June 23, 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. There is one person recovering in the community. Last Friday there was a positive test of a KHSC staff member and this is the only case in the past week. That 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%.
A graphic illustration of the impact of COVID-19 on mortality and a reminder about the 99.9%(click here):
Thanks to Dr. Kathie Doliszny for bringing this animated graphic to my attention. It shows how COVID-19 went from an unimportant cause of death (globally) in January 2020 to being a leading cause of death by the end of May. Click the link to make the animation run. It is noteworthy that the leading causes of death (cancer and cardiovascular disease are not on this graph).
Click here to watch the graph move over time
This impact of COVID-19, though huge, does not compare with deaths from cardiovascular disease and cancer. The WHO estimated that in 2016 cardiovascular deaths were the leading cause of death globally: more people die annually from CVDs than from any other cause (click here) An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Of these deaths, 85% are due to heart attack and stroke. Over three quarters of CVD deaths take place in low- and middle-income countries. This reminds us why we cannot stop providing care for the 99.9% of people uninfected by SARS-CoV-2. The longer their care is delayed the more death and disability we will see from other cause, especially CVD, cancer, mental health and neurologic diseases.
The COVID-19 pandemic is increasing and case count exceeds 9 million. The pandemic hot spots are in the Americas (Brazil and USA), Russia, and India (click here). The global case total is 9,121,337 and the number of death is up to 472,683. The COVID-19 hot spots (red dots, the size of which is proportional to disease prevalence) are in the Americas, particularly the USA and Brazil (see map below).
The graph below shows the trends i.e. which countries are still in the growth phase of their epidemic (click here): Brazil, USA, India, Russia, Iran.
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 air conditioned. 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 (406.2 cases/100,000 population). The prevalence in Toronto has increased every day for the past several weeks, reflecting neighbourhood hot spots. Provincially the epidemic is in modest decline, with a 0.5% increase in cases from yesterday. There were 161 new cases yesterday and 33,637 total cases to date. The 1.4% rate of positive SARS-CoV-2 tests is up 0.3% compared with yesterday.
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 1681cases/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”.
How’s Canada’s epidemic going? We have had 101,637 cases of COVID-19 in Canada and 8436 deaths (see below). There were only 6 COVID-19 deaths in Canada yesterday. The number of active cases per day is also declining.
Canadian aggregate data
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 was 1 death since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 6.88% 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 8.26%.