April 15, 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. Our point prevalence for KFLA testing (% positive/total tests) is 3.1 %.
Infections in health care workers: There are 14 infected health care workers in our region (virtually all infected in the community). There are 4 healthcare workers at KHSC that were infected. All these workers are recovering and all will be tested twice (and must be negative) prior to returning to work. All KHSC workers acquired their infection from travel abroad or in the community (not at work).
Closer to Ottawa there are outbreaks in long-term care facilities (in the north part of Leeds-Grenville-Lanark County). To the west, around Peterborough, Lindsay and to the north east near Perth, Smith Falls, things have stabilized. There remain 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.
PPE: Though 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 still not sufficient PPE reserve to resume elective procedures.
Canadian COVID-19 epidemiology: Where are the hospitalized patients being cared for?
There are currently 27,557 cases and 954 deaths related to COVID-19 in Canada. (click link for daily update). Today I want to focus on where in hospitals active COVID-19 cases are being managed: in Canada (left below) and Ontario (right below). These statistics show that after they leave the Emergency Department roughly 75% of patients are cared for on the Medicine Service while the other 25% require care in in Intensive Care Units (ICU). This is useful information for our government funders and the popular media. They often forget that most patients that require inpatient care will be looked after by internists and infectious disease doctors (and others) on medical wards and (at University hospital) Clinical Teaching Units (CTUs). This has funding and resource allocation implications that KHSC, SEAMO, and the Ontario Ministry of Health and Long Term Care (MOHLTC) should consider.
Active cases in Canada Active case in Ontario
New COVID-19 tests: In Ontario we currently do 5000 tests/day. Premiere Ford has indicated a desire to increase this to 8000/day. Number of tests counts (more is better) but ONLY if the tests are accurate! We have an outstanding lab-based polymerase chain reaction (PCR) test for COVID-19 detection from nasal swabs at KHSC (see April 7th 2020 note). Our assay detects two of the SARS-Cov-2 viral genes and has high sensitivity and specificity. The assay is run in large batches multiple times a day with results usually available within hours. However, it would be nice to have point of care tests that could accurately and rapidly (in minutes) detect the virus (also using PCR) in the community, providing immediate case identification. This would also minimize the need to quarantine people who are awaiting test results. The approved COVID-19 assays in Canada must all be run in laboratories except for Spartan Cube CYP2C19 System (Spartan Bioscience Canada) and Xpert Xpress SARS-CoV-2 (Cepheid, United States).
The Cube is interesting because a) it is made in Canada and b) it’s a very cool looking little PCR machine (a device that amplifies copies of COVID-19 genes from nasal swab samples allowing disease diagnosis). A note of caution: While this assay has been purchased by many health organizations in Canada we still await details of its sensitivity and specificity. The assay appears promising and is certainly a quick way to get results (1-hour). Our KHSC 2-gene assay can detect virus with 99% accuracy down to 250 copies of viral genome. Since viral loads are highest on days 4- 6 after symptom onset and then begins to fall, it will be critical to show that any new assay is sensitive enough to accurately detect cases on patient samples in real world settings. Nonetheless, this story is a reminder Canadian investment in research makes sense (and dollars!). The development of this device was supported by Federal research dollars.
To see the other assays approved for use in Canada click this link.
Communications with family doctors: In times like these communication is key. We want to ensure patient consultation remains vibrant and timely. After consultation with Division Chairs we established protocols for urgent consultation, elective consultation and virtual visits (telephone, asynchronous e-consults and video visits via Reacts or OTN). We shared the letter with our GP colleagues as a draft so that they could shape the message in a way that works for them. The draft letter was discussed with Dr. Robyn Brown (Maple Family Health Team) and Dr Mike Green (Queen’s Family Medicine), who coordinated communication with all other GPs. The resulting letter is below. The SELHIN has created a resource section on their website which goes live tomorrow and they will be posting this letter along with other referral updates from other Departments (Thank you Carol Ravnaas Director, Sub Region Planning & Integration, Ontario Health East).
Capacity in Kingston and beyond: KGH has good capacity, as seen on today’s graphic indicator (below). Note that we have 51 available ventilators and 115 available beds.