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screen shot of news conference with premier Doug ford and others

December 21, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

Change in policy re: COVID-19 testing: 

Effective immediately all patients admitted to KHSC will undergo Covid-19 testing

1) Ontario to enter provincial lockdown Dec 24th: It’s important to understand why this is necessary (click here

2) Update on major outbreak of COVID-19 at Joyceville Institution (click here):

3) COVID-19 volumes continue to increase in KFL&A (see update from KFL& A Public Health):

4) A new strain of SARS-CoV-2 emerges in England (click here)

5) Ontario has had 151,257 cases with 2290 new cases since yesterday, a total of 19,019 active cases and 915 people in hospital (click here)

6) Canada’s second wave of COVID-19: We have crossed the half million case mark with 509,917 total cases to date and 76,210 active cases (click here)

7) Is Canada a vaccine hog? (click here) and “Who should be vaccinated first?”

8) The COVID-19 global pandemic has seen 1,695,846 million deaths and 77 million cases (click here):

screenshot of Premier Doug ford and Ontario min of health

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

1) Ontario to enter provincial lockdown 12:01 am Dec 26th: It’s important to understand why this is necessary (click here

Premiere Ford held a news conference at 1 pm today to announce a 28-day lockdown for the portions of the province south of Sudbury, ON, beginning at 12:01 a.m. on Dec 26th. He flagged an ongoing large amount of travel from high to low prevalence areas and the associated rising numbers of hospitalizations which threaten to swamp our ICU capacity (which is needed to support the care of people with many other diseases and surgical and interventional procedures, beyond COVID-19). The ICU capacity must be preserved. Based on this he announced a province wide shut-down. Essential business will remain open at limited capacity and other businesses will function with curb side service. School breaks will be extended so that elementary schools resume Jan 11th (vs Jan 25th for high-school students). Minister of Health Christine Elliott reminded us of the unprecedented expenditures on the health care system in 2020 and announced new funding for targeted interventions to counteract COVID-19 in 4 high-risk communities in Toronto, York, Peel and Ottawa. The restrictions will initially apply for 28 days in southern Ontario and 14 days in Northern Ontario. This is Déjà vu, in that the restrictions resemble the March shutdown. Mr. Ford explained that the delay of implementing the lockdown until Dec 26th is logistical-i.e. it gives time for businesses to prepare for lockdown in an orderly manner (mentioning several times they need to deal with their inventory). This delay is controversial since this delay may result in up to 45,000 new cases that would potentially be avoidable if the lockdown began today.

screenshot of premier Doug ford and others at news conference

Why are we doing this now with vaccines already available? Essentially Ontario’s second wave is still rising with over 15,000 new cases/week and increasing numbers of hospitalizations and ICU admissions (see graph below). Most cases in Ontario now are either related to outbreaks (in work places or LTC facilities or churches-see circle graph bellow-yellow segment) or are acquired from close contacts (salmon coloured segment in circle graph). It is also clear we have lots of active cases (orange segments in bar graph-top left). Finally our hospitalization and ICU rates are on a steady upward march (line graphs at bottom of figure).

Various graphs showing Ontario's covid data

Ontario’s COVID-19 pandemic Dec 21st, 2021: Rising hospitalizations in Ontario (and a forecast that this could almost triple by January) justify a temporary lockdown

It will be several months, likely into early summer, before enough people are vaccinated to flatten the curve. Until then the only way to avoid hospital collapse is to reduce viral transmission through adherence to stricter public health measures. No one doubts that a lock down is radical and will cause personal and economic hardship (click here); but it is necessary. Currently there are 875 people hospitalized with COVID-19 in Ontario and 261 in ICU beds (3 short of the record set in the 1stwave) in April. Modeling suggests that at the current rate of infection Ontario will have 300 COVID-19 patients in ICUs by the end of December and up to 700 by the end of January! 700 ICU admission would be unsustainable and would threaten our ability to provide care for critically ill patients. This 1 month provincial lock down is needed to reduce infection, particularly in winter months when more activities must be indoors and when the virus is likely more transmissible (because we have dryer mucous membranes and are doing more coughing and sneezing in general than in the summer).

