June 18, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
I am writing my 6th COVID-19 grant in the past 3 months so I will keep it brief today! 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 16,170 tests performed to date.
If there are no new cases tomorrow 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 (399 cases/100,000 population) than Kingston. Provincially the epidemic is also in decline, with a 0.6% increase in cases from yesterday. There were 173 new cases yesterday and 32,917 total cases to date. This is the lowest number of new cases to date. Likewise, the 1.1% rate of positive SARS-CoV-2 tests declined 0.1% from yesterday (the second day in a row of decline). However, the prevalence of cases in Toronto is still increasing daily due to 4-5 neighbourhoods which are COVID-19 hotspots, with 40X the case prevalence as Kingston (click here). Humber Heights, a neighbourhood in Etobicoke (1681 cases/100,000), has the highest prevalence in Toronto. We need better data on demographic and socioeconomic status etc. as we plan hotspot interventions to contain the epidemic! Humber Heights and others like it 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”.
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? We crossed the 100,000 case mark today, with 100,146 cases of COVID-19 in Canada and 8299 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).
Canadian aggregate data
Quebec with 54,383 cases and 5340 deaths (80% in LTC facilities) accounts for >54 % of all cases nationally. Although their active cases numbers were gradually declining they plateaued in the past two days
Data from Quebec
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 NO deaths since yesterday in Ontario LTCs. This is the first such day I can recall in the past months. Finally some good news!!!
Testing for SARS-CoV-2 (click here): We have tested 6.42% of all Canadians (2,360,585 people), see below. Ontario is exceeding the national average for testing with a rate of 7.57%.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total has surpassed 8 million (8,400,320) and the number of death is up to 450,435. The USA, Brazil, Russia and India and the UK are most affected. Brazil is closing in on a million cases (955,377). 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). The USA continues to have 25% of the world’s cases (2,173,804) despite accounting for 4% of the world’s population and no, Mr Trump, this does not reflect superior US testing strategies! America’s epidemic is not yet nearing the end of the first wave.