June 15, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
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 1012 tests at KHSC in past 3 days with 6 positive tests, from Kawartha-Haliburton area . The positive test rate in KFL&A remains at 0.4% for the 14,136 tests performed to date.
Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population). Toronto has a rate ~13 times higher (388.4 cases/100,000 population) than Kingston. The prevalence of cases in Toronto is still increasing daily.Provincially the epidemic is also in modest decline, with a 0.6% increase in cases from yesterday. There were 197 new cases yesterday and 32,189 total cases to date. The % of positive SARS-CoV-2 tests on June 13th was 1%, which is a fall in the rate of positive tests of 0.4% (which is a good sign).
New Rules re: Hospital Capacity for Phase 2 ramp up:To facilitate the ramp up of elective procedures, Ontario Health has reduced the reserve requirement for hospitals. KHSC now can meet a reduced requirement for PPE reserves of 15 days (not 30), medicine reserves (15 days) and empty bed reserve capacity (for COVID-19 surge) 10% (not 15%). This is wise and exemplifies the reality that we must provide care for the 99.9%. To do so we will have to take some calculated risks and these new more lenient reserve requirements reflect this. Should a second wave of COVID-19 occur, we will of course need to revise our plan.
New Rules: Pharmacies in Kingston can now provide 100 day drug supply for prescriptions (it had been limited to dispensing a 30-day supply during the first few months the pandemic). Good news for patients and physicians! For more, read the blog (click here).
New Rule: KHSC screening Questionnaire no longer asks about out of province travel: Because of local low levels of COVID-19 and the favourable changes in Canada’s pandemic, KHSC will no longer be asking about domestic travel outside of Ontario. We will continue to ask about international travel. This is good news for those with travel plans to Quebec. Changes will occur within ~ 24-48 hours.
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 99.9%
We need to remember that of earth’s 7.4 billion people only 0.1% of the population (7,935,698) have contracted COVID-19. We will need to manage the pandemic while providing care for the leading causes of death and disability in society or we will truly be penny wise pound foolish. As discussed in prior notes, there is emerging evidence that our COVID-19 efforts, though necessary to flatten the curve, may lead to a mortality excess for cardiovascular disease and cancer, the two leading causes of death in Canada.
Universal masking and targeted masking policies: We have begun the process today (but it may not be institution wide until tomorrow). 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. Please note one clarification: If you are an administrative KHSC employee located in a non-patient are area (like Etherington hall) please pick up your mask at the beginning of the day on Watkins 2 conf room in KGH between 0660 and 0930.
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 (at the care desk). 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. If you are an administrative KHSC employee in a non-patient are area (like Etherington hall) please pick up your mask at the beginning of the day on Watkins 2 conf room in KGH between 0660 and 0930.
Scenario 3-KHSC 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.
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).
How’s Canada’s epidemic going? To date there have been 98,784 cases of COVID-19 in Canada and 8146 deaths (see below). There is a downward trend in active cases nationally(see graphic below-orange line, bottom right). The number of active cases per day is also declining (top right below). Quebec accounts for 54.6% of all cases nationally, although their active cases numbers are gradually declining.
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 70.9% of all deaths from COVID-19! There was 1 death since yesterday in Ontario LTCs. An ethical health care policy response to the epidemic in LTCs will need to recognize that broad, societal nonpharmacologic interventions are unlikely to help LTC residents. To help LTC residents we need rapid reform to require these facilities have single resident rooms, proper staffing and adequate PPE resources.
Testing for SARS-CoV-2 (click here): We have tested 6.03% of all Canadians (2,256,999 people) and are at a slightly higher rate of testing in Ontario (6.93%).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total is 7,935,698 and the number of death is up to 433,930. Here is a list of the most affected countries: USA, Brazil, Russia and UK. The graphic today is a reminder that the pandemic is worst in America (with 2,094,069 millions cases), Brazil (867,624 cases), and Russia (536,484 cases).
Global pandemic magnitude June 15th 2020.