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June 2, 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). There are no cases in KHSC The running total for the epidemic remains at 63 COVID-19 cases in the KFL&A region. There were 7 positive tests in the lab yesterday (none from KFL&A). Four positive tests were from the Kawartha area and 3 from Belleville. The positive test rate in KFL&A remains at 0.5% (vs 3.9% in Ontario). 

A gentle reminder to MDs: Please don’t call the lab requesting test results as this takes workers away from performing the test. They are going as fast as they can and lab results will be placed in PCS as soon as the test results are available!

Our PPE supply is stable with 3 weeks reserve, at the current level of activity. 

The big news: Screening for out of province travel begins Our screening test questions have changed. Anyone entering KHSC is asked if they have travelled outside Ontario in the past 2 weeks. If they answer yes, access may be temporarily denied. This new question and is provoking some anxiety. The reason for the question, requested by the government of Ontario, is that there are some hot spots in Canada’s COVID-19 epidemic, such as Quebec (see yesterday’s note) and returning from these places risks importing disease into low prevalence regions, such as KFL&A. For example, Montreal has 42 times the prevalence of COVID-19 as does KFL&A. The rational concern behind the question is that brief travel to Montreal could important COVID-19 to KHSC. The irrational part of the policy is that, next to Montreal and Laval, the next hottest spot for COVID-19 in Canada is actually Toronto. For those using logic it does not necessarily make sense to screen for out of province travel and not inquire about travel to Toronto. Like many things in the pandemic, there are political factors at play. One might assume the threshold for a government based in Toronto legislating to limit travel to Toronto is high.

So what happens if you are a healthcare worker and you divulge that you have been out of province? This varies on a case by case basis. If your travel was to a low prevalence city/province you may receive a determination that you can still work/enter KHSC. However, this determination may not be instantaneous. Thus, you and your supervisor should first consider the possibility that even “low risk”, extra provincial, travel could compromise your ability to work in the short term. If your travel was riskier, i.e. vacationing in Montreal, you may be required to self-quarantine and/or be tested for SARS-CoV-2 before returning to work. 

Because these policies are fluid I would strongly advocate for health care workers to avoid elective travel outside the province and, if they travel, return early enough that they can be evaluated/tested prior to returning to work. This is inconvenient; but there is not much about the pandemic that is convenient. In the Maritimes, health care workers are currently required to self-quarantine for 2 weeks prior to returning to work if they have travelled outside their home province.

Also, please be honest about travel out of province. One need only look to the physician in NB who traveled to Quebec and returned infected and spread the infection to see that the public has little tolerance for health care workers traveling and transmitting the virus to others. That said, even if we are all careful, transmission may occur and we should avoid the blame game. I encourage you to read the story of Dr. Ngola Monzinga and why he traveled to Quebec (click here). He said he did not self-isolate after returning from an overnight trip to Quebec to pick up his four-year-old daughter. Her mother had to travel to Africa for her father's funeral. He is quoted as saying, "What was I supposed to do? Leave her there alone?" Ngola said he drove straight there and back with no stops and had no contact with anyone. He said none of his family members had any COVID-19 symptoms at the time.

These are challenging times and while I urge discretion regarding travel and honesty during screening, the virus is highly infectious and even well-intentioned, rule-following health care workers might at some point be an unwitting vector-so, judge not lest ye be judged!

news article of Campbellton MD stethoscope


Will Toronto be next on the no travel list? Hard to say, but again, it would be prudent to avoid elective travel to Toronto until their COVID-19 incidence begins to decline. With a new year of medical residents and fellows coming to town my advice would be to get to Kingston as really as possible, ideally 2 weeks in advance, to ensure you are not caught up in the rapidly evolving travel rules.

COVID-19 screening of asymptomatic health care workers (policy in evolution). Currently testing of asymptomatic health care workers is voluntary and staff will be referred to the Memorial centre if they wish to be tested when they are asymptomatic. This testing is to be done on personal time, rather than during working hours.