Mr. Ford acknowledged the anger in yellow and green areas affected by the lockdown and pledged to reassess in several weeks. Dr David Williams reminded questioners that Yellow and Green zones remain highly vulnerable and thus the lockdown is preventative in these regions. Mr. Ford also stressed that rates of infection in Ontario are, by global standards, low and he relies on the cooperation of the public with public health measures to ensure rates plateau. He was passionate about the point that these interventions are needed so that hospital beds need to be kept open for care of patients with trauma, heart attacks and cancer.

2) Update on major outbreak of COVID-19 at Joyceville Institution and Collins Bay (click here): Last Thursday there were 80 cases of COVID-19 at Joyceville institution. As of Saturday there were 95 infected inmates at this medium-security prison. In addition four staff members have tested positive, according to CSC's website. There are also 6 infected inmates at Collins Bay facility. The Canadian Correctional Service is Federally regulated and reports its numbers independent of KFL&A Public Health. Unfortunately prisoners have been moved amongst institutions, which likely means more outbreaks are coming. An Ottawa CBC report notes “Six of the inmates who have tested positive were recently moved from Joyceville to the Collins Bay Institution, also in Kingston, according to the CSC. Three inmates who later tested positive were transported to Warkworth Institution in Brighton, Ont, while one was taken to the Beaver Creek Institution in Gravenhurst, Ont.”

screenshot of news article of outbreak at prison picture of prison

According to CSC inmates are all being offered testing and those who have tested positive are being medically isolated and closely monitored. In addition, inmates and staff at all CSC institutions are required to wear masks and abide by physical-distancing measures and everyone who enters CSC facilities is screened. Even with rapid testing and isolation of cases the ability to manage the prisons during a prolonged lockdown will be a major challenge. There are mixed reports about the availability of PPE for inmates. Hopefully this outbreak can be largely confined to the prisons and not overflow into the hospitals. We are in line to receive patients who are too sick to remain in prison.

3) COVID-19 volumes continue to increase in KFL&A (see update from KFL& A Public Health)As of noon today our region remains in the yellow category. The total number of cases in KFL&A since the pandemic began is now 486, 48 more cases since my note last Thursday (not counting the prison outbreak). There are now 102 active cases in KFL&A, decreased from 115 cases last Thursday. There are 4 COVID-19 patients hospitalized at KGH. We performed 3319 COVID-19 tests in past 4 days and 48 tests were positive. Eleven positive cases were from KFL&A. There are 13 regional outbreaks in KFL&A. There are now 182 active cases in South Eastern Ontario with a 1.4% positive COVID-19 test rate.

Recent outbreaks include another COVID-19 cluster of 15 cases in an unidentified place of worship (click here), the third day Worship Center (click here) the Chevrolet-Cadillac dealership in Gananoque (click here), and multiple Queen’s University-related, off campus, house parties (click here). 

The city is now charging people in violation of public health regulations (click here). A CTV report indicates the City of Kingston’s bylaw officers filed 31 charges under the Reopening Ontario Act related to indoor social gatherings of more than 10 people. The charges relate to investigations that began in November and continued into December. Each Part 3 Summons under the Reopening Act includes a minimum $10,000 fine upon a conviction. The individuals who received the Part 3 Summons will need to appear before a Justice of the Peace in the new year.” (click here).

graphs showing kfl&A data

KFL&A is experiencing a concerning rise in local cases (and this does not include cases from the Joyceville Institution)

Bottom line: The vaccine will protect us; however, it will take months to get a critical mass of Canadians vaccinated.

