July 15, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
Local COVID-19 Update KFL&A:
The local outbreak of COVID-19, largely related to infections acquired in nail salons, is under control (note our “green status-Figure below). There have been no new cases in over 1 week. Our local epidemiology is consistent with the ongoing improvement in the epidemic we are seeing across Canada and in Ontario, with Ontario reporting the lowest number of new cases yesterday that has occurred in months (111). The running total for the epidemic remains at 105 cases in the KFL&A region (see update from KFL&A Public Health) (Table below). There are now only 7 active cases and these COVID-19 patients are recovering in the community. There are no longer any inpatients with COVID-19 in KHSC. This positions us well for Phase 3 reopening of the province later this week.
SARS-CoV-2 Testing: Over the past 3 days we have performed 921 SARS-CoV-2 tests. There was only 2 positive test both from the Kawartha area. Our test positivity rate in KFL&A continues to fall and is currently <0.4%.
This is good news and will allow us to continue our surgical ramp-up and resume our ambulatory care ramp up, as we continue efforts to provide better care for the 99.9% (click here for more on this). KHSC has capacity for our elective procedure ramp up; but things are busier, with the hospital inpatient census now exceeding 400 patients for the first time in months.
One risk to our capacity is the resurgence in the numbers of Alternate Level of Care (ALC) inpatient people. We had reached a low of 20 ALC people and are now back up to a census of 40 ALC people . These are people waiting LTC and retirement home placement and by definition should not be in hospital. They are “stranded” here as they await a return to home or an LTC. This puts our capacity to provide care for the 99.9% in jeopardy.
Universal Masking Policy Starts Today:
Beginning Today, all people entering the hospital will be required to wear a mask. MASKS WILL BE PROVIDED AT ALL KHSC ENTRY POINTS and they must be used (unless an exemption has been prospectively obtained). All staff will be provided with a mask for “entry/exit” of KHSC (it is light blue). This mask must be worn to enter the building. These masks can and should be reused for a week, storing it in a paper bag when not in use (bag provided). For staff in non-clinical areas this is the only mask you need.
For staff in clinical areas you need to pick up a new masks at the care desk in the clinic and on wards (they are dark blue). Clinical staff will then switch back to wear their “entry/exit” masks when they leave the building. Occupational health will be reviewing requests for exemption. When there is an exemption, it will usually mean that a face shield will be worn as an alternative (i.e. some form of facial PPE will still be required). An important reminder however; face shields are not as effective as masks and personal exemptions will likely be rare.
Where to get a COVID-19 test?
- A) Leon’s Centre testing facilityis open for COVID-19 testing of community members (click here for details of hours). The wait time at Leon Centre is short (10 minutes).
- B) Symptomatic KHSC staff:Should KHSC staff develop symptoms consistent with COVID-19, please contact occupational health and safety and they will tell you how to proceed (ext 4389 at KGH site, or email COVIDrtwadjudication@kingstonhsc.ca). You will likely be tested at the Hotel Dieu testing centre. Do not come to work!
Ontario’s COVID-19 outbreak (click here) Ontario’s prevalence rate is 248.6/100,000, much higher than in KFL&A, at 49.4 cases/100,000 population. Toronto still has a rate >8 times higher (438.6 cases/100,000 population). Provincially the epidemic is in decline. There were 111 new cases yesterday (up 0.3% from yesterday). Ontario has had a total of 36,950 total cases and 2723 deaths to date. The 0.8% rate of positive SARS-CoV-2 tests yesterday continues a trend of low positivity rates.
The prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, defined as rates over 1000 case/100,000 (click here), including: Moss Park, Newton Brook West, Yorkdale Glen-Park, Downsview Roding CFB, Maple Leaf, Rexdale-Kipling, Black Creek, Mount Olive, Beechborough, York University Heights, Mount Dennis, Glenfield Jane Heights, and Weston. Humber Heights Westmount with 1767 cases/100,000 once again has the highest prevalence in Toronto. The ministry has deployed public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”. Nonetheless, things are gradually improving in Toronto, as you can see from their dashboard (click here).
How’s Canada’s epidemic going? We have had 108,486 cases of COVID-19 in Canada and 8798 deaths (see below). Most cases are resolved (89%, green, top left below). The number of active cases per day has plateaued (orange bar graph, below right and orange line graph, bottom right). Quebec remains the hot spot with more active cases than the rest of the country combined (bottom left graph).
Canadian aggregate data
The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they still account for 68% of all deaths from COVID-19! There have been 1836 deaths to date. There were no deaths since yesterday in Ontario LTC centres. Canada had the highest rates of mortality in LTCs of any surveyed country. 81% of all Canada’s COVID-19 deaths occurred in residents of LTCs (click here)! This is sad indictment of Canada’s LTC facilities and attests to a lack of government oversight.
Testing for SARS-CoV-2 (click here): We have tested 9.35% of all Canadians (3,584,948 people) (see below). The rate of test positivity is declining and nationally is 3.03% (vs 2.14% in Ontario). Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average, with a rate of 11.94%. A very promising sign is that more testing is being associated with a lower rate of positive test results. This is the opposite of the Trumpian rhetoric from America (and is a reminder that more testing only reveals more cases if there is more disease in the community!
The COVID-19 pandemic has grown by more 2 million cases in less than 2 weeks! There are now 13,357,992 cases globally and 579,509 deaths. On July 6th there were “only” 11,495,412 cases! The pandemic hot spots are in the Americas (Brazil and USA), Russia, and India (click here). These 4 countries account for half the world’s cases. Here are the countries with more than 100,000 cases. America still has ¼ of all cases in the world. The pandemic is also increasing rapidly in Peru, Chile, Mexico and South Africa.
Global trends: Globally the pandemic is increasing (click here). This is due in large part to failed leadership and the related growth of the epidemic in Brazil and the USA. In America there is a disturbing second part of wave one which is still increasing in intensity (see below).
It is true the USA leads the world in testing (see below, click here). America’s testing rate is double that of Canada’s; however their rate of infection is 10-fold higher.
However, this does not explain the surges in rates of positivity in states like Florida, Texas and Arizona (and the congestion of hospitals and ICUs there proves that increased testing is not simply detecting asymptomatic people). Note that in Florida 84% of ICU beds are now filled (largely with people that have COVID-19 pneumonia) (click here).
A reminder that the number of visitors accompanying a patient to clinic should be kept to a minimum and if authorized they should be preapproved and identified with the screeners: As you are aware, we are still restricting family members from attending at the HDH site due to physical distancing challenges as we work to add clinical services back in that were paused earlier this spring. The exception for patients is where they absolutely must have a caregiver attend in order for us to provide safe care. Examples of this include people with dementia, very elderly/frail, those who are confused (e.g. neurological issues such as post-stroke). There should be a maximum of one accompanying person unless a second accompanying person has been preauthorized.
In other circumstances (e.g. a patient would like their family member to hear a diagnosis, instructions or be part of the appointment), we encourage them to use their cell phone and put their loved one on speaker phone during the appt instead. Screeners have begun this week to track those patients who believe they have been told to bring a family member with them to compare with the list of formally approved exceptions in order to try to understand and prevent miscommunication or delays. In these cases, patients and/or their family members were insistent that they were told to bring someone, but screeners did not have this patient on our exceptions list.
To my physician colleagues: Please use good judgement and try and avoid having patients being accompanying people to in person visits. If there is one required accompanying person that is acceptable. If there needs to be more than one person please arrange an exemption in advance so the screeners are aware of this need.