June 12, 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 comprehensive mask policy which I have summarized below. The requirement for masking and type of masks used vary by location (patient care vs administrative offices). There are also mask requirements for visitors. Please see the 4 mask scenarios outlined below.
Scenario 1: Staff and faculty in patient care areas are required to use Universal masking: This policy applies to all clinical staff entering all clinical areas (wards, clinics etc). Mask delivery will be achieved through a decentralized model in which the masks are provided in the service area (not at the doors of the hospital or clinic buildings, a correction of yesterday’s note). When you enter the clinical area you should go to the unit desk and you will be supplied with a medical grade, American Society for Testing and Materials (ASTM)-approved, mask for use in this area. Staff are expected to us 2-3 masks/shift, changing them if they become damp or soiled. KHSC will be sending out official communication.
FAQ re: Universal masking in clinical areas:
- If I am passing through a medical care area very transiently (i.e. to drop off a package) and not contacting patients do I need a medical mask? No (NB: Although unit managers frequently move on and off the ward they are not considered transient and should mask).
- Can I remove my mask in my private office in a clinical area? Yes
- What if I am on a medical unit but not entering a patient room? The requirement to mask is universal for patient care areas therefore unless you are transiently passing through, dwelling only 2-3 minutes, you do need a mask, even if you are not entering a patient room.
- Is universal eye protection required? No.
- If I have a mask does that remove the obligation for other preventative measures, like physical distancing or hand washing? A resounding no! best practice remains to wash hands frequently and maintain 6 feet of physical distancing whenever possible.
Scenario 2- Administrative staff and non-patient care areas for KHSC staff and faculty: In these areas (where there is no patient care) targeted masking is used and is voluntary.
Who? A KHSC staff member who cannot maintain physical distancing in their non-clinical workspace (i.e. will be within 6 feet of each other for more than 10 minutes ) should wear a procedure mask . KHSC is providing administrative and other nonpatient care staff with these masks. These mask can be used for many days if not soiled and stored in a paper bag. Fun fact: paper bags avoid moisture accumulation are superior to plastic bags for mask storage.
What? The masks KHSC uses for these locations are called procedure masks. The look like ASTM-approved medical masks and meet high standards, although they are not proven to block inhalation of viral particles.
Where? They will be available for pickup by staff at Watkins 2 conf room in KGH and at Centenary 2 at HDH. You will also be given a paper bag to store your mask in.
When? Masks will be available at these two sites for staff from 0630-0930. After these hours screeners will provide masks at screening stations. Remember, physical distancing is superior to mask wearing in preventing droplet spread infections like COVID-19.
Why: These procedure masks are designed to prevent you (the wearer) from transmitting infection (presumably when you are asymptomatic-because if symptomatic you should not be at work).
FAQ: In Etherington Hall the policy does not directly apply since the staff there are largely Queen’s employees. However, if physical distancing cannot be maintained and you will be in close contact with individuals for >10 minutes, voluntary mask use of procedure masks can be considered.
Scenario 3- Visitors: Universal masking is mandatory for all KHSC visitors. Visitors may wear cloth masks (or medical grade masks if they happen to have them). If a visitor doesn’t have a mask, one will be provided to them by KHSC upon entry.
Scenario 4- KHSC patients: Unless a patient has a COVID-19 infection (or some other medical indication), hospitalized patents are not required to wear a mask. Outpatients may wear masks into the clinic areas.
Cloth masks are only for patients and visitors as a source control 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 medical grade mask.
Care of the 99%: a ramp up of ambulatory care begins! On June 26th KSHC outpatient services will return to 50% of our pre-COVID-19 clinical volumes for ambulatory care. This, combined with increased video visits and e-visits, should help ensure safe access to care for the 99.%
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).
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. We did 1713 tests at KHSC in past 2 days with 9 positive tests, from Kawartha area and Perth-Smith Falls. The positive test rate in KFL&A remains at 0.5% for the 13,658 tests performed to date. The daily % positive tests yesterday for all Ontario tests was 1.6% and is 3.5% since the epidemic began (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 (382.7 cases/100,000 population) than Kingston. The good news is that the rate of rise of new cases in Toronto is slowing; however, the prevalence is still increasing daily. The epidemic in the province is also in decline, with a 0.6% increase in cases from yesterday (182 new cases). There have been 31,726 cases to date.
How’s Canada’s epidemic going? To date there have been 97,894 cases of COVID-19 in Canada and 8048 deaths (see below). There is the beginning of a downward trend in the most affected provinces, Quebec and Ontario (click here), which is a cause for optimism. Nationally the number of active cases per day is declining (see graphic below-orange line), as is the number of reported cases.
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 4 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 5.77% of all Canadians (2,130,210 people) and are at a slightly higher rate of testing in Ontario (6.58 %).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total is 7,558,687 and the number of death is up to 422,760. Here is a list of the most affected countries: USA, Brazil, Russia and UK. The graphic today is a reminder that the Chinese epidemic, which seemed so large at the beginning of this journey, has been long ago eclipsed by cases in other countries, most notably America (with over 2 millions cases), Brazil (802,828 cases), and Russia (510,761 cases).
Global pandemic magnitude compared with epidemic in China (click here).