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zoom screen of holiday party participants holding up their decorated cookies

December 14, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

updates

 

1) KHSC’s new screening questions effect visitors and health care workers differently: an introduction to “workplace isolation” for health care workers

2) COVID-19 volumes have dramatically increased in KFL&A related to a super spreader event at a local church (click here), student house parties around Queen’s University (click here) and a super spreader event at the Gananoque Chev Buick GMC Cadillac dealership (click here(see update from KFL& A Public Health):

3) The first COVID-19 Vaccine is SAFE-EFFECTIVE and it’s HERE! (click here)

4) Ontario has had 142,121 cases since the pandemic began with 1940 new cases since yesterday, a total of 16,586 active cases and 857 people in hospital (click here): 

5) Canada’s second wave of COVID-19: We have had 464,299 total cases to date, with 45,556 cases in the past week and 73,423 active cases (click here)

6) The COVID-19 global pandemic has seen ~1.61 million deaths and 72.4 million cases, up ~ 3 million cases since Thursday (click here): 

7) Good news stories:

DOM Holiday party and awards ceremony by ZOOM 

Regular reminders and updates:

  • KHSC bed capacity (not updated at time of note) 
  • Use the Mobile Screening Tool to expedite clinic visits 
  • KHSC visitor policy
  • COVID-19 testing at Beechgrove Community Assessment Center: (click here): 
  • Increased outbreaks and deaths in Long Term Care facilities (LTC)
  • COVID-19 in toddlers and young children: (click here). 

1) KHSC’s new screening questions effect visitors and health care workers differently: an introduction to “workplace isolation” for health care workers

Although COVID-19 has increased in frequency in our region we are still relatively low compared to Ottawa, Toronto, Peel, Windsor o America. Ideally, one should avoid travel to and from these regions. However, life is not always so simple. For example, many of our trainees and staff live in a red zone and commute to work. When it comes to COVID-19 entering our region it is usually imported by a traveler from a high prevalence area (red zone). Likewise for hospitals, COVID-19 infections are almost always acquired in the community and brought into hospitals (not vice versa)! Thus, we must be vigilant about keeping COVID-19 out of the hospital. Consequently, KHSC is implementing new screening questions about travel to and visitors from Red Zones. This question also applies to visitors from outside Canada. The consequences of failing screening (i.e. answering “yes” to the question about travel to and from the red zone or red zone visitors) is understandably different for visitors (who are not essential to running a hospital) versus health care workers (who are needed to keep the hospital running).

Visitors that fail the screening question: If a visitor answers positively (i.e. they have been to a red zone or been visited by a red zone resident) they will not be allowed to enter KHSC facilities.

new changes listed for patients and visitors

New KHSC screening questions

Healthcare workers that fail the screening question (assuming they are asymptomatic): When COVID becomes prevalent it is challenging to staff hospitals and therefore we have to carefully manage health care workers who have low potential for exposure and who are entirely asymptomatic. This does not apply to people who have tested positive for the virus, who should be at home. Moreover, if the health care worker is not essential and has failed screening then, like a visitor, they should not come to work (albeit after talking to Occ Health)!

Health workers who are essential and fail the screening questions because they have been to a red zone or live in a red zone, but who are otherwise well, usually with no known COVID-19 exposure, will be reviewed by occupational health and may be permitted to work under our workplace isolation policy. If Occ Health deems you to be safe to work you will be placed on “work isolation”. In this case you must:

  • stay on work isolation for 14 days after your last exposure to the COVID-19 risk or confirmed positive case; (unless Occupational Health has informed you otherwise) OR
  • stay on work isolation until your close contact/household contact with acute respiratory symptoms is confirmed negative for COVID-19

Work isolation requires you to: 

