Sabina Vohra-Miller
@SabiVM
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Doctor of Public Health student | MSc Pharmacology/Toxicology | Vohra Miller Foundation | Unambiguous Science | First Exposure | South Asian Health Network
Toronto, Canada
Joined July 2011
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The proudest moment of my life.
First Exposure launches today. 4 years in the making. So incredibly proud of the entire team.
“Ontario program to help expectant parents with advice on medication fills gap left by shuttered Motherisk lab”
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The amazing
@DrSamiraJeimy
and I collaborated on a post because we are both tired of seeing the term ‘immunity debt’ being thrown around.
We also get into why we are seeing a record number of pediatric hospitalizations, so stick with us.
🧵(1/8)
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The irony of removing even the measly 5-day Covid isolation bc people need to get back to work, only to infect large swathes of people who then need to take time off work, causing a larger worker crisis. I mean, our govt actually thought this would work?
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The immediate answer to variants should not be third boosters. It should be global vaccine equity.
We will continue to have new, more virulent variants if we allow the virus to grow unchecked. What happens in another part of the world will absolutely impact us.
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My child had RSV at 10 weeks & again at 22 months. Both times resulted in multiple ER visits + hospital stay. Absolutely ZERO advantage for him to have had RSV at a young age, only risks (both acute & longer term). Anyone suggesting willful illness in children has lost their way.
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38% voter turnout. Tomorrow when the Greenbelt is demolished, when our healthcare capacity crashes, when our children’s education is deprioritized & support systems removed, when disparities between communities widen - don’t complain, because this is exactly what you wanted.
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Never in a million years did I think that when we talk about ‘the pandemic’ we would have to specify WHICH pandemic and disease we were referring to. And yet, here we are.
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New data: Reinfection was found to substantially increase the risk of death, hospitalization, and adverse health outcomes, making strategies preventing reinfection critical.
Summary 🧵 1/9
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Time for some serious myth-busting on:
MODERNA vs PFIZER
Hint: they’re pretty much interchangeable.
Here’s why (a little pharmacology and a little immunology): 🧵
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We have a massive shortage of pediatric fever reducing meds, several anti-histamines and antibiotics. Where is the Canadian Pediatric Society? Health Canada? PHAC/PHO? Why is absolutely no one sharing any guidelines or recommendations on what parents with sick children should do?
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To physicians who say children don’t need a Covid-19 vaccine: do you also advocate against other vaccines for diseases that cause fewer pediatric deaths than Covid? How many vaccine preventable deaths makes a vaccine worth it? If you don’t believe in vaccines, why be in medicine?
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Masks on a population level didn’t work as well as we hoped bc we eroded trust in them from the get-go. From suggesting they are unnecessary early on, to unscrupulous studies claiming they are dangerous, to not teaching how to don/doff, to not acknowledging airborne transmission.
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How did the narrative on masks sway so heavily? Plenty of data to show the benefits, and no data right now to suggest ill-effects in majority of the population, including children. We can’t wish Covid away, why wouldn’t we do all we can to prevent unnecessary re-infections?
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Just a reminder, as the names of those who contributed to the trucker convoy become exposed - the leak is from the NEW platform. So everyone who contributed was AWARE the convoy was illegal & breaking laws.
This realization is costing me many friendships, and I’m okay with that.
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A few months ago this year I was lucky to be included in the taping of a fairly big TV show as an extra.
The number of Covid-related safety precautions they took throughout the entire taping was incredible:
🧵
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That every hospital in Ontario has continued to uphold masking protective measures is striking, primarily because it tells us that while the province looks to the CMOH for guidance & support, he delivers on neither.
That the government has abdicated responsibility is concerning.
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Many are using this crisis to claim that public health measures have somehow impacted our immunity - THIS IS NOT A THING.
The public health measures we took in the last few years only helped reduce the burden of illness and did not in fact cause this crisis. (8/8)
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1- There is a reason why ‘personal responsibility’ models don’t work - it puts the onus on the individual (resulting in an interpersonal strife) when really it is the govt who is abdicating responsibility to lead, and obscuring systemic failures.
1/5
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With Canada now at 75% partially vaccinated (>age 12), & Delta requiring an incredibly high fraction of pop needing to be vaccinated, our strategy to reach the remainder will need to change.
It’s time to pivot.
It’s something I’ve been thinking about a lot recently, a 🧵(1/9)
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As a new immigrant, I went to bed hungry bc I didn’t know food banks existed. Life as a newcomer is hard, you’re trying to keep afloat.
