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April 22, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID-19 Update: There are no new cases of COVID-19 locally today. There are 59 cases of COVID-19 in our region. These 2 new cases occurred over the weekend: 1 case from the community and 1 at Providence Manor. There are 2 COVID-19 patients in KGH today, 1 in the ICU and 1 on the Connell 3 COVID-19 ward. Yesterday 362 SARS-CoV-2 tests were performed at KGH and 9 were positive; however, none of the positive tests were from the KFL&A region. As was the case last week, these positive tests were from communities further to the west (Peterborough ) and north (Perth-Smith Falls).

Thus, our local situation remains very positive with a flat incidence curve, the virus is in our community and physical distancing remains crucial. If you are sick with symptoms of an acute respiratory illness (new cough, fever, sore throat or if you have had contact with a COVID-19 infected person) you need to self-quarantine and seek out testing in our community facility (Memorial Centre). Located centrally with access to ample parking, the COVID-19 Assessment Centre at the Memorial Centre operates 7 days a week be (10:00 a.m. to 8:00 p.m).

Please remind patients that our hospitals and clinics are very safe (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). Patients should not delay accessing care that they or their doctor deems to be or semi urgent.

We are noting increased need for urgent and semi-urgent care for numerous diseases at KHSC. Because of several weeks with limited elective care there is an increased demand for management of many diseases, from aortic stenosis and coronary artery disease to gall bladder disease and ruptured diverticuli. We are ramping up the provision of our non-deferable care at KHSC, including modest increases in volumes our catheterization laboratories, operating rooms, and interventional suites.

However, we still have ~ 2 weeks supply of PPE at the current rate of utilization. Likewise, there are predicted shortages related to global supply chains for agents required for certain procedures in operating rooms and the ICU. These two issues limit our ability to more broadly increase our semi-elective procedural volumes. Thus, a balancing act will continue to be required to minimize the risk of patients falling between the cracks while at the same time acknowledging ongoing restrictions in capacity for elective work. That said-if the disease is not clearly elective we are dealing with it in a timely manner, as good medical practice dictates.

COVID-19 testing update: Nationally 614,340 tests for COVID-19 (actually for the virus that causes it, SARS-CoV-2) have been done in Canada. The average rate of positive tests is 6.25%; see below). Testing is ramping up in Ontario, as you can see from today’s data (graph below). We are doing ~8000 tests a day and this accounts for ~25% of all the testing done in Canada. However (just so we don’t feel smug), Ontario accounts for ~39% of the Canadian population. As I discussed in yesterday’s note, I think that before the epidemic is controlled we will need to have both molecular and antibody testing become widely used. It is likely that testing of most of our population will be required to allow society to reopen fully (quite a different testing strategy than the current focus on people with acute illness plus their contacts).

Graph showing COVID-19 tests performed vs postives

The test we use to identify viral infection that we use is extremely accurate. In symptomatic patients our PCR assay has a 97.5% negative predictive value (meaning if a test is negative there is only a 2.5% chance a second test will be positive). Ontario health has now mandated comprehensive testing in long term care facilities which will yield some good information but will also use up substantial testing resources. In addition, the more we test asymptomatic people the more likely we are to obtain false positive results.

Canadian COVID-19 epidemiology: 4.77% mortality rate in Canada

To date we have had 38,422 cases of COVID-19 in Canada, up approximately 1000 cases from yesterday. There have been 106 additional deaths nationally for a total of 1834 deaths related to COVID-19. (click link for daily update). If you are wondering why there is a big gap between the 38,422 cases versus only 13,201 recovered people, this largely reflects the many new cases in the past 2 weeks (10,000 in the past 6 days alone); so most infected people are still sick and in the process of recovering. Recovery takes on average 2 weeks, so there is a time lag.

COIVD-19 timelines by Canadian provinces

To see where Canada stands amongst nations around the world, click here.

Capacity in KGH: KGH continues to have good surge capacity (below), although we continue to feel the effects of the Province’s decision to stop our discharge of patients back to retirement homes and long term care facilities (even if they are tested and proved to be negative for COVID-19). Note that we still have plenty of ventilators and beds available.

KGH Bed Capacity

Charity begins at home: One million Canadians lost their jobs in March. Our national unemployment rate has climbed 2.2% to 7.8%. Behind those numbers lie stress, tears, and people struggling to find food, care for pets and deal with the mental health and social stressors that accompany a life of physical and social distancing. I know members of the DOM are generous, and many have their own preferred charities. However, for our many faculty who are new to Kingston and may be looking to make a difference: here are some links to charities that I personally support and which I can attest greatly benefit our community.

Canada's Unemployment Rate in March

Kingston Humane Society: Through your annual membership dues, you help sustain essential services for over 2000 pets/year

Dawn House: Dawn House is a local charity supporting and empowering homeless, vulnerably housed, and marginalized women living in poverty

Partners in Mission Foodbank: Their mission is to provide nourishment and hope to those we serve, and an opportunity for our community to share. They provide the food distribution centre for our area and donate surplus provisions to over twenty local hot meal and shelter programs in the Kingston area. Partners in Mission Food Bank provides fresh milk, eggs, fruits and vegetables in every grocery hamper and occasionally meat products from local businesses and donors.

Advice on use of your COVID-19 parachute: This cartoon was sent to me by a friend. It is a concise summary on why we are still practicing physical distancing and limiting elective work and why schools, daycares and many non-essential businesses need to remain closed for a while longer.

Cartoon re parachute and flattening the curve

It's Medical Laboratory Professionals Week: Thanks to the folks in the clinical lab at KHSC who provide our diagnostic capacity as we deal with COVID-19. We have featured some of them in prior updates, but this is a good week to say thanks again to these dedicated folks and their leaders, Dr Sandy Boag, Head of the Department of Pathology and Molecular Medicine, Dr. Sandip Sengupta, Medical Director of Clinical Laboratory Services at KHSC and Dr. Lewis Tomalty, Service Chief of Clinical Microbiology. They represent an amazing team of technologists and faculty that support a growing and high-quality regional laboratory. We are fortunate to have one of the best laboratories in Ontario here at KHSC.

Photo of 3 scientists in a lab

(From left) Sam Miller, Medical Lab Technologist, Dr. Sandip SenGupta, Medical Director of Clinical Laboratory Services and Dr. Lewis Tomalty, Service Chief, Clinical Microbiology Lab.

Stay well!

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