  1. Wear a procedure mask at all times when in the workplace along with any additional PPE as indicated by your Point of Care Risk Assessment (POCRA).
  2. Self-monitor for the development of symptoms and take your temperature twice daily. 
  3. Do not eat your meals in a shared space or remove your mask in the presence of others.
  4. Where you have removed your mask to eat, use a disinfectant wipe to clean any surfaces you were in close contact with.
  5. Work in only one facility.
  6. Identify yourself as being on “work isolation” at the staff screening station.
  7. If you are a “high risk” close contact of a person who is positive for COVID-19:
    1. you are also required to self-isolate when outside of the workplace; and
    2. travel to and from work in your private vehicle but if you must take public transit, wear a procedure mask and perform hand hygiene before/after travel to work.
  8. Should you develop symptoms while at work, you must promptly remove yourself from providing care/working, and contact your manager/supervisor and Occupational Health Safety & Wellness (OHSW) (KGH site x4389; HDH site x2265) 
  1. Should you develop symptoms while at home, self-isolate in your home, do not attend work, and contact your manager/supervisor and Occupational Health, Safety & Wellness (OHSW) (KGH site x4389; HDH site x2265)
  2. If on a weekend or at night physicians need to contact occ health for instructions (e.g. say someone developed a cold etc. and not sure what to do), they should call KHSC switchboard and ask for the occ health on-call nurse

11.For more information on How to Self-Isolate while working or at home, see: 

How to Self-Isolate while Working for Health Care Workers https://www.publichealthontario.ca/-/media/documents/ncov/ipac/ipac-covid-19-work-self-isolation.pdf?la=en

How to Self-Isolate (At Home) 

https://www.publichealthontario.ca/-/media/documents/ncov/factsheet-covid-19-how-to-self-isolate.pdf?la=en

2) COVID-19 volumes have dramatically increased in KFL&A related to a super spreader event at a local church (click here), student house parties around Queen’s University (click here) and a super spreader event at the Gananoque Chev Buick GMC Cadillac dealership (click here(see update from KFL& A Public Health):

The total number of cases in KFL&A since the pandemic began is now 397. There have been 26 new cases in the region since my note on Thursday. There are 93 active cases in the region. In Hastings Prince Edward county there are 54 active cases and another 59 in Lennox, Leeds Grenville county, for a total of 206 active cases in South Eastern Ontario. The latest COVID-19 outbreak is in Leeds Grenville county in Gananoque at the Chevrolet and the CSN Gananoque Collision Centre. There have been 37 cases identified related to this dealership to date and 19 of these people reside in KFL&A. People who interacted with their staff between Dec. 2 to 8 may have been exposed and should self-isolate and/or be tested. 

3810 COVID-19 tests have been done at KGH since Thursday. 57 tests were positive (15 from Kingston, 21 from Lennox, Leeds and Grenville, and 21 from the Kawartha region). There are 2 COVID-19 positive patients admitted at KHSC. There are 3 staff from KHSC who have tested positive and are on quarantine. There are ~ 40 patients on workplace isolation. The KHSC admissions are the only 2 admitted patients in southeastern Ontario. There are also 8 active outbreaks in KFL&A. These numbers, the greatest since the pandemic began, remind us we need to increase our vigilance as we await our chance to get vaccinated. 

graphs of positive cases by date

COVID-19 KFL&A Dec 14th-surges in COVID-19 cases (but we are still able to contact trace)

queen's u logoThird Day worship centre front entrance2 hands holding a tray with covid test tubes in the tray

Two Queen’s students who attended house parties have tested positive (click here). The university has reported 10 cases of the virus since Nov 30, all of them off campus. Contact tracing is going on for hundreds of people related to these parties and the potential exposures. The Queen’s motto is Sapientia et Doctrina Stabilitas, from the Latin as "Wisdom and knowledge shall be the stability of thy times." Student’s should apply this “wisdom and knowledge” to guide their behaviours during the pandemic for the safety of their community.

new screen shot showing roof tops of housesscreenshot of tweet saying come to Kingston church if your church in toronto is closed

Another event worthy of mention involves the Third Day Worship Centre in Kingston, which has had a super-spreader event with 24 cases identified (as of Dec 8th) (click here). There were 9 initial cases and then a further 15 cases who were close contacts. This church has now moved its services on-line. However, they shared an egregious Facebook posting soliciting people to come from Toronto (in red zone lockdown) to attend their church (in a yellow zone). This illustrates why travel between Kingston and Red zones requires quarantine and/or should be avoided.

tray with covid test tubes in it

The latest COVID-19 outbreak is in Leeds Grenville county in Gananoque at the Chevrolet and the CSN Gananoque Collision Centre. There have been 37 cases identified related to this dealership to date and 19 of these people reside in KFL&A. I am not sure how this particular outbreak started but perhaps this is not a great time to shop for cars 9since close contact required with salesperson)!

