April 14, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: The COVID-19 incidence and prevalence remain stable in Kingston and KFL&A. There are a total of 55 cases in the region. There is only 1 COVID-19 patient in KGH and they are in ICU. At KHSC we did 1100 tests over the past few days with only 2 positive tests from the Kingston area. Thus we have <1% point prevalence. It is estimated that our peak case load in the SELHIN may occur in mid-May.
There are more new COVID-19 cases in the areas around us (for which we do testing), including Peterborough, Lindsay and Perth Falls. In addition there are several outbreaks of non-COVID-19 acute respiratory illnesses within our region. These mimics of COVID-19, which cause cough and fever, include infections with metapneumovirus, parainfluenza virus and influenza A virus.
Ontario Health has directed KHSC to plan for the worst, while hoping for the best. This means continuing to plan for capacity to meet surge capacity should there be an outbreak in the local prisons or should the situation deteriorate in long-term care facilities. Mike McDonald and others continue to work with city and public health officials to identify a venue for a field hospital. It has yet to be decided what patient populations would be housed at such a facility and who would staff it (should it be needed). The good news is that with recent improvements in screening and use of PPE by Corrections Services of Canada we have reason to hope such outbreaks will not occur.
PPE: Over the weekend we received a supply of surgical masks from provincial stores. However, N-95 masks remain a challenge/shortage. We are still reprocessing used PPE, including masks and eye wear/face shields. We are testing and saving these masks; but have not yet put them into circulation. Our PPE supply is improved and we can confidently assure staff and faculty that we will provide them with the PPE they need when and where they need it. There is not sufficient PPE reserve to resume elective procedures, despite adequate bed capacity and staff availability,
It’s a great time to thank a nurse or other health care professional! KHSC staff are vital partners in dealing with the epidemic. As we build bed capacity to deal with potential COVID-19 admissions, nursing colleagues and other staff are concerned by lack of work due to elimination of elective procedures and decanting of ALC people to other facilities. Some of these staffing issue are being dealt with by redeployment to other services within the hospital or by staff using vacation time. Although no staff have been laid off, there remains some excess staffing capacity. In the short term, some staff are being sent home, which raises financial concerns. The DOM and its physicians are concerned for our colleagues. KHSC is making plans to deal with staff fairly while being required to ensure we have the capacity to deal with anticipated increases in admissions as the epidemic evolves. In the meantime it’s important to be kind to our colleagues in nursing and be aware of and sympathetic to the financial stressors they are facing.
Increased surveillance testing for COVID-19 in the community and expanded testing indications in KGH: Our region has one of the highest rates of COVID-19 testing per capita in Ontario and the rate of testing is increasing weekly. As test capacity increases we are doing more testing in the community to get a sense of disease prevalence (surveillance studies); rather than focusing only on hospital centered testing of specific patient populations and people with acute respiratory infections. Surveillance testing is very important to determine the true incidence and prevalence of COVID-19 in the community. While hospitalization is a good indicator of disease prevalence, and our low rate suggests local prevalence are low, testing is needed to prove this.
Within KHSC we test all people with an acute respiratory infection. In addition we have expanded testing to include people that are failing to thrive, have falls and other less specific indicators of changes in health that often land them on the Medicine services. We also do some case surveillance testing in people within KGH who don’t have respiratory symptoms.
Canadian COVID-19 epidemiology
There are currently 26,897 cases and 898 deaths related to COVID-19 in Canada. (click link for daily update)
When you look at case accumulation (Figure below) one can see that the COVID-19 epidemic have yet to plateau in Canada (top white line). Case accumulation has however plateaued in BC (red line). In contrast, Ontario also has yet to reach a plateau (gold line, 3rd from top)..
Capacity in Kingston and beyond: KGH has good capacity, as seen on today’s graphic indicator (below). Note that we have 49 available ventilators and 138 available beds. It is also noteworthy that even in Toronto, which is the epicenter of the Ontario COVID-19 epidemic, the ICU capacity remains good. ICU occupancy is reported at ~ 70% of maximum capacity.