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April 3, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID Update: There are 46 people with COVID-19 infection today in our region. Out of 182 COVID-19 tests at KHSC this morning there were 8 positives. Once again none of the positive tests are from the Kingston region. Thus in our community there were no new cases; but not in other communities. There remain 5 patients admitted to KGH, 4 on the Medicine’s COVID-19 unit and 1 in ICU.

Of 37 long term care facilities 10 are not accepting new referrals due to COVID-19 related issues. Thus our window for discharging Alternate Level of Care (ALC) patients from KHSC to LTC is beginning to close. Nonetheless, by end of day, we will be at 30 ALC people (an all-time low). As a result of the relocation of patients across the system we have good bed capacity in KGH (see today’s dashboard below). We now have an official discharge order set for patients who have recovered from COVID-19 and later today should have an approved standardized order set. Thanks, Drs. Sid Srivastava and Chris Smith, for creating a standardized approach to admission and discharge of these patients.

KGH Bed Capacity

Here is a look at the progression of the COVID-19 epidemic in Canada since January 25th. As you can see we are now beginning to see a progressive rise in cases.

Cases in Canada epidemic curve

There are currently 11,283 COVID-19 cases in Canada and 158 people have died

COVID-19 Canadian Outbreak tracker

ZOOM Update “Can I keep using Zoom?”We are all ZOOMing to our meetings these days. In the DOM we are using this for business meetings, Medical Grand Rounds and Lab Meetings (below). While any platform can be hacked (and this has happened at Queen’s) I want to pass along this reassuring message re: ZOOM security. This information from KHSC should correct some misinformation.

screen shot of hacked zoom call

KHSC Information Management ZOOM SECURITY ADVISORY

Last week, security researchers identified a flaw in the Zoom application for Windows that could "expose user credentials" to an attacker. This has been widely misunderstood and misreported as Zoom leaking or allowing the capture of usernames and passwords. This flaw requires a specific set of circumstances to occur and is easily prevented through common firewall settings and appropriate use. In addition, as of April 2, 2020 9:47 PST Zoom issued a patch that corrects all the recently discovered flaws. 

What should you do in your ZOOM meetings?

zoom logo on smart phone
  1. Do not share Zoom meeting links to the general public or on social media, and password protect your Zoom meetings where possible.
  2. If an unknown user joins your meeting, kick them out. You wouldn't let strangers into a "real world" meeting so don’t let them into ZOOM meetings. Zoom Etiquette: You should ensure your name is visible on your screen, or you may be eliminated from the meeting. To add your name, Click the 3 little dots that appear in the right upper corner of your window
  3. Update your Zoom software to the latest version.

Bottom line: Zoom remains approved and safe for non-clinical use at KHSC including: Town Halls, Team Meetings and patient family visits (as discussed later in this note).

Special thanks for reducing our pressure!: We had a problem. Some of the rooms on the Kidd ward 10 were under positive pressure ventilation, meaning they blow air out of the room. This is desirable if there is an immunosuppressed patient in the room but would be bad if we put a patient with COVID-19 in the room (it would blow virus out of the room). A few quick emails to the Plant Operations Team and they were able to change the Kidd 10 positive pressure rooms to neutral/slight negative pressure so we can now use them for isolation purposes for COVID patients, if needed. Thanks for great service to Gary Greene, Manager of Plant Operations and Maintenance, Brad Wood, Peter Moeslinger (Maintenance staff) and McKinley Air Balancing (Contractor).

Pressure gauge

Reuse of PPE begins today: The PPE reprocessing and sterilization program of N95 masks begins today. We can process 300 per day and have the capacity to increase as needed. Today we have begun collecting N95 and surgical masks after use by staff in biohazard bags at well-marked hospital collection points. Stay tuned for details on the bin colors and location. Please identify the bin nearest your point of work in KGH and put your mask in for recycling!

recycle symbol

Cloth masks: These should not be used for medical care. However, they may be used for patients coming to visit the hospital and may (unproved) reduce a patient’s emission of large droplets and may improve their psychological comfort. 