Bottom line: Neither youth nor religion will protect a person from COVID-19! The vaccine will protect us; however, it will take months to get a critical mass of Canadians vaccinated.

Meanwhile: 

  • Be extra vigilant because the case load is now high in our region! 
  • Continue to wash hands, mask, and maintain physical distancing
  • Do not assemble in large groups-this is what drives super-spreader events! 
  • Avoid travel to red zones like Toronto, Peel, Windsor and Ottawa. 
  • Avoid shopping in confined spaces
  • Get vaccinated as soon as it is offered

3) The first COVID-19 Vaccine is SAFE-EFFECTIVE and it’s HERE! (click here)

Approximately 1/20 who receive vaccines will likely have some minor side effects like redness and pain at the injection site as well as fever, chills, muscle aches and headaches. Most will have no noticeable side effects.. These minor reactions are brief, lasting <1 day. This is largely a sign one’s body’s immune system is being activated-which is the whole point of a vaccine! Serious side effects are not more common with the vaccine than in the placebo group in the Pfizer study. Remember adverse events are only “real” and related to the vaccine if they are more common in the vaccine group than in the placebo group. There is no risk of viral infection with the Pfizer and Moderna mRNA vaccines, which are the 1st two vaccines that Canada will see. While even mild symptoms may make a person worry they are developing COVID-19 infection, infection from these vaccines is not possible. The Pfizer and Moderna vaccines contain no virus; not even live-attenuated virus. These vaccine only contains the genetic code (mRNA) encoding one viral protein, the spike protein. The vaccine prompts our cells to make spike protein and then our immune cells make neutralizing antibodies and voila, we have immunity without ever being exposed to the virus!

The evidence that the vaccine works rapidly and well is compelling. The graph below shows the data from Pfizer’s vaccine studyof 43,661 people. It shows that the vaccine is 95% effective. A very positive finding is that protection occurs within 10 days of the first vaccine (note the early divergence of red placebo curve from blue vaccine curve). The booster dose at day 28 doesn’t appear to change the already high early protection; however it may enhance the durability of the effect. Show this graph to your most skeptical vaccine-concerned friend or family member to encourage them to be open to being vaccinated.

graph showing first covid 19 occurrence after dose 1 of vaccine


The Pfizer vaccine provides protection within 14 days (blue line)

The first vaccine arrived in Canada last night (click here): 30,000 doses of the Pfizer-BioNTech vaccines, enough for 15,000 people) arrived in Montreal on Sunday night. Quebec is expected to be the first province to administer the vaccine starting with vaccination of residents of two long-term care homes as early as Monday. Vaccines are bound for 14 distribution sites across the country, across all 10 provinces, and more doses are expected to cross the border on Monday. The first vaccines in Ontario will be used in Toronto and Ottawa for frontline healthcare workers. Health Canada is currently reviewing the Moderna vaccine (which will be easier to ship and store).

screen shot of vaccines arriving in Canada with nurse at table and patient in chair

Vaccination is THE way (indeed the only way) we will be able to return society to normal. Mass vaccination, ideally 80% or more of all Canadians, is essential to establish herd immunity and to permanently reopen our economy. Vaccine’s will also be required for our borders to open. Even if vaccines are not made mandatory I’m reasonably sure that certain privileges will be tied to proof that one has been vaccinated.

