Alberta Health Services

Calgary zone Covid-19 Case & Variants update May - AHS admits numbers inaccurate

Alberta Health Services admits on their website they are only screening a sample of positive cases and to “Interpret Case Numbers with Caution”

  • in other words, AHS screening of positive cases is incomplete therefore ‘don't trust our numbers’.

Again AHS decided not to respond to inquiry sent via twitter.

Due to this, it is of questionable value to continue creating the monthly Calgary zone case & variant trend chart updates based on information AHS admits is lacking integrity.

Calgary Zone Total Active Variants.jpg

With Alberta Health’s recommendation to not trust their May 2021 numbers, this may be the final covid update I post, the 1 chart I have not seen them display - Calgary Zone Total ACTIVE Variants - based on their daily published data I could find. I did not see it reported separately or track hence the Feb - Mar gap, however I was able to calculate the initial period.

*Note how fast the reported case #’s dropped, and how variant case #’s did not become the dominant strain as predicted, or as seen in other countries. It is unclear whether this is due to the inaccurate case counts AHS admitted, increasing vaccination rates or people spending more time outdoors.

Given the large # of service workers available receiving CERB payments, there could be an effort by AHS to tap these resources to help make tracing phone calls or case count. This would also reduce pulling trained nurses from the front line to man the phone lines for tracing - and then claim a shortage of nurses.

India variant identified in Alberta May 3.

Schools opened this week though, and the province plans to reopen instead of follow the proven zero covid strategy (details in April covid link) that has consistently resulted in covid free / restriction free countries/provinces.

2021 Alberta Staged Reopening Criteria.jpg


Regarding opening - closing restriction criteria; previous searches have not turned up with a result nor have my inquiries been answered, however the above was recently released. It appears it is based on hospitalizations & vaccination rates.

I’ve been wanting to do an analysis to see if previous opening - closing restriction criteria were based on case numbers. Restrictions were communicated as being in place to reduce healthcare overwhelm, which based on wait times was over capacity in many was prior to the corona virus.
This graphic from CBC allowed me to pull the numbers I’ve been tracking and do the analysis:

Alberta Covid-19 Restriction & Reopening timeline.jpg

Alberta Covid-19 Restriction & Reopening Timeline from CBC

 

May 13 2020 - Stage 1 reopen around 1000 cases & dropping

Jun 11 2020 – stage 2 reopen around 372 cases & increasing

Jul 18 2020 – cases continue climbing past 1000 (would this not trigger Stage 1?)

Nov 23 2020 – after cases climb for 5 months up over 13,000 modest new restriction announced

Dec 13 2020 – after cases further climb over 20,000 stricter restrictions announced

Feb 8 2021 – even though cases have only dropped to 5000, and variants have been identified, this is ignored in lieu of ‘step 1’ easing of restriction (previous trigger 1000 cases)

Feb 23 2021 – at the 2 week mark after easing of restrictions – the corona virus incubation period – cases predictably start increasing again

Mar 8 2021 – ‘step 2’ easing, followed by predictable exponential increase

Apr 6 2021 – instead of addressing the exponential increase, it is allowed to increase above 11,000 before return to ‘step 1’

May 5 2021 – after allowing the largest case climb to date, over 24,300, restrictions similar to the initial pandemic response (which crested at 3,000 cases) are finally returned

May 9 2021 – Alberta hits 25,185 and cases start dropping, however this is only 4 days after restrictions instead of the 2 week incubation period, leaving two explanations:

  1. transmission slowed due to other factors towards the end of April (may include vaccination; people outdoors due to weather)

  2. the numbers are incorrect, plausible as Alberta Health reported on their website that screening is incomplete (“only a sample”) and not to rely on their numbers (“interpret with caution”), therefore it is unclear what the actual case counts are

  • open to other explanations, please share

A cases hospitalized timeline may help determine whether that was what the openings - closing were based on. There is no evidence it was case #’s.

Predictably, restrictions reduce cases, however based on AHS’s recommendation not to rely on their numbers, it is unknown if cases are actually under 9000.

Calgary zone covid19 cases only to date August 30, 2020

As reported daily by Alberta Health. They finally responded to one of my questions on twitter about why there is so much of a difference between their daily published numbers and their trend chart. AHS replied “covid19AB cases may fluctuate between daily increases and net increases due to amendments and updates during investigations; this can include transferring out of province cases and resolving the status of probable cases.”

I asked if this means the daily reported #’s are what was identified in Alberta that day, and if Alberta Health is updating for residents testing positive out of province, and subtracting people visiting AB that test positive here, and have heard nothing for 10 days.

