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June 11, 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 change in policy as required by Ontario Health to institute universal masking in treatment areas and in hospitals. This reflects no change in local epidemiology but is consistent with practices in other Ontario hospitals. More detail is expected soon. Please note an modest update on Etherington Hall today (below)

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 Etherington hall: In Etherington Hall the policy does not mandate full-time mask wearing, since it is both non-clinical and the staff located there are largely Queen’s employees. Nonetheless, masks should be worn when a staff member cannot maintain physical distancing in their non-clinical workspace (i.e. will be within 6 feet of each other for more than 10 minutes ). Physical distancing is superior to mask wearing in preventing droplet spread infections like COVID-19. Please be patient as policy implementation is developed (by next week).

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 some hospital staff. The goal of this testing is 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. The % positive tests yesterday for all Ontario tests was 1.6% (click here). Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population). Toronto has a rate >12 times higher (379.9 cases/100,000 population) than Kingston. The good news is that the rate of rise of new cases in Toronto is slowing. The epidemic in the province is also in decline, with a 0.6% increase in cases from yesterday (203 new cases). 

How’s the epidemic going? To date there have been 97,328 cases of COVID-19 in Canada and 7,972 deaths (see below). There is the beginning of a downward trend in the most affected province, Quebec (click here), which is a cause for optimism.

graph showing total cases vs recovered vs deaths in Quebec

Quebec shows decline in few active cases (orange line)

Graph showing total cases vs recovered vs deaths in Ontario

Ontario new case rate remains flat (orange line)

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 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 6 deaths since yesterday in Ontario LTCs. 

Chart showing covid-19 cases in LTC since Jan

Testing for SARS-CoV-2 (click here): We have tested 5.67% of all Canadians (2,088,560 people) and are at a slightly higher rate of testing in Ontario (6.39 %).

graph showing covid -19 test performed vs positives in Ontario

To see where Canada stands amongst nations in the COVID-19 pandemicclick here. The global case total is 7,426,178 and the number of death is up to 417,829. Here is a list of the most affected countries: USA, Brazil, Russia and UK. This global snapshot shows the pandemic predominantly facing the Americas and Europe at the moment. 

map of the world showing prevalence of covid-19 cases by country

Stay well!

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