4) Ontario has had 142,121 cases with 1940 new cases since yesterday, a total of 16,586 active cases and 857 people in hospital (click here): 

table of Ontario's covid data

Ontario’s pandemic at a glance December 14th (click here)

Ontario’s provincial rate (956.1/100,000 population) has doubled in the past month and is now almost 6X higher than in KFL&A (182.9 cases/100,000 population). However, for those following the local pandemic our prevalence has increased 4X since the summer! There were 1940new cases today, up +1.4% from yesterday (click here). There have been 3972 deaths in Ontario since the pandemic began. The rate of positive SARS-CoV-2 tests in Ontario since the pandemic began is 1.89% but remains high at 4.6% today (which is increased 1.4% than yesterday and trending upward for the past 2 weeks) (click here). 

graph of active and hospitalized cases in Ontario

COVID-19’s large second wave in Ontario is still rising. Note the increase in hospitalizations (black line).

graphs showing positive test results by age

A positive COVID-19 test remains most likely in the young (14-24 years of age) (see graph above); whereas hospitalization and death primarily occur in those over 60 years of age (and especially in those over 80 years of age).

Peel (on Toronto’s western border) remains the hot spot in Ontario with 1970.3 cases/100,000 population. Toronto’s prevalence remains high at (1511.4 cases/100,000 population, more than double the rate 2-weeks ago (711 cases/100,000) and ~8 times higher than Kingston) (see map below). Ottawa also remains a hotspot, with a prevalence of 863.9 cases/100,000 population. Eastern Ontario, around Cornwall, has also passed the 500 cases/100,000 population mark since last Thursday.

map of Ontario highlighting areas with high covid prevalence

COVID-19 in Ontario: Dec 14th 2020

Neighborhood variation in COVID-19 in Toronto: Most of Toronto’s neighbourhoods are COVID-19 hotspots and have a cumulative prevalence of over 1000 cases/100,000 population (click here).

toronto waterfront and skyline with cn tower

Toronto remains a collection of neighbourhoods with vastly different COVID-19 realities due to differences in social/economic, racial and health circumstances. Although COVID-19 is increasing in the city as a whole, case load is widely variable amongst Toronto neighbourhoods. We should avoid travel to and from these hot spots from lower prevalence areas, like Kingston.

Since the pandemic began the Thistletown-Beaumond neighbourhood has had 4595 cases/100,000 residents, roughly 12X the burden of COVID-19 in the more affluent Beaches neighbourhood (403 cases of COVID-19/100,000 residents).

When one examines recent cases (i.e. those diagnosed since Nov 20th), case prevalence is still concerning-ranging from 30 cases/100,000 residents in Runnymeade-Bloor West Village to 1165 cases/100,000 residents, in Thorncliffe Park.

map of toronto highlighting areas of high covid prevalence

COVID-19 infection rates in Toronto neighbourhoods since pandemic began: The highest cumulative prevalence is in Thorncliffe Park

5) Canada’s second wave of COVID-19: We have had 464,299 total cases to date, with 45,556 cases in the past week and 73,423 active cases (click here)We have had 462,678cases of COVID-19 in Canada since the pandemic began (see below). 81% of all cases to date have recovered. There has been a 2.1% mortality rate amongst people diagnosed with COVID-19. Most cases of COVID-19 in Canada have been (in descending order), in Quebec, Ontario, Alberta and BC. Canada has done ~14.4 million COVID-19 tests and has a cumulative test rate positivity (since the pandemic began) of 3.19%. Ontario remains the province with the most testing (6.96 million tests, 2.01% cumulative positive rate).

graph showing increase of hospitalizations during second wave

COVID-19 second wave sees a marked rise in hospitalizations-Dec 14th 2020

Rates of infection are high in all Western provinces (BC to Manitoba) but with introduction of more aggressive public health measures these provinces are hitting a plateau. In BC the positive test rate is a cumulative 5.41% and their wave two wave is showing signs of plateau (see below).

graph showing increase in covid in BC

COVID-19 in British Columbia Dec 14th 2020

Rates of new infection are low in all Maritime provinces, although highest in New Brunswick. There are outbreaks in the North in indigenous communities in Nunavut (click here). The rates in Nunavut are fortunately declining rapidly. Although Quebec still has a higher rate of test positivity (13% cumulative) than Ontario (3% cumulative), its rate of case increase is flat and the total number of cases it accounts for, while still the greatest in Canada, is being approached by Ontario and Alberta (click here)

6) The COVID-19 global pandemic has seen ~1.61 million deaths and 72.4 million cases, up ~ 3 million since Thursday (click here): There are now 72.4 million cases globally and there have been 1,575,701 deaths. The number of cases has increased >4-fold since the beginning of August, 2020, when there were 16,296,790 cases globally. The pandemic hot spots are in the USA, India, Brazil, and Russia (click here). 