Still waiting on responses to my other questions from months ago as well, not expecting a response to them either.

Trend charts based on AHS daily #’s:

20200830 Calgary zone covid19 cases.jpg

Calgary zone TOTAL Confirmed cases to date

20200830 Calgary zone covid19 NEW cases only.jpg

Calgary zone covid19 NEW cases to date

20200830 Calgary zone covid19 ACTIVE cases only.jpg

Calgary zone ACTIVE cases to date

Calgary zone covid19 case update to July 31, 2020

Calgary zone covid19 cases July 31.jpg

Confirmed cases still increasing however recent spike 2 weeks ago seems to have tapered.

Calgary zone covid19 NEW cases only July 31.jpg

Active cases increased for 2 weeks then decreased last week. Mandatory masks start Aug. 1st we’ll see if it has any impact.

Calgary zone covid19 ACTIVE cases only July 31.jpg

Still no proper response from Alberta Health on any questions I’ve asked, they just give me the same link over & over which lacks the information I requested; I also pointed out June 25 the trend chart does not match daily active & confirmed case numbers they published. Here’s the 1st example I sent them:

Alberta Health Reported numbers 2020-07-17.jpg

AHS published 5785 confirmed cases on July 17, the date of this screenshot.

Yet the July 22 trend chart reports

July 17 having 5883 cases.

What accounts for 98 case the difference?

Alberta Health Reported numbers 2020-07-22 1246.jpg
Alberta Health Reported numbers 2020-07-22 1250.jpg

They did not respond to this example. Here’s another: July 30 reports 6470 confirmed cases

20200730 1724 AHS Calgary zone covid19 reported #s.jpg

However the trend chart on August 2 shows a different number of cases on July 30, it says 6499.

20200731 Alberta Health Reported #s Calgary zone.jpg

What accounts for the 39 case difference?

I noticed the numbers are often different so I’ve done a few screen shot examples to have them account for the difference.

AKIC (Acute Knee Injury Clinic) U Calgary - ACL tear follow up - appt 2

May 16 cont...
10:45

2nd AKIC U Calgary appointment (Finally)
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Wait Time has been 57 days so far,

19 days behind actual scan completion
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follow up to go over April 27 MRI results

Again, I feel reluctance to work with me, in only 2nd appointment.  When I bring up ligamys doctor does not seem familiar with it and can't answer questions.  I ask if he read the emails I sent with the information and am told they were not read.
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I inform him the surgeon responded I may be an ideal candidate for InternalBrace and am told “We don’t do that here.”  Concerned the help that could be offered on this will not be provided I said “I just need you to support which ever surgeon I end up working with by helping me get him the information he needs.” I do this to ensure consensus is established on how we’re going to proceed with expectations & responsibilities as I don’t know what may be required.
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I told him I’d send the medical journal on Internal Brace to share & discuss with the surgeons so they know what I was referring to and how they can provide this option.
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At this point I’m perplexed why they don’t know about this and am having some doubts about the Canadian Healthcare system.

20180516 13 46 IBLA info for Can surgeons.JPG

1:46pm

I send the AKIC sportsmed doctor at U Calgary information on internal brace to share with the surgeons he had yet to tell me a name of, as I’ve lost faith they’re offering current practices however I don’t see why they wouldn’t be interested in learning practices with better patient outcomes.   https://www.arthrex.com/what-surgeons-are-talking-about/131FD01B-7B44-491D-B5F7-015A9474A65E

2016 article on AHS from the Calgary Herald on MRI wait times increase in Calgary – how many of these could be understood by the work from my Aug 12 post:

https://www.google.com/amp/s/calgaryherald.com/news/local-news/ahs-seeks-answers-to-the-reasons-behind-lengthy-calgary-mri-waiting-lists/amp?source=images

20180516 1 post from 20180319 pineapple.jpg

Still eating fresh pineapple for bromelain, found in every part of the pineapple, but most plentiful in the stem.  Seems the clot isn’t a concern anymore;  pineapple enzyme is supposed to help break up existing clots and prevent future ones from forming.  I usually blend it into a smoothie.

MRI results wait time: 16 days

20180430 AKIC MRI results email reply.JPG

April 30, 2018

I received the following email:

“We have received your MRI results and Dr. _____ would like to see you back in the AKIC to go over those results on:

Wednesday, May 16th at 10:45am.  (16 day wait time)

We are happy to report that there are no urgent surgical findings in your #knee. Please continue with rehab exercises (ie. physiotherapy, athletic therapy, or home strengthening/flexibility program) and activities as tolerated.  Please remain in linear activity only (no pivoting or twisting) and no impact exercise (no running or jumping).