How does one expect them to know where the vaccine clinics are, how to book appts, get time off etc when they’re just trying to survive?
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Two new Canadian studies demonstrating the efficacy of masks.
These studies show that mandatory masking, esp during periods of high respiratory viruses in the community, can result in reductions in absenteeism, prevent infections and deaths & reduce economic burden. 🧵 1/9
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Some people in medicine need to stop publishing garbage. Herd immunity wasn’t achieved in April. And masks on children is not ‘abusive’.
JUST. STOP.
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Pfizer 5-11 data is out!!!!!!
Robust response, no new safety concerns. Two doses, 21 days apart. Lower dose at 10-microgram (vs 30-microgram for 12+)
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So what is this ‘immunity debt’ concept?
Claims that lack of exposure to infections weakened children's immune systems, causing them to have severe infections.
There is no evidence that this is real.
(2/8)
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Those who supported and amplified this protest were keenly aware of the ideologies of the *organizers*. To now claim you were ignorant, or that it was a small minority is revisionist. Really interesting to see people backpeddle. Let’s not forget when we are at the polls.
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I’ve been inundated with questions on whether people under 60 should get a booster now, or wait until Fall for the bivalent ones.
If there is anything I’ve learned from the pandemic, it is that you simply can’t plan anything that is even a few months out.
My thoughts:
🧵1/6
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Shame on Ontario. We are squarely at ‘survival of the fittest’ phase of the pandemic.
But also, does anyone actually understand these testing and isolation guidelines? They’re a complete disaster.
Lastly, healthcare is going to be crushed. This is just stunning disregard.
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You don’t ask a banker to build a bridge. You don’t ask a lawyer to be your electrician. Somehow everyone thinks they are suddenly armchair medical and public health experts and apparently that’s okay? Epistemic trespassing has been the bane of this pandemic.
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@tMayor_McCheese
That was incredible. I love the dialogue and engagement by PMJT.
Very curious about these ‘women who sleep around’ - do they sleep around by *themselves*? It takes two to tango, dear sweet ignorant child.
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Recent data shows masks prevent transmission, incl two large studies specific to schools + have new data on Long Covid.
So yes, we are moving towards removing protective measures, but whatever the motives, it is abundantly clear that it simply isn’t based on science/evidence.
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In the absence of infections, the immune system does not lie dormant & weaken. We are constantly exposed to & co-exist with, trillions of viruses, bacteria & fungi.
Lack of infections does not weaken the immune system. But some infections, like measles and COVID-19, can. (3/8)
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Created an infographic against the pseudoscience being circulated regarding spike proteins.
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@AdithyaR_YXE
Wow, what an unbelievably horrible experience at Riviera Motor Inn. In Europe earlier this summer, we came in wearing masks & front desk asked if we preferred if housekeeping wear masks when in our room. We were delighted to hear & tipped/left good feedback generously.
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At
@UofT_dlsph
for the week and it’s a little shocking to see public health students not wearing a mask. Feels like the curriculum is missing some key learnings.
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To allow some people the ability to do what they were already doing but now without a mask, it’s going to take away the ability for many to do anything due to no masks.
This is the very definition of inequity. How are we okay with not protecting our vulnerable?
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Today is such an emotional day for me. I never shared this on Twitter, but my son was in the Moderna clinical trial for <5 (and received the active drug!). I am so immensely proud of him, and all the little kids who made this happen.
You can have the 🎤 back now.
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Advocating to ‘normalize Covid-19’ in schools and comparing Covid-19 to influenza is really disheartening to hear from our CMOH Dr Moore.
This is foreshadowing at its finest, and absolutely setting us up for failure.
How do we keep failing our children?
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After two decades of being in Canada, I was finally able to bring my dad over!
He *just* landed officially as a Permanent Resident 🇨🇦.
Christmas will be extra special ❤️
#LifeAsAnImmigrant
#CanadianDream
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1- We are doing absolutely NOTHING to prevent the 5th wave we are walking into with our eyes wide shut
2- Two years in and we learnt NOTHING to prepare for next waves such as preventing critical drug shortages, making decisions early, improving key things like ventilation
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One hypothesis: We know many viral infections, such as Covid and measles, can impact immunity downstream, even after mild infections.
