April 6, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
“Security is mostly a superstition. Life is either a daring adventure or nothing.”
— Helen Keller (June 27, 1880 – June 1, 1968).
Helen Keller a courageous deaf, blind pioneer. This Alabama native was taught by Anne Sullivan. She understood the balance of risk and benefits in life and accepted the inevitable risks in her challenging life, becoming the first deaf-blind person to receive a BA degree. She was a leading suffragette and peace advocate. She understood that absolute security is illusory and took calculated risks to lead…and we all reaped the benefit. I follow Ms Keller’s advice when considering my views on PPE policies.
COVID-19 Update: There are 54 people with COVID-19 infection today in our region. Seven new cases have occurred in the past 4 days and they are within the KFLA catchment area. The prevalence rate based on our COVID-19 testing is <5% and our local curve is flattening, likely reflecting physical distancing, school closings and reduction in nonessential services. There remain 4 patients admitted to KGH, 2 on the Medicine’s COVID-19 unit and 2 in ICU. These data support the current decision not to deploy universal PPE throughout the hospital (yet).
Please fight the urge to socialize on this Easter weekend, our low local prevalence is a function of our active programs of physical distancing.
How is COVID actually spread: Thanks to Dr. Kathie Doliszny for bringing this piece to my attention.
Here are some lessons about how one is likely to become infected (spoiler alert: its not likely going to happen in the hospital). This paper by Luo et al is from the Guangzhou Center for Disease Control and Prevention and published on the MedRxiv pre-print server and thus has yet to undergo peer review (as Dr. David Maslove and I recently discussed).
Luo found in China that among 4950 quarantined closes contacts of patients with COVID-19 (age 38 years, males 50% ) 129 cases (2.6%) developed COVID-19. In terms of the severity of the disease contacts developed it was asymptomatic in 6%, mild in 38.0%, and only 4% were severe to critical cases. Household contacts were the most likely to become infected with COVID-19 (incidence 10.2%). In contrast, the risk of contracting COVID-19 in healthcare settings or by exposure on public transport vehicles was only 1.0% and 0.1%, respectively. So, you are 10X more likely to contact COVID-19 from an infected person in your immediate circle of family contacts than from a patient in hospital. The older the contact person and the sicker the infected person, the greater the risk infection being transmitted. They also found that asymptomatic or mildly symptomatic people are not very infectious. Only 1 person was infected by an asymptomatic COVID-19 patient (0.33%) and only 19 (3.3%) were infected by a mildly symptomatic patient. Finally, when contacts were infected the disease was usually milder than the disease the patient themselves had manifested. So, I personally do not fear coming to work, advising our essential personnel to work and believe, like Ms Keller that security, or at least absolute security, is mostly a superstition.
KHSC capacity: Our capacity to admit COVID-19 patients, when required, remains excellent. We have only 32 ALC people in house. See capacity today’s graphic indicator below.
Here is a look at the progression of the COVID-19 epidemic in Canada since January 25th.
Cases in Canada (left) Cases by Province (right)
As you can see Canada is experiencing a progressive rise in cases and the curve has not yet flattened nationally (although it may be doing so in British Columbia-right panel). It is also flat in Kingston!
There are currently 15,512 cases and 280 deaths related to COVID-19 in Canada.
Think globally but act locally: (IDEA model forecasts for Ontario Public Health Units)
You will note the COVID-19 incidence curve in Kingston (graph below) is flat, with few cases in the past week (top graph). This will likely change over the next 2 weeks; however the low local prevalence gives us further time to prepare and justifies our local PPE policies.
The local data in Kingston (KFL&A) shows no increase in the incidence of COVID-19 between March 1st and now. Thanks Dr. Kieran Moore, Public Health KFL&A, for these data.
PPE recycling update: At KHSC we are currently using 10,000 masks/week. This high rate of PPE utilization is occurring prior to a significant influx of COVID-19 cases locally. Thus, we will need to continue to conserve and recycle to avoid being short of PPE at the time when/if the peak case load arrives at KHSC.
At KHSC we recycle each type of noncontaminated PPE in a customized manner. Surgical and procedural masks get autoclaved. Eyeglasses are cleaned by chemical means. N95 masks are sterilized by hydrogen peroxide ± ozone. None of these procedures leave any toxins or residual chemicals on the cleaned equipment. Occupational Health is ensuring that the recycling is safe and effective since staff safety is priority 1.
Rules for recycling: When you remove the masks for recycling, don’t pull them off, remove them as you put them on, carefully! Soiled, damaged or wet masks, including those with makeup on, cannot be recycled.
- Never touch the front of the mask.
- Do not pull the mask off. Remove it by using the ear loops or by untying from the back.
- Avoid wearing makeup to prevent soiling your mask. Any mask marked by makeup/lipstick must go into the waste bin.
- Place used PPE in the appropriate bin—there are dedicated bins for N95 respirators, procedure/surgical masks and eye wear/face shields.
- Do not contaminate collection bins with other waste.
Occ Health is ensuring safe and tested recycling of PPE occurs with an emphasis on employee safety. Here’s what the bins for the various PPE look like. Thanks to Heath Candon, IPAC!
Hotelling of staff: Mr. Chris Gillies from Medical Affairs is working with local hotels and the Donald Gordon Centre to secure discounted housing for staff who feel the need to live outside their homes during the epidemic. Currently they have secured preferred rates for staff and faculty at the Donald Gordon Centre and various local hotel. Rates vary from $49-89/day and some include food. KHSC ID badges must be presented to obtain these lower rates. Stay tuned for more details.
Today’s random act of kindness: Reduced rate for Stuart St. parking garage
- The daily hourly maximum parking rate for the Stuart Street underground parking garage will drop from $20 to $5 during April.
- Queen’s University is extending free parking (without permits) at the Tindall surface lot (Albert and Union Streets) and former St. Mary’s of the Lake Hospital site (Union Street) through April 13.
- Free parking is also available at KCVI, street (metered) parking and municipal parking lots.