my kids (private) school. Effective filtration and ventilation stops outbreaks. Right now only the rich who send their kids to private schools get to enjoy this perk, but this is cheap and easy to implement everywhere. There's no excuse.

Suspending @jvipondmd is an outrage. No one has done more to save lives in Alberta than him. This is coordinated activity and is a massive reason this sector needs regulation and the unmasking of anonymous troll accounts. Anyone have a connection to @TwitterSupport to fix this?

A colleague of mine retired today, one who would tell me stories of the 'bad-old days' when kids routinely died of vaccine preventable diseases, like this one: epiglottitis. The infected throat closes up and chokes the infant to death. Very few doctors today would recognize it or have the skills to save them. We simply are not ready for the return of diseases that have largely disappeared in the last 20-30 years.

The cognitive dissonance here is incredible. In the same edition of the same London newspaper, they pathologize Japanese safety practices that have successfully controlled Covid spread, while wondering where all the workers went in the UK. We are surely in the dumbest timeline.

Thanks for reminding Canadians why you lost your seat and deserved to lose the election. Hamas should be defeated and the hostages released, but 2 million people don't deserve to be starved to death. All of our allies agree. Where is your humanity?

Japan and South Korea did not have a crippling early wave of RSV in their kids. There was no ‘immunity debt to be paid - that concept is pure fiction. Both countries still use common-sense measures like masks to mitigate respiratory viruses. None of this suffering is necessary.

We usually go to the US for March Break. Last year was Disney, before that San Diego. Not this year.

Lesson #328237 on why ER and primary care should be more accessible, and telling people to stay home for minor things is pure horse manure: A clinic admin colleague asks for some advice. Her young child had an ear infection, and she couldn't see her MD, but started using topical antibiotic on the affected ear. Fever on and off for a week, fussy with foods. "Can I show you a picture?" Me: "Ok sure" I nearly fell out of my chair. It looked something like this:

Good for @TIME for bringing attention to this lesser known complication of infection. Don't rush to resume your gym workout after you recover; I've been recommending to my patients that they avoid intense exercise for at least 6-8 weeks, and even lighten work duties (if possible). The cause of long term symptoms are still unknown, but rushing back into intense exercises anecdotally seems to exacerbate the mysterious autonomic nervous system damage that seems to happen. Some patients seem to have a weeks-long elevation of their resting heart rate during this period, which wearable devices might capture.

This is what a severe respiratory illness looks like in a child. Resp rate is nearly 60/minute, muscles flaring in the neck are a sign she’s struggling, the listless distracted look in her poor eyes. Hard to watch and not get emotional considering that this is all preventable!

Was not happy to go my first in-person meeting in 3 years, but I went prepared. Brought my trusty Aranet CO2 monitor with me, an N95 mask and a plan. Read on for details -> The day started off fine, but gradually the CO2 levels started increasing, indicating to me that the ventilation system was not doing well in clearing the air from the 30 or so unmasked people in the room. No one had visible symptoms, which was reassuring somewhat. I used equation in this tweet: nitter.app/adsquires/status… to estimate the room ventilation. The room was empty for lunch break, where the CO2 went down from 850 to 620 in 1 hour. This gives roughly a calculation of 2 air changes an hour. Not great -> you want at least 6 air change an hour, a standard that many health care and @uoft uses for its buildings. The room had 6 medium sized HEPA filters, which were either turned off or on the lowest setting. I quietly went around and set them on the medium setting. Checking the brand on the web, I found they had a Clean Air Delivery Rate (CADR) of 130 cubic feet per minute. The room was roughly 40 feet x 30 feet x 10 ft ceiling, so a volume of 12k cubic feet. The 6 HEPA filters provided 130 cu.ft/min x 6 filters x 60 minutes = 46.8k cubic feet of filtered air per hour, which when divided by the room volume of 12k cubic feet, gave me 4 additional air changes an hour, so up to 6 total, which is the magic number. Ideally fresh or highly filtered air should be the standard in every indoor setting; the benefits in preventing respiratory infection of all types are huge. But until society comes around to doing so, this process is something you can do to make every office meeting just a little bit safer.