Omicron spread widely among kids, & they may not have immune reserves to fend off subsequent viruses & infections as efficiently as before. (6/8)
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Many questions about the recent study on mRNA vaccines & IgG4 antibodies over time, so
@LizMarnik
& I teamed up again to address. Lots of misrepresentation/extrapolation of data.
In this post we discuss what IgG4 antibodies are, what the paper shows & what it means. 🧵 /1
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There must be a federal investigation of how the US interfered and funded an unlawful occupation in Canada. That the CPC is okay with this shows you exactly where they stand in their patriotism.
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This feels like the upside down place.
@PeterHotez
developed many vaccines that were distributed for free. Not just during Covid but for many other diseases prior to Covid.
He has saved so many lives around the world, & those who cannot see this are being intentionally obtuse.
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I took a break last month bc of burnout & had the privilege of traveling to Europe & NYC. I also saw Beyoncé at the SoFi stadium in LA.
3M Aura indoors & crowded outdoors, dined outside always. Gratefully haven’t had Covid yet. Masks work & being cautious doesn’t hinder living.
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I have so much to say about the Ontario Elections, but nothing nice to say. All I will say: Ontario, you dug your own grave.
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For the record, nearly 50% of truckers in many provinces are South Asian. A friend who is Punjabi like me is in the trucking business, and she tells me that most of their South Asian drivers are vaccinated, and in fact, were even before they were eligible in Canada.
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PSA: You DO NOT need to get sick to build a strong immune system!
There is simply NO ADVANTAGE to getting sick. Exposure to a pathogen does not necessarily mean you mount long-term immunity. Even where you can have life-long immunity, it comes at a cost to overall health.
PSA: Masks & other public health measures have NOT caused an increase in viral illness or severity.
Lack of exposure to infections does not weaken the immune system & infections do not build your immune system.
Public health measures only helped reduce burden of illness.
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Many parents have told me that their kid hasn’t had a single stretch of not being sick so they can get a flu shot.
Too many children do not have optimal protection & this will have disastrous consequences.
PS: you can get the flu shot as long as not actively ill (eg: fever).
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One of the biggest threats of the 21st century is how disinformation has been weaponized.
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Have received so many concerned messages from people who I recommended get vaccinated with AZ just last week.
I’ll be honest, this is tricky and complex. I’ll try and explain my thoughts as best as I can, and as always, be as balanced as possible.
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Pediatric hospitals are filled with sick children. What is going on?
While numbers of RSV & influenza are not higher than last yr at this time, MORE children are hospitalized than last yr. So higher proportion of children are coming to hospital with severe illness. (4/8)
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The decision for the govt to appoint a for-profit org - Shoppers Drug Mart - to act as the sole distributor of Covid vaccines makes absolutely NO sense.
We need an inquiry on the relationship between SDM & the govt, bc this favouritism is clearly not beneficial for the public.
🏥After administering thousands of vaccines over the past few years, we've made the tough decision to conclude our vaccine season, & possibly for all future seasons for publicly funded vaccines.
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Why is this occurring?
With removal of public health measures such as masking, many viruses are spreading widely. Given we have had a break from these, most of the population is susceptible & exposed again at the same time. But doesn’t explain the higher % of sick kids. (5/8)
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Taking a two week mental health break. Omicron, ineptitude of the government and now the news on pediatric vaccines <5 is soul crushing. I haven’t had a day off In over a year. I am burnt out.
Happy Holidays - Stay Safe
See you in 2022
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I personally disagree with ON mandating 12 weeks after AZ (regardless of what you get for 2nd dose).
With the original variant, 12 weeks showed better efficacy. But with the rapidly spreading Delta variant, earlier full protection is more advantageous.
Needs to be changed ASAP.
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SIX reasons for getting kids 5-11 vaccinated as soon as they are eligible!
1- Protect children from Covid-19 illness, hospitalization and death.
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To add, there is a massive healthcare staffing crisis. Healthcare workers are sick themselves, leaving healthcare due to being burnt out & underpaid. Without staff, hospital beds are in short supply.
Also, there is an ongoing shortage of fever reducing meds for children. (7/8)
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Many vaccine clinics are sitting empty, our supply of vaccines far outpace doses being administered. More vaccines coming every week.
But I still cannot get my 67 year old father with high risk factors an appt. I don’t understand any of this. What are we waiting for?!
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1- The ableism.
2- The authors of the study - without any data - removed >50% of deaths bc they *felt* wasn’t due to Covid-19 despite death certificate having that as cause.
