April 23, 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 and of these 54 people have recovered and 2 have died. There are 2 COVID-19 patients in KGH today, 1 in the ICU and 1 on the Connell 3 COVID-19 ward. Yesterday, 314 SARS-CoV-2 tests were performed at KGH and 5 were positive; however, none of the positive tests were from the KFL&A region. As has consistently been the case, the positive tests were from communities to the west (Haliburton/Peterborough, n=3) and north (Perth-Smith Falls, n=2). Thus, the local situation remains very positive with a flat incidence of COVID-19. This shows that our community interventions and physical distancing are working.
A reminder about the 97.5 % negative predictive value of our molecular test for COVID-19. In Ontario only 85 of 4220 tests that were initially read as negative became positive (thus a 2.5% “false” negative rate). However, there are legitimate reasons for a test converting to positive, including when the initial swab is acquired very early in the disease course when viral load is low or when there are technical issues with the swab acquisition of sample. In short, the test we use is highly reliable, provided the patient has symptoms!
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.
Caring for the 99%: We continue to note increased need for urgent and semi-urgent care for numerous diseases at KHSC. We are ramping up the provision of our non-deferable care at KHSC, including modest increases in volumes in our outpatient clinics, catheterization laboratories, operating rooms, and interventional suites. However, our ability to ramp up further is restricted by logistical constraints. First, we have only 2 weeks supply of PPE and second, there are predicted shortages of some drugs and devices required for surgery, interventional procedures and mechanical ventilation due to global supply chain disruption. In addition, the hospital is coordinating its ramp up with Ontario Health. It’s hard for us to move ahead without careful coordination with provincial partners, despite our favorable local epidemiology.
Canadian COVID-19 epidemiology: highlighting the distinct severity of the epidemic in Quebec
To date we have had 41,757 cases of COVID-19 in Canada. There have been over 300 additional deaths in the past 24 hours, roughly triple the death rate yesterday, resulting in a national total of 2141 deaths related to COVID-19. (click link for daily update). Here is a snapshot of COVID-19 in Canada today.
Half the cases (20,965) and more than half the deaths (1134) have occurred in Quebec (bottom panels in graph below). This is a very high burden of diseases as Quebec is home to only 22% of Canadians. It does appear that cases per day are beginning to plateau nationally (below).
COVID-19 testing update: Nationally 640,292 tests for COVID-19 (actually for the virus that causes it, SARS-CoV-2) have been done in Canada (up > 36,00 tests from yesterday). The average rate of positive tests is 6.28%; see below). ). It is noteworthy that Quebec is doing ~ 5000 test a day whereas Ontario is performing over 8000 tests a day. At KHSC our lab has become an assembly line. They are now performing 6 runs a day. The first at 9:00 am to catch anything from overnight; the last run is performed at 10:00pm and reported by midnight. KUDOS Team Lab!
Some other interesting epidemiology. To date 66% of cases in Canada were acquired from travel abroad or contact with a traveller (see below). This will change as the epidemic evolves and domestically acquired cases will predominate.
In addition the gender distribution shows equal impact on males and females (see below).
The age distribution (see below) confirms that most cases of COVID-19 are diagnosed in people over the age of 50 years, with very few in those under the age of 20 years. This does not mean young people are immune. They may simply not develop symptoms or they may be less likely to be tested.
To see where Canada stands amongst nations around the world, click here.
PPE reprocessing update: Thank you to everyone who is supporting the collection of used PPE for reprocessing. Our work now is focused on testing reprocessing methods to ensure that the reprocessed PPE meets a high standard that ensures your safety. This work involves close quantitative and qualitative analysis of any reprocessing method to ensure the integrity and safety of the end product. While we are collecting PPE for reprocessing we are not using any reprocessed items at this time and will communicate if and when such items are introduced for clinical use.
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. Some nursing homes and LTC facilities are making individualized decision allowing some patients (who are proven to be COVID-19 negative) to be repatriated back to their facilities. Note that we still have plenty of ventilators and beds available.
Random act of kindness: Thanks to BARCO who donated over 30,000 scrubs for health care workers. Thanks locally to Glennis Newton, RN & Crystal Huntley PCA who entered a draw from Scrubs for Them a company based in Ottawa and won! This picture of our nurses in the winning scrubs below courtesy of Alyson Lazier, Charge Nurse Connell 10 Internal Medicine.