June 16, 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. The positive test rate in KFL&A remains at 0.4% for the 14,345 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 (391.2 cases/100,000 population) than Kingston. The prevalence of cases in Toronto is still increasing daily.Provincially the epidemic is also in decline, with a 0.6% increase in cases from yesterday (see bar graph below). There were 181 new cases yesterday and 32,370 total cases to date. The % of positive SARS-CoV-2 tests on June 13th provincially was 1.3%, a rise of 0.3% from yesterday.
However, in Toronto there has been a June bump in the incidence of new cases, as shown below in turquoise (click here). Hopefully this will be dealt with by more intensive testing in hotspot neighbourhoods and by more intense contact tracing.
Reopening pains-lessons from abroad remind us we need ongoing vigilance and adherence to sound public health measures: As Ontario enters Phase 2 of reopening and KHSC increases hospital Capacity for Phase 2 ramp up we need to remain vigilant with use of physical distancing, hand washing and other nonpharmacologic measures. China has begun to experience a resurgence of COVID-19 which may be the start of a second wave of COVID-19 in the Beijing area. The USA, which reopened despite lack of evidence that their COVID-19 curves had flattened in many states, is experience many areas of disease resurgence (click here). While there is no need for fear, and there is a need to resume health care and other activities in society we should also avoid magical thinking. The virus is still circulating in North America and its infectivity remains unaltered. For example in the New York Times today, Takenaga and Wolfe report “In Texas, cases are rising rapidly around the largest cities, including Houston, San Antonio and Dallas. Florida on Saturday reported its highest single-day case count yet: 2,581. The number of new infections has topped 1,000 for the past six days. Across the state, bars have started voluntarily shuttering their dining rooms after workers tested positive for the virus.”
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%.
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.
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. 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. Masks are available for pickup by staff at Watkins 2 conf room in KGH and at Centenary 2 at HDH from 0630-0930. You will also be given a paper bag to store your mask in. 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 maintainedand 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.
How’s Canada’s epidemic going? To date there have been 99,147 cases of COVID-19 in Canada and 8175 deaths (see below). There is a downward trend in active cases nationally(see graphic below-orange line). 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 were 2 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 6.13% of all Canadians (2,293,497 people) and are at a slightly higher rate of testing in Ontario (7.08%).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total has surpassed 8 million (8,075,962) 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 pandemic is worst in America (with 2,118,798 millions cases), Brazil (888,271 cases), and Russia (544,725 cases). As can be seen in the bottom right graph, the COVID-19 pandemic has not yet plateaued and has certainly not shown a decline.
Global pandemic magnitude June 16th 2020.