So Monkeypox/Mpox can be airborne. Of course this was known some time ago, but anyone who pointed this out was labeled as an alarmist.

Attended a seminar at @uoftmedicine recently. - Masks required, and many wearing N95s - Ventilation system at full-blast, with each classroom having at least 6 air changes an hour (ACH) No one is getting sick here today. Well done @UofT!

Wanted to share with you something near and dear to my heart. Today my colleagues and I are proud to launch the Canadian Covid Society. @CanCovSoc Covid-19 is thankfully not the threat it once was, but there are still significant issues with having a new disease roughly 4x as bad as Flu (and much more contagious) floating around, which also disables a lot of people as well. In Canada it was the 3rd leading cause of death 2020, 2021 and 2022. We have the Canadian Cancer Society, and Heart and Stroke foundation for the 1st and 2nd causes, it's time we have one for the 3rd leading cause of death. It is perfectly natural to not want to deal with this issue anymore. But that's part of the problem isn't it? Many of us have a visceral aversion to discussing it, perhaps a natural reaction to memories of the most traumatizing days of the pandemic. But the fact remains that it's still out there, that it will continue to cause strain on our health systems, disable people, and shorten life for many of us. We need a national body that will keep advocating for things like updated vaccines and therapies, as well as common-sense fixes that prevent the spread of disease, like cleaner indoor air (which could have been very useful stopping this nasty measles outbreak we're having). We need a national strategy to support and improve access to care for Long Covid sufferers, many of whom are simply unable to access any care for a devastatingly disabling condition. 2 out of the 3 Long Covid advocates we approached for our launch event were not able to attend due to illness, which should tell you something! There's no way to predict who will get it, when they'll get it, and there is no cure, yet. We are organizing a virtual press conference for 1pm (ET) today, Wednesday March 6, 2024. A video stream will begin on Youtube, and this url will forward you there: covidsociety.com. Journalists who wish to ask questions please send me a DM and I will send you instructions to join. Our website is up at covidsociety.ca You'll hear more from us as we grow the range of activities offered by the Society. We would love to share resources and help like-minded groups start national societies in their own countries. Would love to see and collaborate with an American Covid Society, a British Covid Society etc. It is time that we create a permanent effort to fight this disease, and not have these efforts subject to political whims or a societal wish to indulge in denial.

Ask yourself this: You've spent thousands on your vacation. You've planned for months. You're going to have the time of your life. Do you really want to catch something on the plane on the way there? Is as simple as that.

Schools and daycares are the main source of respiratory bugs every winter (and beyond). Imagine if we could eliminate a huge portion of illness with better ventilation. Whatever it costs will easily be paid back with by reduced illness, hospital use, sick days.

Some thoughts after a recent family vacation to Southern California - Was really amazed to see the quality of indoor ventilation in almost every building we went to. Almost never saw a reading above 600, even when moderately crowded. Probably easy to do in a state where the weather is much milder than in Canada where I'm from, but still sets a high bar for us all. - Lovely to see that many store and restaurant-owners have internalized the importance of natural ventilation. Saw doors and windows propped wide open, even during recent unseasonal chilly rainy weather - Good to see California public health still pushing the importance of testing, treating and beating the virus in public advertising. - Happy to see the long drought ending, and to see the vegetation and greenery come alive. California is truly a verdant paradise when it gets enough water.

Some hotels have Infinity pools, we have an Infinity Hallway in our hospital. 10-15 EMS crews at any time, trying to offload patients to an emergency room with no beds. Stay safe out there folks.

This will turn out to be, I think, a landmark paper on the mechanisms of severe infection. Basically, many infections are mild and life goes on, but some will: 1) Infect and persist in the bone marrow, which could explain long term symptoms 2) Create a certain type of 'poisoned' antibody that makes your immune system go into overdrive. Not everyone gets this, but when it does, severe disease develops. Congratulations to @farid__jalali and @ZaidYounes9 and team on an amazingly informative paper!

This is a really good point. You can do all the right things in trying to stay safe, but a lack of leadership from the top, a lack of honesty with the public about what's happening in our hospitals, is going to create these immense pressures.