The USA with 16,293,597 cases and 299,455 deaths tops the COVID-19 list and accounts for ~23% of the global pandemic (up from 21% 2 weeks ago), while the USA only accounts for ~4% of the world’s population (see below).

The COVID-19 incidence map below shows the high incidence of infection in the US and the western half of South America, as well as in Europe (the bigger the yellow dot the higher the incidence-cases/100,000 population). Note the concerning accelerating rate of new infections in the bottom right graph (orange line). The ONLY solutions to this are adherence to public health measures and rapid, mass vaccination.

world map with markings and ranking of high covid countries

Global COVID-19 burden continues to accelerate: Dec 14th 2020

USA positive test rates (click here): In contrast with Ontario’s ~3.2% rate of positive tests, the USA has an average positive test rate of 11.4% (click here). There was a definite rise in rates of test positivity after a Thanksgiving that saw much of that country ignore public health guidelines about limiting travel and large group gatherings and the use of masks in indoor spaces (see blip on the right side of the graph). While vaccines are coming, these data reminds us we can do irreparable damage in the meantime by ignore science and public health (and conversely that with attention to both we can bridge the next 3 months until vaccines are widely deployed).

graph showing the usa post thanksgiving rise in covid cases

The American post-Thanksgiving rise in case numbers is evident on the right end of the graph above From ~8 to ~12 %)-a lesson we should learn from

Rates of positive testing remain a staggering 42.6% today in South Dakota and 18% in Arizona (both down from last Thursday). Illinois and New Jersey have positive test rates of 8.9 and 11%, respectively. The US-Canadian border will remain closed for routine travel at least until the December 21, 2020 and, for other countries, borders remain closed until Jan 21st 2021 (click here). That said, Canadians can still fly to America (although certain rules apply) and as discussed in my note 2 weeks ago, Canadian citizens can return to Canada from America, with a number of requirements, including quarantine) (click here).

traffic signs at the USA Canadian border in port huron

Regular reminders

KHSC bed capacityBed capacity at KHSC has 78 beds available (versus 72 beds on Thursday last week) (see below). Ventilator capacity (46) also remains good. Elective care including procedures and outpatient clinics continues. We are doing contact tracing related to a 2 positive staff members on one a KGH ward (thus far all 15 contacts have tested negative) and one at Hotel Dieu. It remains very safe to come to our hospital and clinics and I encourage patients to advocate for themselves to get the healthcare they need!

Use the Mobile Screening Tool to expedite clinic visits: Complete the COVID-19 pre-screening tool here and you will be able to “skip the line”: One way to safely expedite entry of patients into our facilities is to have all patients complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility for everyone. Reducing lines waiting to enter the clinics will be particularly important as colder weather arrives. The mobile screening tool only takes a few minutes to complete and you will receive an email with confirmation to bring with you, along with your appointment slip, in printed form or on your mobile device. To complete the mobile-screening in English, click here and in French, click here.

screenshot of pre screening app for KHSC

KHSC visitor policy: One of the hardest aspects of COVID-19 care in the hospital is the need to restrict visitors to ensure we don’t import COVID-19 into the hospital. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected. All details on the policy can be found using this link (click here). 

COVID-19 testing at Beechgrove Community Assessment Center: (click here): All COVID-19 test must be scheduled appointments (versus walk in). Our online system, Coconut, launched today and will assist in contact tracing. Appointments can be scheduled by telephone or by our new Eventbrite on line scheduling system. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). The Beechgrove Complex is south of the King St. West/Portsmouth Avenue intersection. Signage will direct people through the Complex to the Recreation Centre building at 51 Heakes Lane for walk-in testing. Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily. To be tested you will require: A valid Ontario health card or a piece of photo identification. You must also wear a mask and maintain physical distancing at all times while in the walk-in line.

female getting nasal covid swab, showing inside of nasal cavitythree young boys dressed up as doctors

Because health care workers (doctors and staff) are increasingly having to miss work because their children have been sent home from school or daycare with symptoms of a upper respiratory tract infection, we have arranged that their children can access expedited testing at Beechgrove . The goal of this service is simply to allow the healthcare worker to return to work as quickly as possible for the public good. The children of staff will be tested between 1230 -1300 by appointment, 7 days/week. The new program for families applies to children up to age 18, an includes children of staff and physicians who provide clinical care and service. Staff and physicians themselves should contact occupational health to book their testing appointment. To book an appointment for a child, KHSC staff should call 613-548-2376. Testing of clinical staff and faculty and their children is processed at the KHSC lab with an average turnaround time of less than 24 hours.

