April 2, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 update: There are still 46 cases in our region. Per KFL&A Public Health, 39 of the 46 people have traveled abroad recently or have had contact with travelers. In KHSC there has been no increase in cases. There are currently 5 inpatients, 4 on the Medicine service’s COVID-19 ward and 1 in ICU. KHSC lab did 218 tests for COVID-19 this morning and while there were 6 positive tests, all positive tests were from people outside our region. No new tests were positive from local individuals. Thus, Kingston and region remain at the early part of the epidemic growth curve with a doubling time measured in weeks. We are observing (in the literature and locally) more atypical presentations of COVID-19 disease (more on this soon).
Thank you team medicine: Dr Chris Smith, Michelle Matthews and I delivered baskets to Connell 10 (top) and Connell 9 (bottom) teams from the faculty in the DOM, thanking them for their calm and professional care of our patients during the COVID-19 epidemic.
PPE strategy-think local!: We continue to balance COVID-19 prevalence, epidemiologic evidence and PPE supply to ensure your safety comes first! This leads to frequent changes in policy as the epidemic evolves (locally) and as supply of PPE changes (locally). Thank you Heather Candon from IPAC and Dr. Gerald Evans and team for your skilled efforts on our behalf. Heather is leading plans to conserve PPE by having staff appropriately retain PPE and to reuse PPE after re-sterilization. Congratulations to our infection control folks for being at least a week ahead of the curve! The hospital leadership and leadership from our 3 Unions have met and the unions have expressed confidence in our approach to PPE supply for the frontline staff.
KHSC Capacity, a nice example of data sharing: One of the very positive things that has come from our united response to the pandemic is increased data sharing and partnering between the hospital and university and more data sharing within the hospital. Each day I get a dashboard that informs me of our bed and ventilator capacity (below). This is very helpful to manage our inpatient services, thanks David Barber and KHSC Decision support team! As you can see we have created substantial capacity (beds and ventilators) for future COVID-19 patients.
AGMP Anxiety: COVID-19 is largely spread by droplets coughed or sneezed out from the upper respiratory track. However, there are certain procedures, such as intubation or bronchoscopy, where violent cough or exhalation generates an aerosol (smaller droplets that can hang in the air). As discussed in prior briefings, we advise the highest level of PPE for these AGMPs and they should only be done by experienced personnel. That said, there are often questions whether various routine procedures could geneate aerosols. In case you think that our amazing IPAC team’s advice regarding aerosol generating medical procedures (AGMP) is unusually strict, I can attest that it is (in my opinion), fair, balanced and evidence-based. If you want an external opinion I refer you to a blog on the same issue from the USA (they refer to AGMP as AGP and begin their post with:“Since my post last weekend, I now have found the term (AGP) that , once this is all over (and it will be over someday, my friends), will send me into flashbacks and result in me sitting in the corner, rocking back-and-forth, saying "Please, Mommy, make it stop.(AGP discussion that is).” Click the link: http://haicontroversies.blogspot.com/.
The new normal, academic medicine thrives in th DOM: COVID-19 is here and we will be combatting it for the coming months. That said, life goes on. Spring is arriving, flowers are blooming, babies are being born. In short, life remains (for the most part) a beautiful thing. In that spirit, we have relaunched our Medical Grand Rounds (MGR) series in its usual time slot, 0745 Thursday am. Dr. Mala Joneja, Chair of Rheumatology, and I host it live from Etherington Auditorium, where there is lots of room for physical distancing. Our faculty join by ZOOM.
Today’s MGR lecture was delivered by Dr. Bikram Sidhu, one of our endocrinologists. He gave a TED talk-quality lecture entitled, Back to the Future: Integrating old and new care models to address inequity. It was an eloquent consideration of the consequences of health care inequality for rural and indigenous people and offered clever ideas for the use of Video visits and e-consults to address some of the barriers imposed by distance. You can evaluate his talk on line by downloading our App, well-rounded @ queen’s, from the Mac App store. MGR was enjoyed by 90+ colleagues and there was a spirited and interactive Chat driven Q&A period at the end with live questions as well. If you want to be part of this enjoyable academic community let Karley Salsbury in our office know and she will add you to our distribution list (email@example.com). Next Thursady Dr. Gerald Evan’s will be giving an update on the COVID-19 pandemic.
Reminder about the need to restrict vistors to our hospitals and clinics: Doctors please remind your patients that we are only seeing people who have non-deferrable health problems. This is to protect them from COVID-19. On a related note, we need to limit accompanying persons to those clinic visits where an accompanying person is absolutely required to permit the patient to reach the clinic (such as when the patient has a mobility or cognitive limitation). Sadly, for the duration of the epidemic, being present even for valuable emotional support, is an insufficient reason to have a family member accompany the patient to clinic. In this regard, I have had success looping in family members by phone from the clinic room, as an alternative to accompanying the patient into the clinic.
Field hospitals: If and when we have a large surge of cases coming from nursing homes and Corrections Canada it will be important to cohort patients in few facilities, so as not to spread the virus. Several possibilities are being considred by Dr. Pichora and other community/university/college leaders, including caring for COVID-19 patients in repurposed College and University gyms and arenas. Hopefully this capacity will not be needed but we will plan for the worst while hoping for the best.
An interesting article in the NEJM on the reality and psychology of PPE use in the pandemic: This in no way alters our PPE recommendations, which are based on solid evidence and tuned to local realities; but it’s a nice read and reminds us about the emotional aspects of policy. As Shakespeare said, “Man is a Giddy thing” (meaning not always logical).