Meanwhile we have to rely on good public health practices: 

  • Be extra vigilant because the case load is now high in our region! 
  • Continue to wash hands, mask, and maintain physical distancing
  • Avoid travel to red zones like Toronto, Peel, Windsor and Ottawa. 
  • Avoid shopping in confined spaces
  • Avoid large group assemblies both for safety and to avoid being charged!
  • Get vaccinated as soon as it is offered

3) A new strain of SARS-CoV-2 in England (click here)

Viruses mutate on a regular basis. Some change their cell surface proteins rapidly, such as influenza. This is why we have a new vaccine each year. Other viruses rarely change their surface proteins, which is why a measles vaccine gives us decades of protection. In the case of COVID-19 we have seen several mutations already. The virus identified in Wuhan China had differences in genetic sequence from the D614G mutation in Europe in February, which has become the globally dominant form of the virus (click here). Another variant called A222V, has also emerged after apparently arising in Spain

A new variant in the UK known as VUI–202012/01 or lineage B.1.1.7, was first identified in Kent county on September 20 (click here). The latest variant is concerning both because it has 14 new mutations (a lot of changes), some in critical regions of the virus, and because it has rapidly emerged as the commonest form of virus in London England, suggesting it may be more contagious than prior strains. The new strain has several mutations that may make it more infectious, one called N501Y involves part of the virus’ spike, which is how it gets into cells. Indeed this mutation has been shown to enhance viral uptake into cells (click here). Another mutation (H69/V70) removes part of the spike and was found in the recent mink coronavirus infection outbreak (click here). It is thought that this mutations enhances the viruses ability to evade the immune system (click here).

In a BBC article, Boris Johnson, the prime minister, and his chief scientific advisors said that “The new variant could increase transmission of COVID-19 by as much as 70% and increase the R or reproduction number by 0.4%. (click here)

graph and map showing the new strain of covid outbreak in the UK

In the phylogenetic tree looking a SARS-CoV-2 strains above, the new UK variant is in green (at the top). Other variants are in other colours (e.g. South African variant is the one with large yellow circles nearer the bottom) (click here)

Here are answers to FAQs re: the new COVID-19 variant, based on a new posting by Rambaut A et al from the ARTIC group (click here):

1) Are viral mutations always dangerous? No, many viral mutations do not increase or alter infectiousness or disease severity. In an excellent article in The Conversation, Dr Lucy van Dorp notes, There are many thousands of lineages of SARS-CoV-2 which differ on average by only a small number of defining mutationsThese variants are useful to track the virus but do not cause more severe disease.

2) Is the new viral strain more lethal? There is no evidence for increased lethality or disease severity thus far.

3) What evolutionary processes or selective pressures might have given rise to the new variant (lineage B.1.1.7)?Rambaut et al note that immunosuppressed people often retain SARS-CoV-2 for prolonged periods of time and often receive numerous therapies, including antibody therapy. This may provide the circumstances for spontaneous mutations to accumulate. They note that viruses from immunosuppressed patients are more like than others to have numerous significant mutations. They propose that natural selection, arising from antibody therapy that immunosuppressed patients often receive, may accelerate mutation rates. This remains a theory.

4) Will the existing vaccines provide protection against this variant virus? Our vaccines target the spike protein but despite the mutations in the spike protein of this new strain it is likely the vaccine will work. If enough changes were made in the spike protein the antibodies the vaccine raises might be impaired from protecting us (in theory). This phenomenon, which we hopefully won’t see, is called vaccine escape.

5) Ontario has had 151,257 cases with 2290 new cases since yesterday, a total of 19,019 active cases and 915 people in hospital (click here): It is very concerning that we are now consistently over 2000 new cases of COVID-19 per day and the viral R0 (its reproductive value) is over 1.0-meaning every 1 case generates 1.02 new cases (a recipe for growth of the infection in society).

table of Ontario Covid data

Ontario’s pandemic at a glance December 21st (click here)

