June 10, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
New Universal masking and targeted masking policies to start next week:Beginning next Monday (probably) Incident Command will implement a significant change in policy as required by Ontario Health to move to universal masking in treatment areas and in hospitals. This reflects no change in local epidemiology but is consistent with practices at other Ontario hospitals, almost all of which are in higher prevalence locales.
Universal masking means hospital staff and faculty will be issued a surgical grade mask at the entrances to KHSC/HDH/PCH at the beginning of each shift. They will then wear the mask throughout the shift. Mask reuse is permitted.
Targeted masking: In non-patient care areas, like Etherington Hall, targeted masking is required. Targeted masking in nonclinical areas requires people who are going be within 6 feet of each other for more than 10 minutes to wear a surgical mask. In the case of targeted masking one can use the mask all week. The mask can be kept in your desk. I am requesting the masks be supplied within Etherington Hall.
Cloth masks are only for patients and visitors as a barrier technique (i.e. they are used on the assumption that the patients and visitors wearing them are not symptomatic from any form of respiratory infection symptoms). If a visitor were symptomatic they would fail screening and be required to wear a surgical mask.
New Hospital policy on SARS-CoV-2 testing for hospital staff: Ontario Health has requested KHSC create a program of voluntary testing of hospital staff to identify the baseline rate of asymptomatic infections. We will be testing staff in the renal program (to be done in June). In July we will test 450 staff in other higher risk areas (including Connell 3, our COVID-19 unit, the Emergency Dept and ICU). This is one-time testing to establish prevalence in a hospital in which we assume the baseline infection rate is very low (or absent).
Please stay tuned for communication by Friday and please be patient!
COVID-19 Update: There are no new cases of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region (see update from KFL&A Public Health) and no COVID-19 cases in KHSC. The running total for the epidemic remains at 63 cases in the KFL&A region and all are resolved. The positive test rate in KFL&A remains at 0.5% for the 13,313 tests performed to date (vs 3.5% positive in Ontario). We did 709 tests in the past 2 days with only 2 positives from the Kwartha area. 2.9% of swabs were poor quality samples, as expected when testing asymptomatic people. Thus, Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population), positioning us to carefully reopen the city and ramp up activity at KHSC and Queen’s University (read the blog if you’re interested in hearing more re: Queen’s). However, things are not so rosy in Toronto. Toronto has a rate >12 times higher (377.1 cases/100,000 population) than Kingston.
The epidemic in the province is also in decline, which is great news (see below).
COVID-19 in younger patients: There has been an uptick in cases of COVID-19 in young people in the Hamilton area (click here). This may reflect increased testing of asymptomatic or minimally symptomatic people, which would identify more young people) or, as the image below implies, it may reflect young people finally getting out and about and thereby acquiring more infections.
It has been clear all along that COVID-19 occurs in young adults with the same prevalence as older people (see graph below) (click here for Ontario data).
However, it is equally clear that youth are much less likely to require hospitalization than in those over 40 years of age (see below). Parenthetically, I consider 40 to be impossibly young!
When it comes to causing death the COVID-19 curve is even further shifted to affect the elderly (see below).
The take home message for Canada’s young people is that they are not immune to infection and need to continue to practice physical distancing and engage in other public health interventions to prevent the spread of disease to others and attenuate a second wave of COVID-19 (a responsibility we all share). This reminder will be challenging as we enter the (Phase 2 reopening of Ontario-click here) and summer arrives in full force.
How’s the epidemic going? To date there have been 96,652 cases of COVID-19, only 50 new cases since yesterday!. There have been 7,896 deaths in Canada (see below), meaning only 2 additional deaths. The number of daily reported cases continues to decrease (click here), which is great news.
Travel outside Ontario-is our policy aligned with other centres? (quick answer, basically yes): Currently, if a health care worker answers “yes” to out of province travel during screening their risk of being infected is assessed by occupational health and their subsequent management is determined accordingly. If they traveled to low risk areas they will likely be allowed to return to work under conditions referred to as Work isolation. In such cases, the healthcare workers must wear a mask, monitor their temperature twice/day and self-isolate immediately if symptoms develop. This work isolation would last for 14 days, even if a SARS-CoV-2 test is negative. If a staff member has questions about this they should contact Occupational Health (ext 4389 at KGH site, or email COVIDrtwadjudication@kingstonhsc.ca) prior to travel. Please note that most workers who have traveled out of province and return with no illness and no contacts with sick individuals will not be precluded from working in KHSC. This policy may change with the coming Universal masking policy-stay tuned for decisions as they become available.
The epicentre for COVID-19 mortality remains within 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 account for ~71% of all deaths from COVID-19! There were 28 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 5.49% of all Canadians (2,052,711 people) and are at a slightly higher rate of testing in Ontario (6.08 %).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total is 7,277,489 and the number of death is up to 412,106. Here is a list of the most affected countries: USA, Brazil, Russia and UK. America with 1,982,264 cases has the same number of cases as Brazil, Russia UK, India and Spain combined. This high US prevalence has major ramifications for opening of the US-Canadian border.