April 30, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: There are two new cases of COVID-19 in our region today. The running total for the epidemic is thus 61 cases in the KFL&A region. This is a cautionary note, reminding us the virus is still circulating at a low level in our community. Nonetheless, the prevalence and incidence of the disease remains low in our area. For example, there are no COVID-19 patients in KGH today. Locally we did 319 tests yesterday and 4 were positive, with 4 of these being from Perth-Smith falls and 4 from the Peterborough area. Two local tests were positive, in the KFL&A region. Flattening of the COVID-19 curve is occurring nationally and in Ontario, although there are still many new cases occurring each day, just fewer than in past weeks.
Educating tomorrow’s health care workers: We are preparing to safely bring back our health care professional students (in medicine, nursing, rehab and others). They will initially be quarantined upon return to Kingston and then, with full attention to safety, they will be returned to training, including within the hospital. A tentative start date for their return is June 1st. This is great news and shows vision, wisdom and courage. We will need these people in the future and we need to prepare them now and not keep them sidelined during this unique and defining moment in history. Thanks to many folks in the Faculty of Health Sciences for moving this forward, notably Dr. Tony Sanfilippo who leads our medical school (pictured below), with the strong support of Dean Reznick, and the leadership at KHSC.
Care for the 99%: KHSC is finalizing a preparedness plan for the anticipated and necessary return to increased service for all patients, under the leadership of Dr. Mike Fitzpatrick, Chief of Staff. We want to be prepared to rapidly ramp up provision of care as soon as we receive the green light from Ontario Health.
Pandemic pay update: Recently the Ford government announced that front line healthcare workers” workers in Ontario will receive a pandemic pay premium. Premier 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 is important to remember that it is the provincial government, not the hospitals , that are determining who is eligible or ineligible. This process continues to evolve. The criteria of eligible work place now includes all hospitals and care sites. The health care workers covered by the program now includes: Personal service workers, RNs, RPN, nurse practitioners, attendants, porters, cooks, custodians, laundry services, mental health, respiratory therapists, public health workers and paramedics. The last 3 groups are new to the inclusion list. Excluded people include some allied health workers, like pharmacists and pharmacy techs and management areas, although this may be clarified in the coming days. This program excludes management and physicians.
To mask or not to mask, that is the question:
To mask or not to mask: that is the question
Whether ‘tis nobler in the mind to unmasked suffer
The slings and arrows of outrageous glares
Or futilely mask and still face a sea of troubles,
And by opposing end them? Not to die: to sleep.
Apologies to Mr. Shakespeare and Hamlet (and my high school English teacher, Mr. McCaffrey)
Should people wear non-medical grade masks in the community? The history of masks begins in the late 19th century as a means of early surgeons avoiding wound contamination. In Asia with the SARS outbreak, wearing a mask in public became a symbol of being a participant in making society safe, as well as serving as a psychological comfort for the individual, For more on this read “History of Surgical Face Masks: The myths, the masks, and the men and women behind them,” by John L. Spooner.
On a lighter note this NY Times article, accessible by creating a free account, demonstrates that some have made the mask just another fashion accessory (image below).
A fashionista approach to masks: providing pandemic pizzazz or viral vavoom!
Masks are symbolic and send strong and often opposing messages. There are those who feel wearing a mask as off-putting (overstating a risk). This may be contextual (i.e. many feel it’s OK to wear a surgical mask in the Emergency Department but not on the street, where the risk of infection is low). Conversely, there are those who feel not wearing a mask in public to be irresponsible (a la Mike Pence’s recent Mayo Clinic visit).
American VP Mike Pence: Maskless at Mayo
The operative word in both cases is “feel”, this is an emotional, not a rationale issue. To be rational for a moment, there are no data showing simple homemade, cloth masks prevent coronavirus infection.
However, the Centre for Disease Control (CDC) and the Public Health Agency of Canada (PHAC) support the wearing of masks in public places where there are crowds. PHAC says
“Wearing a homemade facial covering/non-medical mask in the community has not been proven to protect the person wearing it and is not a substitute for physical distancing and hand washing. However, it can be an additional measure taken to protect others around you, even if you have no symptoms. It can be useful for short periods of time, when physical distancing is not possible in public settings, such as when grocery shopping or using public transit.”
A homemade mask may (or may not) avoid an infected person spreading infection; however, if you are infected you should not be out and about! It’s not clear whether home-made masks work but I acknowledge that it is symbolically important. “Masks are a talisman that make people feel safe”, says Dr. Gerald Evans, Chair of Infectious Diseases at Queen’s. So there may be psychological benefit regardless whether masks alter disease transmission.
A talented infectious disease colleague Dr. Elaine Petrof has been developing what I call a “hybrid homemade mask”. She makes them from fabric but with a variety of inserted filters and a deformable wire seal over the nose. She uses various multilayered filters to enhance anti-viral efficacy. These masks require testing to confirm efficacy, but could be a way forward offering something between a surgical or N-95 masks (which though effective are unnecessary in most scenarios and are in short supply) vs the simple cloth mask (which is likely of more psychological than infection-prevention benefit). A reminder that any effective mask must cover your mouth and nose and make a reasonable seal around the nose. Sorry Zorro!
PPE: Our PPE supply chain remains improved. We have a 3-4 week reserve at the current rate use, up from 2-weeks. This includes N-95 masks. However this reserve depends on using our pandemic supply, the store of last resort.
Advice to people in the community re COVID-19 testing: People in the community can self-refer for assessment and possible and testing. We are still focusing on testing either symptomatic people (since the test for COVID-19 is likely not as specific in asymptomatic people) or people with confirmed COVID-19 contacts. In either circumstance please self-quarantine and seek out testing at Memorial Centre in Kingston, see instructions below.
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-some good news: To date we have had 53,015 cases of COVID-19 and 3180 deaths. There are 2887 people in hospital and of these 512 are in ICU beds. If you look at the colored bar graphs at the bottom of the page one can see the number of active cases/day is decreasing (orange), as are the number of deaths (yellow). At the same time the number of people recovered (green) is increasing. This is what happens when the curve has flattened. To date 810, 969 tests have been done in Canada and 2.23% of our population has been tested. (click link for daily update).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3.275 million cases and over 231,577 deaths globally. There is continuing evidence that the global incidence of COVID-19 is flattening (blue and gold graphs at bottom of Figure).
Capacity in KGH: KGH continues to have good surge capacity (below). Note that we still have plenty of ventilators and beds available.
A moment in history: How did we survive the last pandemic? Kathleen Arthurs was my maternal grandmother. This is an excerpt from a news clipping in which she gives a simple first person account of her childhood when the Spanish flu pandemic hit Saint John New Brunswick. Grammy Kay was a spirited and feisty lady who devoted her life to improving mental health in all around her. She was a survivor and her experiences left her with a great sense of humor and an irreverent ability to spot anyone who was acting like a horses arse (which occasionally included me)!