Ontario’s provincial rate has is1063/100,000 population, double the rates in November and is now almost 6X higher than in KFL&A (219.1 cases/100,000 population). For those following the local pandemic in KFL&A our prevalence has increased 4X since the summer! There were 2123new cases in Ontario today, up +1.4% from yesterday (click here). There have been 4167 deaths and 8867 hospitalizations in Ontario since the pandemic began. The rate of positive SARS-CoV-2 tests today is high at 4.7% today (increased 1.1% since yesterday) (click here). COVID-19’s large second wave in Ontario is resulting in rising rates of hospitalizations on Medicine wards (gold below) and ICU (black line in graph below).

graph showing increased capacity in ICU beds

Peel (on Toronto’s western border) remains the hot spot in Ontario with 2176.1 cases/100,000 population. Toronto’s prevalence remains high at (1661.4 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). Windsor (1374.9 cases/100,000 population) and Ottawa (888.4 cases/100,000 population) remain hotspots. Eastern Ontario, around Cornwall, has also passed the 500 cases/100,000 population mark since last Thursday (571.6 cases/100,000). Note that the province is gradually turning orange and red as cases rise broadly in Ontario (see map below).

map of Ontario colour coded showing prevalence of covid

COVID-19 in Ontario: Dec 21st 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 5048 cases/100,000 residents, roughly 11X the burden of COVID-19 in the more affluent Beaches neighbourhood (459 cases of COVID-19/100,000 residents).

When one examines recent cases (i.e. those diagnosed since Nov 27th), case prevalence is still concerning-ranging from 40 cases/100,000 residents in Runnymeade-Bloor West Village to 1042 cases/100,000 residents, in Thorncliffe Park.

6) Canada’s second wave of COVID-19: We have crossed the half million case mark with 509,917 total cases to date, with 76,210 active cases (click here)We have had 509,917 cases of COVID-19 in Canada since the pandemic began (see below). 82.6% of all cases to date have recovered. There has been a 2.03% 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 ~15.1 million COVID-19 tests and has a cumulative test rate positivity (since the pandemic began) of 3.34%. Ontario remains the province with the most testing (7.4 million tests, 2.12% cumulative positive rate).

graphs showing increase in hospitalizations during 2nd wave

COVID-19 second wave sees a marked rise in hospitalizations-Dec 21sth 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 now all plateaued (which is the intended outcome of the Dec 26th Ontario lockdown).

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 (7.1% cumulative) than Ontario (2.1% 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).

bar graphs showing provincial covid #s

Rising case numbers in Ontario and Alberta

7) Is Canada a vaccine hog? (click here) and Who should be vaccinated first?

It is laudable that we have secured a more than sufficient supply of vaccine; however, it looks like we are over compensating. With a finite supply of vaccine for the foreseeable future we will create shortages in low income countries if we monopolize the supply. This graph speaks for itself. The government has indicated that excess vaccine will be distributed to other countries (click here).

graphs shwoing vaccine distribution

Canada is 1st globally in procured vaccines /capita: is this appropriate?

A related question is, who should get the vaccine first? In Ontario the ministry of health’s stated prior hierarchy of which groups should be vaccinated first are, in descending order:

  1. Residents and staff of LTC (but they may wind up waiting because of logistical challenges related to the cold-storage requirement of the Pfizer vaccine)
  2. Front line health care workers
  3. Indigenous people
  4. Frail elderly receiving home care support
  5. The public at large

In group 2 (health care workers) it will be critical to ensure we first vaccinate people who provide direct patient care. There is a lesson to be learned about what happens when administrators and get vaccinated before those workers on the front line-see the recent apology from Stanford University (click here). Stanford administrators took heat (and reversed policy) after initial vaccination of pathologists and radiologists and others who did not attend to covid-19 patients while overlooking the house staff (residents) who provide direct patient care.

“The “residents” — medical school graduates who staff the hospital for several years as they learn specialties such as emergency medicine, internal medicine and family medicine — were furious when it became clear that just seven of the more than 1,300 at the medical center were in the first round for vaccinations. Also affected were “fellows,” who work in the hospital as they train further in sub-specialties, nurses and other staff. Residents across specialties had just been asked to volunteer for extra intensive care unit work in preparation for a surge in covid-19 patients.” The report further states “The Associate Dean of Graduate Medical Education Laurence Katznelson told demonstrators that department chairs would ask their faculty without comorbidities to give up vaccination slots for residents and fellows. Chairs have agreed to say that all leadership will not get vaccinated until residents and fellows do.”