REACTS Video visits: Since elective clinic visits have halted during the epidemic, the DOM has undergone a major move toward performing home video visits. This allows appropriate patient to be seen using their own home tablet or computer. The platform we use is called REATCS and runs on Google Chrome. We already have 59% of DOM physicians signed up in week 1 (121/206 faculty and medical secretaries in the DOM). Thanks for tremendous help to Val Gamache-O’Leary and her team at KHSC, Chris Gillies in Medical Affairs, Danielle Claus’ SEAMO team and my own DOM team.

Face masks work to reduce COVID-19 in breath: https://www.nature.com/articles/s41591-020-0843-2.pdf The viruses that cause acute respiratory illnesses (including COVID-19) travel from our upper airway and lung and infect others in respiratory droplets. Some droplets are large and fall rapidly to the ground via gravity (diameter >5μm), others are smaller and make a mist, called fine-particle aerosols (≤5μm). This paper looked at the effects of a surgical face mask on the amount of virus that escaped into the air from the breath of people with various respiratory infections, including COVID-19. Participants included: people with (seasonal) coronavirus (= 17), influenza virus (= 43) or rhinovirus (= 54). The graph below shows that (look at the green dots and brown/orange dots), a surgical mask reduces virus in the breath in both size of droplets. Interestingly, breath collected without a face mask, did not contain detectable coronavirus in 65% of participants with coronavirus infection. Data like these are why we use a surgical mask, together with gowns, gloves and face shields at KHSC which dealing with infected or suspected COVID-19 patients. We will be expanding PPE use as the local prevalence of this disease increases.

types of samples taken

A solution that keeps families in contact while we are forced to restrict in-person visits:Kingston Health Sciences Centre (KHSC) is temporarily limiting family presence to protect the safety of all during the COVID-19 outbreak. To help patients, families and friends stay connected with each other we are happy to assist patients with a “video chat” or “Virtual Visit” with their loved ones. A Virtual Visit is an alternative to visitors physically coming into the hospital. It is a free service and involves a KHSC facilitator helping to set up the visit using an iPad provided by KHSC. Virtual Visits can be initiated by the patient, anyone connected to the patient or a care provider within the hospital. Virtual Visits are not intended for clinical use.

Do I need to do anything before a Virtual Visit? Virtual Visits are accessed through an easy-to-use app called Zoom, which allows a number of people to join a scheduled meeting/visit at once. Family and friends must have the following in place in order to connect with the patient:

  • an email address
  • a computer with a camera and microphone (either external or built in) OR a smartphone or tablet (with Zoom downloaded and installed)
  • permission from the patient for the Virtual Visit to occur.

How does the Virtual Visit work?

  • Patients can make a request by speaking with staff who then forward the request to virtualvisit@kingstonhsc.ca
  • Family or friends can request a Virtual Visit by emailing virtualvisit@kingstonhsc.ca. Please include the patient’s name and room number, names of people who will participate in the Virtual Visit with the patient, preferred time and date.
  • The family/friend will be sent an email with the confirmed date and time, Zoom link and instructions on how to connect. We recommend that the link be tested beforehand; this will be outlined in the instructions sent.
  • At the time of the visit a facilitator will bring an iPad to the patient and help the individual connect to the Virtual Visit. On their end, the family/friend will click on the link sent in the email.
  • When the Virtual Visit is over, the facilitator will collect the iPad.
  • Each visit request, including date and time, must be booked separately at virtualvisit@kingstonhsc.ca.
man with a telephone booth over his head

 

Random acts of kindness: Today’s good deed was super sweet. Ms Karley Salsbury, from the DOM, celebrated the reopening of Kingston landmark (considered an essential service by some)Coffee Way, located at Division St and Concession St. Her TGIF, random act of kindness was a box of their amazing homemade donuts.

Photo of Karley with donuts

 

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