July 31, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
- The people behind the COVID-19 Dashboard
- Update on this update-summer hiatus
To write my note I have relied on high quality data. Much of this comes from the Johns Hopkins dashboard. I recently asked a collaborator and friend at Johns Hopkins University, Dr Paul Hassoun, a respected respirologist and pulmonary hypertension researcher, if he knew the folks behind the amazing Johns Hopkins COVID-19 dashboard. This online resource is the source of my daily Canadian and world COVID-19 data. He sent me a link to this amazing story of the people who invented and maintain the dashboard (click here). We owe them a huge vote of thanks.
Civil engineering professor Lauren Gardner (left), of the Center for Systems Science and Engineering at Johns Hopkins University, is the lead behind the dashboard project. First-year PhD student Ensheng Dong (right) helped create the dashboard in less than a day.
Here is an example of the teams handiwork today (click here).
Like most great things in science this is an idea that emerged over coffee. Dr. Gardner notes, “About 25 people from multiple disciplines now support the website,including graduate students and senior software developers and research scientists primarily based in Maryland, California and England. They update the site hourly and pull data from dozens of sourcesincluding local health departments and data aggregating websites, the dashboard reports cases from more than 3,500 locations — at the province level in China; at the county level in the US; and at subnational and national levels elsewhere.” They manually validate the data and approve it before making the graphics that we have all come to rely upon. This adds critical validity to the process.
Lest you take free access to honest data for granted, let me remind you that the Trump administration recently diverted healthcare data from the CDC to their HHS Department, raising question about the politicisation of American COVID-19 data (click here).
The Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and send all COVID-19 patient information to a central, government controlled database. That’s one way to “flatten the curve”! Make no mistake, sidelining the CDC is pure politics and reflects an attempt to mislead the American public and control the message in a manner favorable to the president. The Johns Hopkins data (in contrast) remains a reliable source of information.
So what are the lessons for Queen’s University, CIHR and the people of Canada from the Johns Hopkins story? First, fund science and the people who perform science! Providing stable funding for research is crucial if we hope to have a cadre of competent researchers at the ready when the next pandemic arises. Our funding is currently unstable and insufficient to guarantee that even an excellent lab can survive the peaks and troughs of peer-reviewed, project specific, funding. Rates of success per grant are <15% at CIHR. When a lab loses funding it’s like a small business during the pandemic-it closes and the people disperse. Second, this story is a reminder that all the peoples of the world share the same desires for peace, health and happiness. Isn’t it uplifting that a Chinese post doc has provided America and the world with the data it needs to address its healthcare crisis! This is true in my own lab where trainees from around the world are working hard every day to be part of the COVID-19 cure! Third, all types of science are valuable. In the cases of this medical crisis, this dashboard is the work of from engineers, epidemiologists and IT folks-not physicians! In my own lab we are collaborating with physicians, chemists and virologists to design mitochondrial targeted therapeutics for COVID-19. It takes a diverse village to fight a pandemic (click here).
Finally, thank you to philanthropists who fill in the gap that funding agencies have left. They provide timely access to money that gives us flexibility and which often validates the importance of our research to our own universities! I am personally grateful to Dr. David Pattenden and the W. J. Henderson Foundation for the philanthropic support of my research (click here).
Local COVID-19 Update KFL&A:
There have been 3 new COVID-19 case in our region in the last week (see table below). The running total for the epidemic is now 109 cases in the KFL&A region (see update from KFL&A Public Health). There are 3 active cases, all recovering in the community. Our stable local epidemiology is consistent with the ongoing improvement in the epidemic across Canada and in Ontario. There are no inpatients with COVID-19 in KHSC.
Ontario’s COVID-19 epidemic: (click here) Ontario’s prevalence rate is 263.8/100,000, much higher than in KFL&A, at 51.2 cases/100,000 population. Toronto still has a rate 9 times higher than Kingston (452.5 cases/100,000 population). The region with the highest prevalence of COVID-19 is Windsor (540/100,000), largely because of a poorly regulated agricultural sector and suboptimal housing of farm workers. Over the past weekend there were 56 new cases in Windsor and of these 25 were in agri-farm workers, (click here).
Despite this grim news, provincially the epidemic is in decline. There were 134 new cases yesterday (up 0.3% from yesterday). Ontario has had a total of 39,209 total cases and 2775 deaths to date. The 0.5% rate of positive SARS-CoV-2 tests yesterday continues a downward trend over the past 2 weeks, consistent with the epidemic being controlled.
On the ongoing theme that SARS-CoV-2 is a litmus test for social inequities let’s consider the epidemic in Toronto (click here). Don’t think of Toronto as a single city; rather, think of it as a collection of neighbourhoods with vastly different realities and social/economic and health circumstances. For example, the Beaches has 79 cases of COVID-19/100,000 residents. In contrast, Weston has 1817 cases/100,000! Thus, there is no single “Toronto”, as seen through a COVID-19 lens; it’s a diverse patchwork with a >22-fold variation in disease prevalence.
While things are gradually improving in Toronto (overall), it remains in the yellow zone due to these local hotspots (click here) and graphic below. Toronto remains in Stage 2 of recovery. The best way to stop the epidemic in Toronto is to address housing conditions in its poorest neighbourhoods.