Let’s ensure that at Queen’s-KHSC our residents, nurses, orderlies, and attendings on clinical service are vaccinated early in our vaccine roll out!

screenshot of news article Stanford vaccine plan. people along a staircase with signs

8) The COVID-19 global pandemic has seen 1,695,846 million deaths and 77 million cases (click here): There are now 74.7 million cases globally, up 2 million + from Thursday. There have been 1,695,846 deaths. The number of cases has increased almost 5-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). Note in the bottom right the rate of rise in daily deaths is continuing to increase.

world map and ranking of countries with over 300,000 covid cases

Global COVID-19 burden continues to accelerate: Dec 21st 2020

The USA with 17,862,876 cases and 317,749 deaths tops the COVID-19 list and accounts for ~23.2% 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 death bottom right graph (white line). The ONLY solutions to this are adherence to public health measures and rapid, mass vaccination.

USA positive test rates (click here): In contrast with Ontario’s ~4.7% rate of positive tests, the USA has an average positive test rate of 11.2% (click here). Ontario’s rising rate of positive tests is similar to rates in a number of states (like Massachusetts at 5.4%). However, rates of positive testing in the USA are extremely variable by state (as are public health policies!). Illinois and New Jersey have positive test rates of 7.8 and 6.3%, respectively whilst South Dakota remains at a staggering 39.1% today in (both down from 50% 2 weeks ago). 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 us and Canada port huron border

Regular reminders

KHSC bed capacityBed capacity at KHSC has 99 beds available (versus 76 beds on Thursday last week) (see below). Ventilator capacity (42) also remains good. However our ICU capacity is extremely limited (by non-COVID-19 cases) (see graph below). We are being very cautious to only reduce elective care to the smallest extent required, ensuring we provide care to the 99% of patients who do not have COVID-19. Elective care is really a misnomer-many of these people have cancer and other serious disease which will not tolerate delay in care. I am seeing this increased burden of disease every Wednesday afternoon in my own cardiology clinic. We are encouraging physicians to optimize the use of e-health visits. We are also reminding patients who are coming to clinics in person that unless it is essential (and approved) they need to come alone, to minimize crowding in our clinic waiting areas. 

bar graph showing bed capacity at KHSC

KHSC has limited ICU capacity-Dec 21st 2021

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 KHSC prescreening mobile app

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). Appointments can be scheduled using our 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 (click here).

memo stating voiced testing centre moved to Beechgrovenasal covid swab on a female showing how far the swab goes internallythree 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 2508 deaths in nursing homes (up 62 cases from Thursday) account for ~60% of all deaths in Ontario, click here. There are ~ 960 active cases in LTC residents and a similar number of active cases in LTC staff! 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). To this advice we now happily add the early vaccination of support staff in these facilities!

table of LTC covid data

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 5103 up from 3570 case 2-weeks ago and ~5 times the number from ~ 1 month ago (985 cases). Approximately 20% of schools in Ontario have at least one confirmed case (table below).

table of covid data in school aged childrenfemale 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. 661 toddler age children have now been infected to date, up from 482 cases 2 weeks ago. Approximately 4% of day care centers have a confirmed case (table below).

table of covid data in licensed childcare centres

KHSC’s 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 or 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 covid screening questions for hospital entrance

KHSC screening questions regarding red/gray zone travel

Healthcare workers that fail the screening question (assuming they are asymptomatic):

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 maskat 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:
  8. you are also required to self-isolate when outside of the workplace; and
  9. 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.
  10. 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) 
  11. For more information on How to self-isolate while working, for health care workers(click here). For information of how to isolate at home for all others (click here).
memo on how to self isolate

Stay well!

 

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