Increased outbreaks and deaths in Long Term Care facilities (LTC): We have 4060 LTC beds in KFL&A. As discussed in many prior notes, most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and long term care facilities (LTC). As of today, the 2400 deaths in nursing homes (up 42 cases from Thursday) account for ~60% of all deaths in Ontario, click here. In the last month the rate of death amongst LTC residents continues to increase daily and is now >50/week! Outbreaks in nursing homes usually start with a person in the community (health worker or family) acquiring the infection and importing it into the facility. Thus, protecting LTCs is best done with a combination of reducing community spread of COVID-19 and ensuring single occupancy rooms in LTCs (as well as appropriate pay for PWS workers, provision of PPE and rapid testing capacity).

table of LTC covid data

60.4% of all deaths in Ontario since the pandemic began have occurred in LTC residents

COVID-19 in toddlers and young children: (click here). 

Fortunately kids remain much less likely to be infected by SARS-CoV2 and when they are infected they usually become much less ill (click here). The vast majority of upper respiratory tract infections in kids in Ontario are caused by other viruses, like rhinovirus and RSV. Thus, health policy makers and parents of young children should recognize that while children are not immune from COVID-19 infection, infections are relatively uncommon and outcomes are usually excellent for those who are infected. 

two young boys in a classroom

Children are usually infected by an adult, usually in their home, rather than by other children. The number of cases in school age children (which includes teenagers) has increased dramatically to 4330 up 1430 cases from 2900 case just 2-weeks ago and >4 times the number from ~ 1 month ago (985 cases). 

female toddler holding an apple

Amongst younger children and toddlers COVID-19 remains relatively rare. In Ontario’s 5,500 licensed child-care centres and over 120 licensed home child care agencies there is a very low COVID-19 burden (see table ). The rise in cases has been modest in these young children. 580 toddler age children have now been infected to date, up from 418 cases 2 weeks ago.

7) Good news: DOM Holiday party and awards ceremony by ZOOM 150 faculty, staff and kids (and quite a few dogs!) assembled by ZOOM on Friday to celebrate the achievements of Department members and enjoy time together. We listened to Old Docs New Tricks (ODNT) our house band, who played a great Arkell’s set remotely, while masked and physically distanced. We decorated cookies (from Bread and Butter) and then judged the most seasonal, the most and least likely to be on Pinterest and selected the cookie with the most icing. The kids were on fire! Shout out to Jaxson Hartwick for some amazing seasonal cookie decoration! We ate pizza from Paradiso Pizza. We also did holiday trivia and had a virtual door prize draw. Many awards were given to faculty for clinical, education and research excellence. Particularly notable this year was a new (and hopefully not to be repeated) award for service during the COVID-19 pandemic. This was won jointly by Dr. Gerald Evans (for his amazing leadership of IPAC and being a source of wise counsel both locally and provincially during the COVID-19 pandemic) and Dr. Chris Smith (for his leadership in organizing our CTUs to deal with COVID-19 at KGH). Well deserved!

zoom screens of everyone holding up their decorated Christmas cookie

We honored our care partners (nurses and other allied health staff) by transforming our annual basket drop off on the wards to a Holiday Gift Basket sale – the proceeds of which are going to the Partners in Mission Foodbank. To date we have raised $2500 for the Foodbank from our basket sale. We still have 3 Decadent Deluxe Baskets left ($180/basket)! If you are interested in making a donation for a basket contact Karley Salsbury (karley.salsbury@queensu.ca) asap! Thank you to Brenda from Bursta Baskets for creating the beautiful baskets and to everyone who has donated so far. 

Stay well!

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