Please reply to this email confirming the above appointment”

 

 

20180430 AKIC MRI results email response.JPG

To which I promptly replied:

“Are there any non-urgent surgical findings?

It really blows my mind I know 2 people who had MRI's scheduled, results provided and in 1 case surgery conducted in less than 2 weeks, and I have to wait over 2 weeks just to review them.  A phone call would be great to give me an idea of what's going on. 

Also wondering if I am better to have results sent to my previous sports medicine doctor in Toronto and fly their to speed receipt of diagnosis.  I understand from my healthcare background this is due to the medical care system setup, not individual people.  If you would like to reduce your turn around times, I would be happy to help.

As for your recommendation not to run or jump, I can barely walk.

Evening prior to MRI I stepped off a curb and bent my knee more than it wanted, and it has been quite challenging since then.
Confirming the appointment in half a month.”

 

The step off the curb 3 days prior brought the inflammation back to where it started. 

 

Received call from AKIC doctor at U Calgary next day, who provided some clarification.  Very grateful for this.

 

*even though the radiologist completed their report promptly, & the doctor received it, there’s still a 16 day wait time for results instead of scheduling them within 24 hours of actual availability.  Go back 4 & 7 posts to see examples how wait times are reduced with lean healthcare in the emergency room and MRI, which can be done

 

Total Wait Time so far for diagnosis: 40 days

Plus the additional 16 days now.

 

MRI - Richmond Road Diagnostic - Alberta Health Services

20180427 MRI scan (1).jpg

I want to mention how grateful I am we actually have access to healthcare.

Just the fact that it is available at all in a world where many don't have the option.

A lot of people complain without offering a solution or appreciating the fact that despite the imperfections, we're lucky to be in this part of the world.

 

Last 2 weeks I'm starting to walk (limp?) a bit better despite limited range of motion; has it improved slightly?  for straightening I have gotten it a cm or two closer to the ground, not sure if that translates to a degree or more.

Still very slow, just to & from parking lot for work & necessities, which has been treacherous at times.

Lucky snow & ice is gone in the city; would not have been able to walk on ice.

 

Apr 26

- evening before MRI

stepped off curb; it must have been a bit lower than I expected, likely I was going a bit too fast as I feel things are improving - bending beyond the comfort zone and couldn't stay up, naturally caught myself with the other leg & hands on the road.  Push through the pain to straighten it again, stood up and assessed.  Sat on my bumper for a few minutes while it settled down.  Hopefully it didn't make anything worse; happy the MRI is tomorrow and we can finally get a diagnosis. 

Surprised no one stopped to ask if everything's alright; there's a fair bit of traffic in this area - it wouldn't have help me, but what if it was someone else that actually needed help?

After this I decide to start keeping detailed notes regarding #injury progress & how it feels.

 

20180427 MRI scan (2).jpg

Apr 27

- MRI scan

- 37 days after injury

- surprisingly long walk from front door to the MRI lab, a great exercise in patience for me.

wait time of 37.4 days for 15-30 minute scan Alberta Health Services

 

*side note

- within the week I waited, my friend requested & received and MRI at a private clinic in Calgary

- so the problem at Alberta Health is not a shortage of access to equipment or capacity.  Had my appointment not been moved up I would have done the same, as the doctor explained there is a window to treat these injuries for a positive outcome

20180427 MRI scan (3).jpg

HOW TO REDUCE MRI TIMES

20180414 Reducing MRI Wait Times.JPG

Here's an example

HOW TO REDUCE MRI TIMES:  

https://pubs.rsna.org/doi/full/10.1148/rg.347140025

This was done at Department of Diagnostic Radiology, Henry Ford Hospital,

2799 W Grand Blvd, Detroit, MI.

It is more complex than most I would expect, and the team did not quit, they followed through their learning. 

 

I've been implementing Lean for 10 years, part of that in healthcare, if you have questions or a hospital CEO interested in leading your facility to obtain these results.

It works. 

The question is are you learning how to apply it Alberta Health Services?

1 year MRI wait times in Alberta

20180413 MRI appointment call.JPG

I receive a call saying MRI appointment is for March 2019

- 1 year away. 

 

Cannot straighten leg or bend it near 90 degrees.

 

*Would be 3 weeks post op in US and recovering; being told I have to wait a year now here. 

 

Consider that other people have families, children or their elders to take care of; or may not be in a financial situation that allows a 1 year pause due to pending injury diagnosis - 1 year is unacceptable for MRI wait times.

It can impact their quality of life, #recovery potential & ability to economically contribute or support dependents. 