Universal masking policy (policy in evolution): The Ontario government has suggested universal masking should occur in hospitals. However, this is currently not policy (just a recommendation). Such a recommendation may make sense in Toronto hospitals but is unlikely to be needed (at present) in a low incidence region like Kingston. Stay tuned for more!

How’s the epidemic going? To date there have been 92,391 cases of COVID-19 and 7396 deaths in Canada (101 since yesterday) (see below). Nationally, the COVID-19 curve has flattened, with a decline in the number of new cases (see bar graph below, right). However, the disease remains most prevalent in Quebec (below left), with 51,059 cases and 4641 deaths. Quebec accounts for 56% of the cases and 64% of all deaths from COVID-19 in all of Canada.

map and graph of Canada showing prevalence of cases

Montréal alone accounts for ~28% of all cases in Canada to date. So this is not the time to be visiting Montréal or Laval for tourist purposes (see below)! 

Map of Montreal and area showing prevalence of cases

Contrast this to Ontario. Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population), positioning us to carefully reopen the city and ramp up activity at KHSC and Queen’s University (read the blog if you’re interested in hearing more re: Queen’s). In Ontario as a whole cases are up 1.6% from yesterday to a total of 28,709. Toronto has a rate 11 times higher (335. cases/100,000 population) and this rate continues to increase daily (see below). 

map of GTA showing prevalence of cases

COVID-19 continues to disproportionately affect the elderly and particularly the frail residents of 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 ~72% of all deaths from COVID-19! There were 4 deaths since yesterday in Ontario LTCs. 

chart showing cases in LTC since Jan

Testing for SARS-CoV-2 (click here): We have tested 4.82 % of all Canadians (1,775,350 people) and are at approximately the same rate of testing in Ontario. 

Graph showing tests performed vs positives in Ontario

To see where Canada stands amongst nations in the COVID-19 pandemicclick here. The global case total has exceeded 6 million cases (6,325,303) and the number of death is up to 377,460. Here is a list of the most affected countries (USA, Brazil, Russia and UK are the top 4). America has 29% of all the COVID-19 cases in the world.

world map showing prevalence of cases globallyalarm clock with smiley face

A revised reminder for people in the community (last updated May 27th)

1) People in the community can self-refer for assessment and possible testing. We are now on testing people for much broader indications (we are no longer requiring fever or travel as preconditions for testing). We are testing people who have only 1 COVID-19-type symptom or who are concerned they have been exposed to the disease. KFL&A has also suggested that health care workers should be routinely and repeatedly surveyed by nasal swabs (discussed above). You can seek out testing at Memorial Centre in Kingston, (see instructions below). Here is a link to the self-assessment tool used to see if you should be tested (although I suspect it will be updated soon): click here

The Community COVID-19 Assessment Centre is located at:
Kingston Memorial Centre (please use the well-marked main entrance) 
303 York Street, Kingston, Ontario 
Monday to Friday: 10:00 a.m. - 6:00 p.m.
Saturday and Sunday: 9:00 a.m. - 12:30 p.m. 

2) Our hospitals and clinics are safe places to receive care (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). Upon entry to the hospital there is now a new screening question related to the discussion above about the high local prevalence of COVID-19 in Quebec: Have you traveled outside the province? You should not delay accessing care that you or your doctor deem to be urgent.

Your moment of Zen: You may be comforted to know that the COVID-19 world is stressful for most people (i.e. you are not alone). I picked an interesting phrase from Japan today to give voice to the stress we feel when forced to engage in an unusual behaviour, such as speaking a foreign language. The Japanese have a phrase for this, YOKO MESHI, as summarized in Christopher J Moore’s book “In Other Words”, a gift from Dr. Mala Joneja. As we read COVID-19 articles and parse epidemiological texts we too suffer from YOKO MESHI, the stress of a meal eaten sideways!

definition of Japanese phrase Yoko Meshianimated photo of man eating bowl of rice sideways

 

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