June 24, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
Important update (new cases, new inpatient case)
COVID-19 Update: There are 3 new cases of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region (see update from KFL&A Public Health). They were diagnosed yesterday.
1) One patient is an infant and is being managed as an outpatient. That patient was an outpatient and had minimal exposure to people within KHSC.
2) One infected person is a patient on Kidd 7 who was identified on a routine, pre-discharge swab, obtained because they had been scheduled to move to another institution.
3) A third case is a patient who died in a local LTC facility, details and contact tracing pending.
Response to new inpatient case: We are testing all patients and staff on Kidd 7 and putting the ward in quarantine. The stroke unit, which is nicely isolated, has been thoroughly cleaned and will continue to provide a safe area to continue to provide ongoing stroke therapy. Because our stroke service ranges from 9-13 patients we will be adding beds, in addition to those in the 6 bed stroke unit. The quarantine of Kidd 7 is scheduled to occur for 14 days but may well be shorter, depending on the results of testing and contact tracing. The main messages for patients and staff on Kidd 7 is that the risk is low and is being managed. It is also critical for patients and partner hospitals to recognize we are open to provide life-saving care for acute stroke and acute neurosurgical emergencies.
KFL&A metrics (see figure below): The running total for the epidemic is now 65 cases in the KFL&A region. There are 2 people recovering with COVID-19 in the community, which includes the KHSC staff member who was diagnosed last week. As discussed there is one person recovering in KHSC. When the recent COVID-19 nursing home death is registered our count will increase to 66 cases. These new cases, occurred despite the continued low local COVID-19 prevalence. This reminds us of the importance of our universal masking policy and the need for ongoing handwashing and physical distancing. It also supports the increasing COVID-19 surveillance testing we are doing in staff and faculty at KHSC. The positive test rate in KFL&A remains at 0.4% versus a 2.8% positive test rate for the province as a whole.
Capacity at KHSC: Our bed occupancy is over 400 patients for the first time in a long while. We do have adequate bed and ventilator capacity (see Figure below). With Davies 5 and Kidd 7 in quarantine there are increasing challenges in patient flow from the Emergency Department. Thanks to Dr. Chris Smith and Michelle Matthews, program operational director for Medicine, for their excellent work ensuring patients get the care they need in safe locations.
The COVID-19 pandemic is increasing and case count exceeds 9 million. The pandemic hot spots are in the Americas (Brazil and USA), Russia, Iran and India (click here). The global case total is 9,295,365 and the number of death was revised down to 472,289. The COVID-19 hot spot countries are in red below (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. The community testing site will move 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 3 new cases, Kingston remains in a bubble with a low incidence of COVID-19 (30.1 cases/100,000 population). Toronto has a rate ~13 times higher (410.5 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 163 new cases yesterday and 34,016 total cases to date. There have been 2631 deaths to date. The 1.3% rate of positive SARS-CoV-2 tests is down -0.5% 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 1690 cases/100,000, has the highest prevalence in Toronto. 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 102,126 cases of COVID-19 in Canada and 8466 deaths, 30 deaths since yesterday (see below). The number of active cases per day is declining (orange line below right). Quebec remains the hot spot, both for total cases and active cases (below left).
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 were 3 deaths since yesterday in Ontario LTCs.
Testing for SARS-CoV-2 (click here): We have tested 7.29% of all Canadians (2,701,573 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 8.54%.
In addition, I want to acknowledge both the Queen’s and KHSC teams that work in the Department of Medicine (DOM) or with us. You do amazing things to fight the pandemic and make your city, province and country healthier. You deal professionally with uncertainty, with courage in caring for new cases, and with the inconvenience of wards in quarantine. I admire your commitment to balance COVID-19 care with the care of the 99.9%. Your professionalism is all the more admirable as I know most are dealing with stressors, personally or within your families, related to job insecurity, unemployment, school and day care issues, and the care of elderly parents. To all of you in the extended DOM family, a heartfelt thank you and a reminder to take your well-deserved vacation time.