"Asking medical workers to keep stepping up, when almost no one else is... is a lot to ask" "We have the tools to reduce pressure on our hospitals, but there's no willingness by our leaders to use them" My comments on @CTVNews tonight: ctvnews.ca/video?clipId=2572…

What's happening now in Australia should be a wake-up call to all of us. They have the twin misfortunes of: - Being in the middle of winter - a prediction for our own coming fall and winter - Media dominated by Rupert Murdoch-owned outlets, keen to push that 'it's over'

I hate getting sick on vacation, and this is a great strategy by @JeromeAdamsMD to prevent that after flying. I also aim the air vents (called gaspers) right at my face. Cabin air goes through a hepa filter so quite safe. I might take off my mask briefly to grab a drink when the plane is at cruising altitude (engines are at full power, so is the ventilation system), but if my seat mates are sick, probably would tough it out.

Proud to have a leader that runs half marathons rather than running his mouth!

Trudeau leaves with a rousing speech on his last day as PM. Nobody can doubt that he worked hard and sincerely for what he believed to be the betterment of the country. And now he gracefully makes way for his successor on a high note.

Rewatching the 2011 pandemic movie Contagion was interesting; the one thing that really struck out at me was the emphasis on fomites and close contact precautions by the CDC for the fictional MEV-1 coronavirus. Kate Winslet's character got herself killed talking to dozens of people in a city with an outbreak, without a mask, by what likely was an airborne virus. And this kept on happening repeatedly to other characters in the movie... the country and economy grind to a standstill until a vaccine comes along. The whole movie would have been a lot shorter if everyone had just donned some N95 masks for a few weeks! Similar mistakes were made in 2020 by the pandemic response in the real world, and I just hope our public health authorities fully commit to containing airborne spread of novel pathogens in the future. Could have spared us a lot of trouble in the present too.

Once again seeing C19, Flu and other viral cases in huge numbers in the ER. Hardest hit are kids <2 and adults >65. Some advice for this season: Use fever medications - Every child with a high fever will look terrible. Keep ahead of it with Tylenol/Paracetamol and Advil/Ibuprofen - Kids will often refuse solid food, but will still drink; give lots of fluids/electrolytes, especially after you bring down the fever. The appetite will usually recover after a day or two with the more benign viruses. - most cold/flu meds (eg pseudoephedrine, benadryl) are not recommended or approved for kids <6 When to come to see your physician/come to the hospital (not an exhaustive list) - fever more than 4-5 days - not eating/drinking - lethargic/sleepy even with tylenol/advil - not peeing, or peeing too much - rapid or noisy breathing - Any fever in a child <6 weeks, or in a chemo patient - focal source of possible bacterial infection - ear pain (ear infection), severe sore throat (strep), pain on urination (UTI), etc. - if you're worried Do a Rapid Test - It is a big help to your physicians to know if you're C19 positive or not. This could mean faster access to antivirals that could save a vulnerable patient's life, or at least prevent a hospitalization. It could also mean you're not prescribed unnecessary and possibly harmful antibiotics. It also helps you keep vulnerable babies or older relatives away from infected family members. Prevention - Mask wearing is not popular, but when used in poorly ventilated, crowded places (planes, trains, buses, hospitals, malls full of holiday shoppers) is a high yield activity that might spare you a lot of misery - If you're sick with any cold symptoms, stay home, wear a mask if you need to go out. Spare someone else a lot of misery. - It's a hard thing to ask, but don't go to the big family dinner and infect everyone if you're sick - It's no longer 'brave' or a sign of hard work to show up sick to work. It's a terrible Christmas present that your colleagues will hate you for. - Get boosted (for C19, flu, and RSV if available), will hopefully prevent some infection and ensure a milder course of illness for most. To give you an idea of what's circulating out there (in Ontario, Canada) for now:

Tomorrow we launch the CleanAir Map by @theRavenApp, an app that helps you find places with good indoor ventilation. We’ll have meetings twice a week and build this movement until every one of us is safe indoors from Covid! Join our space tomorrow: nitter.app/i/spaces/1LyxBonOjbYKN

Every patient in every hospital bed deserves to breathe clean, disease free air. HEPA filters go a long way to doing that in older buildings with poorer mechnical ventilation. Frequent respiratory outbreaks in hospitals should be a think of the past.