3- THEN, they removed deaths due to MIS-C post Covid.
What a joke of a ‘study’.
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I don’t often comment on all the animosity amongst science folks on Twitter, but comments like these - esp from health leaders - are wholly inappropriate at a time when people are confused, anxious, unsure. Scicomm should always be about reducing chaos and building confidence.
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Ontario friend who is 60+ with two risk factors has Covid. 3 vaccines only, no bivalent. Called pharmacies, no one would prescribe Paxlovid. Called doctor, 24 hrs later got a call-back, doc (incorrectly) said she doesn’t qualify!
Why is our healthcare so broken & inaccessible?!
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It takes a special kind of person to look at last two years of lower Influenza rates and suggest we shouldn’t have employed public health measures instead of wondering why we don’t always employ these in bad flu seasons, knowing full well they prevent hospitalizations & deaths.
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Nearly 10k cases today, just as predicted by
@COVIDSciOntario
. This is likely severely under-reported given PCR test shortages, and test positivity of almost 20%.
We need a circuit breaker ASAP.
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Shared the hospitalizations by vaccine status data from
@COVIDSciOntario
and got slammed by messages from AVers showing me
@ONgov
pie charts of raw data as a ‘gotcha’.
Classic base rate fallacy - as explained here:
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At the end I had an opportunity to meet the main actors at a meet and greet. They asked me what I did for a living - I said I worked in public health, bracing for backlash.
Instead, all of them THANKED me for keeping them safe during Covid and were incredibly appreciative.
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We (
@LizMarnik
and I) have been asked many times to share Long Covid data, especially as it pertains to mild infections and neurological, cardiac effects. So we rounded up some recent data. 🧵 1/9
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I predict that on Jan 1st our numbers will fall significantly and guess what?? We crushed Omicron! Omicron has peaked! There is no more Covid! Covid is everywhere and nowhere! It’s Schrödinger's Covid! Happy 2022!
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Don’t know if we made the scene, but if I do, I will update this thread & post a clip!
It was the season finale of my husband’s fav show.
This was my first (and only) time maskless indoors and I didn’t catch Covid at the set because of these precautions.
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If you care about healthcare, then vote like it means something to you.
#OntarioElection2022
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About last night. Heard a Peel region hospital did not have sufficient nurses, had to transfer patients out to other hospitals. Peel Code Black called because one or less ambulances available.
Massive staffing shortages across province, expect to see more of healthcare crumble.
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Hello, dunno who needs to hear this (a lot of people apparently), but no Guinness Book of World records were broken. There were 113 trucks per the OPP report.
Thanks to
@snopes
for being on top of this fact checker.
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The irony of removing even the measly 5-day Covid isolation for children bc they need to go to school, only to infect large swathes of children and make them very sick causing them to miss even more school. I mean, our govt actually thought this would work?
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Says something about our leadership in Ontario when a group of volunteers are getting people vaccinated using unpaid labour, while millions were wasted on big orgs to develop an abysmal booking system via a highly convoluted process.
Ontario, where businesses come before people.
Many have asked if
@VaxHuntersCan
volunteers will be getting paid by the City of Toronto for their partnership.
From Toronto official: ”No cost to the City. Just a partnership – no money exchanged.”
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“If I had been offered 5,000 doses unrestricted, I would have happily taken them” - Dr Loh
The truth emerges:
- These were ONLY for Brampton Amazon location
- To prevent closure of the warehouse (that’s not how vaccine work!)
- Big business over people
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Making a mega thread with resources.
First, Rapid Antigen Tests:
~$10-14 per test, can purchase bulk of 25 tests or smaller 5 test packages:
or
(1/6)
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Lord grant me the strength to argue with people who don’t even have Grade 9 biology, but rate themselves a 9/10 on DEEPLY understanding immunology.
(FtR, I would rate myself a a 5.5, maybe a 6).
My week so far:
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Remember when I said a million effing times that if do 24/7 clinics, people will come? Yeah. People came. Finally seeing the province and PHUs moving with urgency to get people vaccinated.
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As someone who runs a foundation, I get invited to a fair share of galas - which are personally not my thing (why not just donate the funds?).
But the irony of having super spreader events to raise $ for the sick/vulnerable is evidence these are simply parties for the privileged.
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Did anyone ask Ford today why we were building field hospitals in parking lots three weeks ago?
We knew this was coming. Everyone knew this was coming. That Ford now spins this and says they are being proactive & moving quickly is so disingenuous.
