June 22, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: There is one new case of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region (see update from KFL&A Public Health) but no COVID-19 cases in KHSC. Last Friday there was a positive test of a KHSC staff member. The person had complied with screening and did not come to work with symptoms, rather they first developed symptoms at work, which led to their being tested and going home. The only date of potential exposure to patients and staff at KHSC was June 18th. Fortunately, this event (which occurred on Davies 5) happened after institution of KHSC’s universal masking policy, which lowers the risk of transmission. Review of this case revealed the universal masking policy was followed. We have already tested all exposed people and all patients on Davies 5 and quarantined this ward as a precaution. Contact tracing related to this infection is currently underway. To date all exposed staff and patients have had negative swabs. For those who may have transited Davies 5 briefly on June 18th, a reminder that COVID-19 transmission usually requires fairly intimate contact (<6 feet separation from the infected person) and prolonged exposure (>10 minutes). Thus, for people transiting the ward briefly the risk of having been infected is very low. The running total for the epidemic is now 64 cases in the KFL&A region with this one active case, who is recovering at home. The positive test rate in KFL&A remains at 0.4%. We did 1320 tests over the weekend with 4 positive tests, 3 from the Kawartha area and this 1 from KFL&A. This is a reminder COVID-19 is not easily defeated.
A reminder to all staff related to breaks for meals etc: None of us can eat while wearing a mask. However, while break rooms are not clinical areas a mask is required if one is in the break room for more than 10 minutes and unable to physically distance (6 feet separation between people) (which would usually be the case). Please take your breaks on your own ward. Also, after eating please re-mask if physical distancing cannot be achieved.
Populist politics and pandemics are a toxic combination:
The COVID-19 pandemic is increasing, as this plot of total cases from January 2020 to present shows. The pandemic hot spots are in the Americas (Brazil and USA), Russia, and India.
The global case total is approaching million (8,975,776) and the number of death is up to 468,724. The hot spots (red dots, the size of which is proportional to disease prevalence) are the Americas, particularly the USA, Russia and Brazil (and let’s not forget Modi’s India) (see map below).
In the Americas, a toxic mix of populist leaders and muddled policies are feeding the spread of COVID-19, largely fueled by poor understanding of the virus and a governmental failure to clearly articulate and enforce nonpharmacologic interventions and failure to understand rudimentary aspects of public health policy required to contain an epidemic (my opinion), click here. In a CNN article Angela Dewan notes, “Much to their frustration, the macho leaders of these countries are finding the virus immune to their playbooks. Intimidation, fear-mongering and propaganda just aren't working. Being guided by science, communicating transparently and long-term planning are proving the sharper tools“ (click here). Canada, though not perfect, is doing reasonably well in its public health efforts.
As prime evidence of failed leadership in countries led by populist politicians, USA, Brazil, Russia and India are the world’s most affected countries. Brazil has surpassed a million cases (1,083,341,). Brazilian health policies are muddled and the man at the top, Mr Bolsonaro, is considered to be part of the problem (click here). Brazil has had 3 health ministers in the past few months. As with Mr Trump, Bolsanaro’s focus is on the economy and health ministers are resigning (it appears) in protest to what they and most epidemiologists see as premature opening of gyms, beauty salons etc., while the incidence of new cases rises.
Below is a table showing the countries with over 100,000 COVID-19 cases.
The USA continues to have 25.4% of the world’s cases despite accounting for 4% of the world’s population and this does not reflect superior US testing strategies! America’s epidemic is not yet nearing the end of the first wave. This is a reminder that anti-scientific leaders, most of whom are male populists, are a disaster when it comes to managing health crises, a pandemic being a prime example.
A revised reminder for people in the community
1) People in the community can self-refer for assessment and possible testing. Memorial centre remains the site of community COVID-19 testing centre (see instructions below). The physical plant there is not air conditioned and is thus becoming uncomfortable with the summer heat. A new site will open next week and it will be airconditioned. Test results are available within 24-48 hours from this site. 250 people were tested on the weekend at the Memorial center. Here is a link to the self-assessment tool used to see if you should be tested: click here.
The Community COVID-19 Assessment Centre is located at:
Kingston Memorial Centre (use the 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.
Symptomatic KHSC staff: Should KHSC staff develop symptoms please contact occupational health and safety and they will tell you how to proceed (ext 4389 at KGH site, or email COVIDrtwadjudication@kingstonhsc.ca). You will likely be tested at the Hotel Dieu testing centre. Do not come to work!
Despite the new case, Kingston remains in a bubble with a low incidence of COVID-19 (29.6 cases/100,000 population). Toronto has a rate ~13 times higher (405 cases/100,000 population). Provincially the epidemic is in decline, with a 0.5% increase in cases from yesterday. There were 175 new cases yesterday and 33,476 total cases to date. Likewise, the 1.1% rate of positive SARS-CoV-2 tests remains stable for the past few days.
However, the prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, rates over 1000 case/100,000 (click here), including: Moss Park, Newton Brook West, Yorkdale Glen-Park, Downsview Roding CFB, Maple Leaf, Rexdale-Kipling, Black Creek, Mount Olive, Beechborough, York University Heights, Mount Dennis, Glenfield Jane Heights, and Weston. Humber Heights Westmount, a neighbourhood in Etobicoke , with 1690 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 has deployed public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”.
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%.
How’s Canada’s epidemic going? We have had 101,333 cases of COVID-19 in Canada and 8430 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.
Canadian aggregate data
Active cases (orange line in graph below) have continued to decline in Ontario (see below); but the reservoir of COVID-19 in Toronto neighbourhoods remains a concern.
Data from Ontario
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 69% of all deaths from COVID-19! There were 3 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 6.78% of all Canadians (2,360,585 people). Ontario SARS-CoV-2 testing is on a steady upward trajectory (see below) and is exceeding the national average for testing, with a rate of 8.11%.