April 27, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: Of 3664 tests for COVID-19 performed to date in the KFL&A region (see map below) there have been: 59 positives, 3456 negatives (with 149 tests pending). This is a cumulative 1.7% positivity rate.
Over the past weekend 805 COVID-19 tests were done. There were 20 positive tests. One of the positive tests was from the KFL&A region. As has consistently been the case, most positive tests were mostly from communities to the west (Haliburton-Peterborough) and north and east (Perth-Smith Falls), see map below. The Leeds-Grenville area, to the north and east, has the highest rates of positive COVID-19 tests amongst nursing home residents in Ontario.
There is 1 new case of COVID-19 in our region and that person is being managed at home. There are a total of 59 cases of COVID-19 in the KFL&A region. There is 1 COVID-19 patient in KGH today on the Connell 3 COVID-19 ward.
For those of us that are geographically challenged I have added a map.
We are still awaiting resumption of permission to discharge patients to long-term care facilities. We have 34 people who are designated alternate level of care (ALC), meaning they do not require admission to hospital and are in hospital awaiting placement. We are continuing to discharge appropriate patients to retirement homes who are free from COVD-19, as confirmed by a negative PCR test. Maintaining our discharge capacity is critical to ensure we retain capacity at KHSC for potential COVID-19 surges.
Pandemic pay (click here) This Saturday the government made a statement that some workers in Ontario will receive a pandemic pay premium. Premiere Ford indicated that there will be a temporary $4 per hour salary increase for “front-line workers” to recognize their efforts in the fight against COVID-19. Designated employees working more than 100 hours /month would also receive $250 per month for the next four months. This means eligible employees working ~40 hours per week would receive $3,560 in additional compensation. “It's our way of saying thank you," Premiere Ford said. The government estimates there will be ~ 350,000 eligible workers. For some of these folks, a pay raise is overdue and may address longstanding problems of recruitment and retention. Such examples include staff at long-term care homes and PSW workers providing home and community care. However the plan, which has yet to be fully defined, appears to include some (but not all) workers in hospitals. Also, while the plan focuses on “front line workers” it appears to reward groups who do not directly interact with patients.
The policy will likely be popular but there is a risk that the rhetoric could be construed as an offer of “danger pay”. In well run hospitals, where screening is done properly and PPE used properly, we are not putting our health care workers at undue risk nor have any been infected at work at KHSC. There is a false narrative about extreme health care worker risks on popular media and while the risk is certainly not zero; it is not high enough to justify supplemental pay, particularly while people in most sectors of society are facing unemployment (1 million Canadians filed for unemployment assistance last month). So, by all means raise the pay for long term care workers, especially PSW workers in long term care facilities and nursing homes; but let’s not misunderstand this initiative as “danger pay”. The danger is not high, and if it were, $4/day would be inappropriate.
Advice to people in the community: This is old news but I feel compelled to offer this on a daily basis. 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 and received from all Departments a list of key conditions for which care cannot be deferred. This will guide us when we ramp up the provision of more elective care. Like all hospitals in Ontario, KHSC still does not have authorization from Ontario Health to return to provision of normal levels of care (i.e. we are not allowed to perform elective procedures and elective clinic visits). However, we continue to provide all necessary emergency care, urgent care and nondeferrable care (defined as conditions where harm would occur if care were delayed by 3 months). We have had some increase in clinical activity (largely nondeferrable care) and this has, as predicted, led to more rapid use of PPE. Our PPE reserve is ~2 weeks supply with some specific forms of PPE being in short supply.
The current state of affairs is not sustainable if we are to avoid unintended non-COVID-19-related adverse outcomes. As I mentioned last week, 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. Ontario Health will need to authorize resumption of expanded services as soon as feasible, as dictated by the availability of PPE and the local and provincial epidemiology of COVID-19. In this regard, while our COVID-19 case incidence remains flat, Toronto’s peak incidence will likely not occur for 7-14 days. This is likely a major driver of Ontario Health policy.
A daily reminder: 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: To date we have had 46,895 cases of COVID-19 in Canada, up ~4000 cases since Friday. There have been 357 additional deaths since Friday, resulting in a national total of 2560 deaths related to COVID-19. (click link for daily update). The good news is that testing is up by ~70,000 since Friday, currently at 734,824 tests completed. Here is a snapshot of COVID-19 in Canada today.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3 million cases and over 200,000 deaths globally.
Capacity in KGH: KGH continues to have good surge capacity (below). Note that we still have plenty of ventilators and beds available.