 

This situation supports unnecessary ACL amputation & ACL reconstruction when diagnosis & #treatment is not achieved within the time frame for natural ACL regrowth  - more explanation to follow.

 

Is MRI magnet time at 100% ?

If so, are we executing Lean Healthcare reducing costs in other areas to free up the available funding to purchase new equipment like so many other hospitals? 

 

For example, Lean has been used to improve hospital utilization, improving patient outcomes while reducing the need to add entire proposed #hospital WINGS.

When properly applied the CEO frees up $$, space & resources which can be redeployed for additional healthcare services (or MRI suites).

 

One way to learn a solution Alberta Health Services

- in the same way emergency wait times are consistently reduced through 3-5 day Rapid Improvement events, MRI wait times are reduced the same way.

 

see how it's done in next post

 

Alberta Health Services Emergency Department Wait Times

20180327 Rockyview hospital defective equip exam room.jpg

Thu Mar 27 - day 10

Happy to see hand washing % sign on wall in emergency Alberta Health Services; still need to start continuous improvement though.

Triage & admitting were reasonably quick; next wait room was 2 hours - at least they know the wait time - no sign of Lean Healthcare.

While waiting for knee diagnosis saw the sign (in pic) - assuming someone else has also - hoping I don't rely on it either if still in disrepair.

At least it's visual.

 

speak to orthopedic surgeon,

says we can do aspirin and check in about 10 days to see if things clear up, or weeks of Rivaroxaban.

Has a pager call (they still exist!) & says to look it up while he takes the call.

A quick review of its side effects and I don't see why one would take this unless absolutely necessary.  There's also no reversal (as there would be warfarin/rat poison).

We talk more and are in agreement checking back in 10 days is a reasonable course of action.

He says he'll get a 2nd opinion from the hemotologist, comes back and is pro Rivaroxaban prescription.

I call it and point out how flip flop this is, & I prefer not to take the prescribed anticoagulate.  We agree so I'll set up another ultrasound.

I look up natural blood thinning options and adjust my diet with daily pineapple for bromelain, tumeric, apple cider vinegar, cayene pepper, garlic, fish & sardines, lemon, green tea and natto.

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Wait Time for Diagnosis

20180326 wait time for diagnosis.jpg

Thu Mar 22

Drop in to my Chiropractor. and they notice a few things seem out of the ordinary & request another ultrasound to check for thrombosis / DVT

 

Mon Mar 26

Acute Knee Injury Clinic at the University of Calgary responds 6 days after request regarding appointment, says to complete forms online & they are booked out for weeks, Apr.19 is next appt;

which means I won't receive a diagnosis for another 4 weeks.


How many injured people cannot wait 1 month & still achieve a positive outcome?

*Another example where lean healthcare can reduce wait times & improve patient outcomes.

 

another Chiropractor appt. today, worked on shoulder as it was sore from how I've had to adjust to get in & out of truck.

*also grateful to be somewhere that healthcare is at least available

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20180327 J1 ultrasound.JPG

Thu Mar 27 - day 10

have DVT ultrasound appt identifying 3.8cm thrombus in 2 superficial veins of the popliteal trifurcation.  not sure where that is, feel free to tell us what popliteal trifucation means in comments.

Met family doctor, suggests some aspirin to help the body naturally disolve the clots, and to obtain a 2nd opinion from an orthopedic surgeon who should be available at the emergency.

head to Alberta Health Services Emergency

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Torn ACL - wait time for diagnosis

20180319 xray ultrasound 1.JPG

noticed more painful to walk in running shoes than ski boots

 

Sunday March 18

- drove back to Calgary

Will be interesting navigating healthcare as a patient with my background implementing lean at 3 hospitals.  Alberta is behind all the western Canadian provinces in their adoption of Lean Healthcare to improve patient outcomes.

BC started a few years before they moved me there,  Saskatchewan is at the point they're using 3P, and Alberta sandwiched in between by my measure has not even started.

Going to pay particular attention to wait times.

20180319 xray ultrasound 2.JPG

Monday March 19

went to see my doctor who sent me for xray & ultrasound on knee - went same day - report in photo.  I still think everything is ok and may be able to hit May long Sunshine village. Didn't go for the meds or crutches.

so far

88% wait time (10.75 hours) for

12% value add/service (1.5 hours).

 

Tuesday March 20

morning - walking is tough, actually considering crutches MRI & Acute Knee Injury Clinic appointments requested.

 

Wed. Mar 21

24 hours later AKIC responds to request, no appt yet.

Nothing from MRI. 

*If I were in the US I would have had it yesterday and would be reviewing the results.

let's see how long it takes Alberta Health Services

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