The first wave of Canada’s epidemic is resolving (although there is an increase in cases in Alberta, BC and Saskatchewan in the past week) We have had 115,935 cases of COVID-19 in Canada and 8832 deaths (see below). Most cases (88%) are resolved. The situation in Canada remains good, with low levels of hospitalization (top left below), low rates of new cases (top right below) and most cases resolved (bar graph bottom left). There are however concerns about focal outbreaks on farms in Ontario and increases in disease incidence in the Western provinces, related to people associating without respect for masking and physical distancing. A reminder: we remain as susceptible to this virus as we were last year with only 1% of random people in BC having antibodies against the virus!
Canadian aggregate data
No one in Canada can be complacent. Things have been great in Alberta for most of the epidemic; however, clearly there is a rise in the disease now, as people begin to assemble with less caution (see below).
Alberta data July 31st 2020
The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below). Canada has ~ 7% of seniors in LTC facilities, so this is a big problem (click here). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they still account for ~67% of all deaths from COVID-19! There have been 1845 deaths to date. There was 1 death since yesterday in Ontario’s LTCs. Canada had the highest rates of mortality in LTCs of any surveyed country (click here)! This is sad indictment of Canada’s LTC facilities and attests to a lack of government oversight and lack of a comprehensive plan for senior care.
Testing for SARS-CoV-2 (click here): We have tested 11.44% of all Canadians (4,333,451 people). The rate of test positivity is declining and nationally is 2.67% (vs 1.82% in Ontario). Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average, with 15% of Ontarians having been tested (see below). A very promising sign is that with more testing we are finding a lower rate of positive test results. More COVID-19 testing does not “produce more cases” (and it will also not increase the rate of finding cases unless they exist, undetected in the population).
COVID-19 testing in Ontario
In contrast with Canada’s 2.67% rate of positive test, the USA today has an average rate of positive COVID-19 tests of 7.8%. However, Texas, Florida and Arizona are in trouble, with rates of 11.5, 19.4 and 22% (click here)!
The COVID-19 pandemic has grown by almost 6 million cases in less than 4 weeks! There are now 17,334,539 cases globally and 674,038 deaths. On July 6th there were “only” 11.5 million cases and now, less than 4 weeks later, there are 5.8 million more cases. The pandemic hot spots are in the Americas (Brazil, Mexico, Peru, Chile and USA), Russia, and India (click here). The USA with 4,496,737 cases alone accounts for 26% of the global pandemic. The data sheet below shows countries where there are more than 100,000 cases to date.
Where to get a COVID-19 test?
- A) The public: Leon’s Centre testing facility is open for COVID-19 testing of community members (click here for details of hours). The wait time at Leon Centre is short (10 minutes). Our community centre will be moving to a new location shortly, stayed tuned for more details.
- B) KHSC staff: Should KHSC staff develop symptoms consistent with COVID-19, please do not come to work! Instead, contact occupational health and safety and they will tell you how to proceed (ext 4389 at KGH site, or emailCOVIDrtwadjudication@kingstonhsc.ca). You will likely be tested at the Hotel Dieu testing centre. Results are usually available next day.
KHSC capacity: We continue our surgical ramp-up and resume our ambulatory care ramp up 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 420 patients (see Figure below). 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:
Should I discard my KHSC provided mask after a single use? No, please reuse the mask for a week if it is not soiled. To help keep the mask dry please store it in the paper bag we provide at the door with the mask.
How many masks are we using? We are using 5300 masks/day at KHSC as part of our universal masking process. We have ordered 1 million masks.
How many people can get on a hospital elevator now that we are universally masked? Because dwell time in elevators is brief, we are allowing up to 6 masked people on hospital elevators.
All people entering the hospital are required to wear a mask (unless an exemption has been prospectively obtained). MASKS WILL BE PROVIDED AT ALL KHSC ENTRY POINTS. You will be allowed to wear a cloth mask when entering the building (this includes both staff and visitors).
- a) Fabric masks cannot have an exhalation valve.
- b) Fabric masks cannot be used in patient care.
If you use a hospital provided medical mask:
- a) they should be reused for a week, storing it in a paper bag when not in use (bag provided). These are not single use masks.
- b) these masks can be used in patient care as well, with the sole exception of caring for a patient on droplet precautions, such as a patient with COVID-19. In these cases you will need to get a different mask which is available at the nursing station.
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.
TGIF and Thank You!
The pandemic has been the marathon it was predicted to be. By my guess, we are in the first half of this extravaganza. We will know we are in the second half when we have an approved, effective vaccine. There have been periods of fear, moments of confusion and more than occasional frustration. Through it all I have been so impressed with the professionalism of the faculty and staff at KHSC (at all levels) and in the Queen’s DOM family. You have adapted to changing policies, you have learned to don and doff, you have mastered the art of taking a lunch break while wearing a face mask and all the while you provided exemplary patient care, continued to teach our trainees and performed research. You have maintained your humour and humanity, which makes me confident about our future. That said…
Vacation: I will be taking vacation so my briefing will be on hiatus until September…unless COVID-19 dictates otherwise. If there is any significant change in the epidemic I will resume my note from Anne’s Island.