April 24, 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 58 cases of COVID-19 in our region. There are 2 COVID-19 patients in KGH today, both of whom are on the Connell 3 COVID-19 ward. Testing positivity rate remains <2% in KFL&A. Our PPE reserve is ~2 weeks supply and we are using our pandemic stores of PPE as a buffer for any potential supply chain delays. 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.
Yesterday, 307 SARS-CoV-2 tests were performed at KGH and 17 were positive; however, none of the positive tests were from the KFL&A region. As has consistently been the case, the positive tests were mostly from communities to the west (Haliburton/Peterborough, n=5) and north (Perth-Smith Falls, n=8).
750 people joined the KHSC Virtual Town Hall meeting yesterday. This was a great example of effective communication with the hospital staff and faculty-KUDOS to Dr. Pichora, Theresa MacBeth and team.
Advice to people in the community: 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), see instructions below.
Caring for the 99%: We continue to note increased need for urgent and semi-urgent care for numerous diseases at KHSC. Dr. Fitzpatrick, Chief of Staff, has solicited all Departments to provide a list of key conditions for which care should not be deferred. This will guide us as we are ramping up the provision of non-deferable care. We are implementing and planning 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: 1) supply of PPE and 2) predicted shortages of some drugs and devices required for surgery, interventional procedures and mechanical ventilation due to global supply chain disruption. While we need to be respectful of coordination with provincial partners, with our favorable local epidemiology and the burden of many common diseases, we know we will need to provide increasing amount of care for the other 99% of diseases. There is limited ability to triage patients who have not been seen in person. The ethics of equitable care delivery requires us to ensure patients with COVID-19 are neither advantaged nor disadvantaged by our policies.
Advice to our patients: Our hospitals and clinics are safe places to receive care (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). You should not delay accessing care that you or your doctor deem to be urgent.
Canadian COVID-19 epidemiology: highlighting increased testing in Ontario
To date we have had 42,750 cases of COVID-19 in Canada, up 1000 from yesterday. There have been 56 additional deaths in the past 24 hours, resulting in a national total of 2197 deaths related to COVID-19. (click link for daily update). Here is a snapshot of COVID-19 in Canada today.
As noted yesterday, half the cases (21,838) and more than half the deaths (1243) have occurred in Quebec and they are doing ~5000 tests/day. This is a very high burden of diseases as Quebec is home to only 22% of Canadians.
COVID-19 testing update: Nationally 663,423 tests have been done for COVID-19 (actually for the virus that causes it, SARS-CoV-2). This is up > 23,000 tests from yesterday. The average rate of positive tests is 6.35%. It is noteworthy that Ontario is performing over 10,000 tests a day (see below).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been 2.7 million cases and 193,665 deaths globally.
Nursing homes-a favorable change in policy: In follow up to the April 16th memo to hospitals asking for the temporary pause of discharging patients to long-term care homes and retirement homes, Deputy Health Minister Helen Angus, Matthew Anderson, CEO Ontario health, and others, just announced that hospitals may resume discharging patients to retirement homes if the receiving home is not in a COVID-19 outbreak, the patient has been tested for COVID-19 at discharge and has a negative result, and the patient being transferred completes a 14-days of self-isolation upon arriving at the home.
Fake News and Cognogens: the other lethal pathogen: One of the main reasons I write this daily note is to communicate sound medical information that is based on robust scientific and epidemiologic data. In an information vacuum, bad information and outright lies flourish (see Churchill quote below).
An information vacuum may exist due to lack of high quality information or to a central vacuum between one’s ears. In the latter case, bizarre ideas easily take root. These ideological earwigs, which burrow into vulnerable brains, are best referred to as cognogens (aka bad ideas not grounded in reality that lead to harmful behaviors and dysfunctional world-views). Cognogens are common. I previously discussed herd immunity, the idea that having many immune people in a population stops the spread of an infectious disease. Herd immunity also applies to the spread of cognogens. While we don’t have a vaccine to confer COVID-19 immunity, we do have a vaccine for cognogens: namely, education and frequent, measured, communication.
It’s important to know that 10-20% of Canadians have one or more COVID-19 related cognogens. There is a nice article on the prevalence of conspiracy theories and fake news in the CBC today by Andrea Bellemare and Katie Nicholson.They summarize the results of a survey from University of Sherbrooke. This survey by Dr. Marie-Eve Carignan asked people whether they believed any of 6 COVID-19-related “theories”. Half of the 600 respondents were from Quebec and the rest from the other provinces. Listed below are the cognogens and the % of respondents who ascribed to them. You may have heard one or more of these theories from a passionate relative or friend during a recent ZOOOM cocktail party.
Carignan asked participants if they believed that:
- My government is hiding important information about coronavirus. A whopping 38% of surveyed Canadians believed this! That is sad and dangerous. Not even the loyal opposition has this low an opinion of the government.Our government gets a A- from me. Nationally and provincially they are behaving responsibly, relying on public health and medical advice and attending to the financial and social ramification of the pandemic. Federal and provincial governments are doing their best to deal with an unprecedented challenge. If one looks globally it’s easy to see that, while Canada may not be the best in our response, we are far from being the worst. Objective data support this opinion (like our incidence, prevalence, mortality and testing rates).
