June 17, 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 14,546 tests performed to date. There is 1 new case in Leeds-Grenville Lanark, nearer to Ottawa.
KHSC did 726 tests with no positives and only 1.2 samples considered inadequate for measurement. If there are no new cases by Friday we are technically at the end of the first wave of COVID-19!
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 (396.7 cases/100,000 population) than Kingston. Provincially the epidemic is also in decline, with a 0.6% increase in cases from yesterday. There were 190 new cases yesterday and 32,744 total cases to date. The % of positive SARS-CoV-2 tests on June 13thprovincially was 1.2%, a fall of 0.1% from yesterday (i.e. good news). However, the prevalence of cases in Toronto is still increasing daily.
1) Toronto COVID-19 hotspots have 40X the case prevalence as Kingston: To understand why Toronto is on the rise while the province as a whole is declining, look at the neighbourhood prevalence map below (click here). The prevalence of COVID-19 in some neighbourhoods is over 40 times higher than in KFL&A and is 4-5 times higher than the Toronto average: Weston (1345 cases/100,000), Humber Heights (1699 cases/100,000), Glenfield Jane-Heights (1223 cases/100,000). This is why we need better data on demographic and socioeconomic status etc. as we plan hotspot interventions to contain the epidemic! These neighbourhoods and others like them need customised intervention for their good and for the broader good of society. The ministry is deploying public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”.
Multi-bed rooms in acute care hospitals: Ontario Health just advised all hospitals to put a maximum of 2 patients per room or engage in extensive and expensive mitigation strategies. This effects 24 multibed rooms (rooms with 3-4 beds) in KHSC. Closing the extra beds in these multibed rooms is logical in light of the potential for COVID-19 spread within a shared room and lessons learned from the LTC outbreak, where such multi-occupancy rooms were a major part of the problem of disease propagation with the site. However, this advice (it’s not a rule at present) would deprive KHSC of 40 total beds. We are working with IPAC to determine whether to close these beds or introduce mitigation strategies. For history buffs I include a picture of a nightingale ward, reminding us of what hospital beds and wards looked like in the early 1900s. BTW the desk in the middle of the ward is a nursing station!
New Rules re: prescriptions: 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%.
New hours for pick-up of masks as part of Universal masking and targeted masking policies: We have begun universal masking . 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. 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 0600 and 1000.
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.
Two new reminders re masks:
- Masks are mandatory in clinical areas. If you feel you cannot wear a mask (i.e. allergic reaction etc.) you need to seek advice/accommodation from your manager or Dept Head as required.
- You will see some people either wearing masks when you don’t expect it (i.e. clinical folks in transit) or not wearing masks when you do expect it (i.e. admin staff in transit). We have great faculty and staff so please give your colleagues the benefit of the doubt and do not act as individual “policy police”. If you have concerns consult your manager or Dept Head as required.
New hours for pick-up of masks as part of 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 0600-1000. 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).
New hours for pick-up of masks: 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 0600 and 1000.
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 99,467 cases of COVID-19 in Canada and 8213 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 were 4 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 6.28% of all Canadians (2,324,820 people), see below. Ontario is exceeding the national average for testing with a rate of 7.4%.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total has surpassed 8 million (8,214,571) and the number of death is up to 444,853. USA, Brazil, Russia and India and the UK are most affected. As can be seen below Canada has joined the countries with over 100,000 COVID-19 cases (Canada’s numbers vary from earlier in article due to different data base).