Stop lying to our faces.
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Doug Ford just told Brian Lilley that Doug and his wife Karla think Lilley’s articles are the only ones worthy of reading. So ridiculous. No wonder his daughter spews unscientific garbage on ‘natural immunity’ over masks/vaccines.
This is who is leading Ontario.
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The news of an adult acquiring monkeypox at a crowded, outdoor event and that of a child with no known contacts, not attending daycare is worrisome.
While current risk is low, it may not remain as such if don’t curtail this outbreak. Low availability of vaccines is a concern.
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Saskatchewan will be sending 2-4 ICU patients daily to Ontario, meanwhile still continue to have large indoor events where majority are unmasked. This is unprincipled and unfair.
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Such a huge honour. Thank you,
@TorontoStar
for the recognition.
Love all the incredible people featured in this article. Our province (and country) has many, many, many more heroes that I am beyond grateful for.
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Seeing all the people in shorts today reminded me of the day I landed in Canada as a new immigrant. End of May, everyone in shorts and tank tops. Meanwhile, I had two sweaters, mittens and a toque on 😂
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Made a one-pager infographic on how to help manage your child’s cold at home, given the crisis unfolding in Ontario (and personally having a sick baby right now).
Please feel free to share with other parents.
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Has the government considered that dropping masks would make people less likely to feel comfortable in indoor public spaces, to travel or support businesses in-person, which can have an impact on the economy?
#onpoli
#AntiScienceGovt
#VoteFordOut
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It’s an absolute honour to host a Vaccines for Kids - Family Friendly Chat with Prime Minister
@JustinTrudeau
this morning at 9:30am EST.
We will also be joined by Dr
@SharkawyMD
to answer Qs live from parents & kids.
The event will be live streamed here:
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Remember this thread where I spoke about how higher proportion of children were having severe RSV illness and discussed the potential of previous Covid-19 infection (particularly post widespread Omicron) having an effect?
Turns out, data support this.
Pediatric hospitals are filled with sick children. What is going on?
While numbers of RSV & influenza are not higher than last yr at this time, MORE children are hospitalized than last yr. So higher proportion of children are coming to hospital with severe illness. (4/8)
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The ‘need more evidence’ from predominantly male physicians on Twitter reminds me of the time I was presenting my grad research proposal on evaluating the safety of a drug in pregnancy & received many snide comments about it not being an RCT from the predominantly male faculty.
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This is not the time to pat ourselves for a job well done.
We cannot lose focus and need to continue the momentum and pivot our strategies to meet people where they are.
And we need to act quicker than Delta. (9/9)
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Recently a very flawed publication in JAMA Pediatrics stated that wearing a mask was detrimental for children. The author also had another flawed article retracted from Vaccine today.
The Nerdy Neighborhood put together this to address the major flaws in this study 🧵 (1/4)
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Shame on you, Dr Moore, for politicizing data. Watching you speak about sickness & death with a smug smile turned me away from your pressers, so thankfully I did not have to hear you talk so cavalierly & devoid of morality about deaths *due* to Covid when we aren’t even testing.
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Example of people being left behind:
Helped a person get an appt yesterday.
This person works in a warehouse on a month to month basis. Is told they will extend contract by a month if she has zero absent days. Her friends lost their job at this workplace bc of sick days off.
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Receiving many messages daily on multiple doses in vials getting wasted at the end of the day. This makes NO sense. Rigid guidelines, during a pandemic when being nimble is critical, is antithetical to public health. Can we not add 65+ year olds to waitlists for leftover doses??
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If you think an email is anyone’s worst nightmare, then you lead a very privileged life. This is just laughable.
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The same incredible team behind AZ decision guide put together this infographic on what ‘fully vaccinated’ means. Key points we wanted to highlight:
- 2 weeks post 2nd dose
- regardless of timing b/w dose 1 & 2
- many countries, incl US, consider 2 doses of any as fully vacc
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As a wealthy Canadian, I am in favour of the proposed tax changes. One can’t say they’re progressive if they don’t value wealth equity.
Trickle down economics is a scam & it’s laughable that the 0.13% think they single-handedly hold economy up. 19bn goes to much needed services!
Raising the capital gains inclusion rate to 2/3 on the largest investments will bring in $19 bil over 5 years, creating an important revenue stream to fund things like housing, childcare, and food programs. It’s long overdue and a very good thing!
#Budget2024
#CdnPoli
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