- The pharmaceutical industry is involved in the spread of the coronavirus. 15% of people believed this. Drug companies have flaws (mostly in over charging for medications and sometimes in failing to detect adverse effects of their products); however, they make their money largely by producing safe and effective agents, not by unleashing pandemics for which they lack an effective therapy.
- Coronavirus medication already exists (we know one commander in chief who believes this). President Trump recently stunned people in a news briefing (which is no longer an easy thing for him to achieve), by claiming disinfectants and ultraviolet light might treat COVID-19. Listen to the piece on this in The Guardian.
- There's a link between 5G technology and the coronavirus. Now it’s time to put on you tin-foil hat. The idea (spread by a disgraced American physician) that 5G signals damage cells and the debris becomes the virus or that the signal depresses our immune system would be laughable but sadly believers, such as some in Birmingham England, have been setting 5G towers on fire. This cognogen is a tough one, because it reflects both a lack of trust in the government and a lack of understanding of viruses, biology and the nature of infectious diseases (not to mention telecommunications).
- Coronavirus was intentionally made in a lab. In fact the SARS-CoV-2 virus coronavirus likely originated in bats.There are many Coronaviruses out there and they affect all species, usually causing diarrhea and liver disease. SARS-CoV-2 is just an unfortunately infectious version that has an affinity for humans and our lungs. As discussed below it originates in bats and likely came to us via the spiny anteater (no joke).
- Coronavirus was manufactured in a lab by mistake (see above).
Genetic analysis showed early on that this is a naturally occurring coronavirus, with bat and pangolin “footprints” in its RNA. There is nothing man-made about it. We learned a lot from the last 2 coronavirus outbreaks (SARS and MERS). Most importantly that both viruses originated in bats. There are numerous genetically important coronaviruses in bats worldwide. The same is true for SARS-CoV-2. SARS-CoV-2 is the seventh coronavirus shown to infect humans. SARS-CoV, MERS-CoV and SARS-CoV-2 cause severe disease, whilst other strains cause mild disease (HKU1, NL63, OC43 and 229E). In a 2020 Nature Medicine article Andersen et al conclude “Our analyses clearly show that SARS-CoV-2 is not a laboratory construct or a purposefully manipulated virus.“
Despite my love of debunking myths the story of how this scourge arose is admittedly a bit “wild”. In a 2020 Cell Biology paper Zhang and Zhang show the SARS-CoV-2 virus likely arose in bats and then passed through pangolins enroute to us. The SARS-CoV-2 virus is 96% the same as bat coronavirus. However, it is not uncommon for these viruses to pass through another species before infecting humans. In this case it appears that, “the other species” may have been the pangolin (the spiny anteater). Genomic data from the lungs of two dead Malaysian pangolins (who died with lung edema and fibrosis) showed they were infected with a pangolin coronavirus (CoV) that was 91% the same as human SARS-CoV2.
The pangolin or scaly ant-eater (Manis penta-dactyla dalmanni)
The proposed transmission route is illustrated below.
So you may ask: ????pangolins??? Why/How??? Pangolins are trafficked in China, despite being legally protected there. While they are eaten, what really drives this trafficking is their scales, which are valued in traditional Chinese medicine. The pangolins are boiled to remove the scales, which are dried and roasted, then sold based on claims that they treat excessive nervousness and hysterical crying in children, women possessed by devils, malarial fever and deafness.
The genome of the Pangolin CoV is very similar to the human SARS-CoV-2 virus
So what to do about cognogens? In short stay off Facebook and get your news from trusted sources that are rooted in science and public health information! Listen to Samantha Bradshaw who explains how disinformation plays on people’s fears. She makes the case that part of the proliferation of fake news is based on fear. The other driver is the reliance of social media algorithms on “engagements” to determine what stories they promote. The algorithms behind Facebook and other such platforms promote stories not based on importance or accuracy but based on engagements. An engagement means that someone has interacted with a Facebook Page. They may like a post, click on a link or comment on an image for example. The more Facebook engagements the more the news spreads. The more fear and uncertainty an issue raises (like a killer virus pandemic) the more engagements.
Click here and scroll to bottom of story to listen to Samantha Bradshaw.
My advice is that we understand fear and ignorance are the culture media of cognogens. We can help those infected/affected by patiently explaining truths. We can share high quality information and through our grounded behaviours and support of valid leadership in government, public health units, hospitals and universities. In short, through our own rationale behaviours we can establish herd immunity against the cognogens that drive fake news. You might enjoy an earlier blog on cognogens (click here), inspired by a lecture delivered by my colleague Dr. Johanna Murphy.
Capacity in KGH: KGH continues to have good surge capacity (below). Note that we still have plenty of ventilators and beds available.