June 26, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
Please see the new order from KFL&A re masking in indoor public spaces:
Section 22 order
Effective 12:01 a.m., June 27, 2020 Dr. Kieran Moore, Medical Officer of Health for KFL&A Public Health has ordered all persons who own or operate a commercial or municipal establishment in the KFL&A area to:
- Prohibit Persons from entering the premises of the Commercial Establishment or remaining in the premises if the said Person is not wearing a Face Covering. The Face Covering must be worn inside the Establishment at all times, unless it is reasonably required to temporarily remove the Face Covering for services provided by the Establishment. A Person shall be exempt from wearing a Face Covering on the premises if:
- The Person is a child under the age of two years; or a child under the age of 5 years either chronologically or developmentally and he or she refuses to wear a face covering and cannot be persuaded to do so by their caregiver;
- Wearing a Face Covering would inhibit the Person’s ability to breathe in any way;
- For any other medical reason, the Person cannot safely wear a Face Covering such as, but not limited to, respiratory disease, cognitive difficulties or difficulties in hearing or processing information.
- Ensure the availability of alcohol-based hand rub at all entrances and exits for the use of all Persons entering or exiting the Establishment
Important update (new outpatient cases)
An editorial reminder from me pertinent to Binh’s nail salon, the Rustic Spud and other future sites where COVID-19 cases may arise: It is critical for each of us to follow public health rules and regulations. Physical distancing, avoiding large group gatherings, wearing a mask when in crowded areas, hand washing and staying home when symptomatic are the best defenses against spreading/contracting infection. Businesses have additional responsibilities (limiting access, installing barriers, and tracking customers). Some Kingston businesses follow best practices better than others and while that’s not desirable it is reality. It is not helpful to shame or blame businesses or individuals where COVID-19 infections occur. They are themselves victims of the infection. There are variable levels of understanding of the infection and variable financial and logistic realities that may explain breaks in compliance. While local businesses must strive to meet public health standards, let’s focus on education and support and avoid (as individuals) policing or blaming businesses. It is public health’s responsibility to monitor businesses and they are doing their job admirably.
Local COVID-19 Update KFL&A:
The running total for the epidemic is now 73 cases in the KFL&A region (see Figure below). There are 5 people recovering with COVID-19 in the community, which includes the KHSC staff member who was diagnosed last week. These new cases, occurred despite the continued low local COVID-19 prevalence. All the new cases appear to relate to the outbreak in the local nail salon. This reinforces the importance of nonpharmacologic interventions and for businesses to follow required public health practices. This new outbreak is also a reminder that most cases of health care workers being infected relate to community infections (not to acquisition of the infection in the hospital). It also supports the universal masking and 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 2.7% positive test rate for the province as a whole.
Local outbreak: There have been 10 new cases of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region in the past week (see update from KFL&A Public Health). All are recovering at home. These cases relate to a local nail salon (see below). We are advocating testing and 14 days quarantine only of “first circle contacts” (i.e. people who were actually clients of the nail salon). The risk of infection in secondary contacts (i.e. people in contact with people who attended the nail salon but who did not attend the salon themselves) is an order of magnitude lower and there is no need for testing or quarantine if they are asymptomatic. Because of this outbreak, we have a significant number of staff awaiting testing on self-quarantine and this may slow our ambulatory ramp up efforts. However, for now, we are continuing our elective procedure ramp up.
Local testing: We have done 1305 tests, with 4 positive tests, all from the Haliburton-Kawartha area. This outbreak primarily reflects a loosening of physical distancing and phase 2 reopening of the province. It would qualify as an outbreak, not a provincial second wave of COVID-19.
KHSC quarantine: Davies 5 remains in quarantine even though all tests of patient and staff to date are negative. More testing will be done on Monday to determine when quarantine can be lifted.
A reminder to researchers entering KHSC: If you are performing research at KHSC you should have an approved protocol, approval to proceed with your research from Dr. Steve Smith VP research AND your research unit should provide you with the necessary PPE to enter the facility. The hospital is reserving PPE for clinical use and authorized patient visitors. So, please ensure bring that you bring your mask when you pass through screening. Queen’s is looking into obtaining more PPE for research staff, stay tuned.
Starting Monday, testing will move from Memorial Centre to the Leon's Centre. People in the community can self-refer for assessment and possible testing. Memorial centre will close on Saturday with Leon Centre opening on Monday. Arrangements are being made to bridge the move with an interim testing site (stay tuned). Here is a link to the self-assessment tool used to see if you should be tested: click here.
Symptomatic KHSC staff: Should KHSC staff develop symptoms consistent with COVID-19, 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 cases, Kingston remains in a bubble with a low incidence of COVID-19 (33.8 cases/100,000 population). Toronto has a rate ~13 times higher (413.3 cases/100,000 population). The prevalence in Toronto has increased every day for the past month, reflecting neighbourhood hot spots. Provincially the epidemic is in modest decline. There were 111 new cases yesterday and 34,316 total cases and 2644 deaths to date. Both the case rate and mortality rate is decreasing. The 1.3% rate of positive SARS-CoV-2 tests is down -0.4% compared with yesterday.
The prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, defined as 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 1708 cases/100,000, has the highest prevalence in Toronto. 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 102,733 cases of COVID-19 in Canada and 8507 deaths (see below). The number of active cases per day is declining (orange line below right). Quebec remains the hot spot, with Ontario close on its heels. Both provinces have reached a new plateau in active cases but neither has a clear vector toward zero new cases.
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 4 deaths since yesterday in Ontario LTCs. Kelly Grant published in the Globe and Mail recently work showing that, compared to other countries, Canada was the worst in term of mortality in LTCs. 81% of all COVID-19 deaths occurred in residents of LTCs (click here)! This is sad, embarrassing and requires rapid change in how we license, fund and monitor LTCs. A simple starting point-single occupancy rooms!
Testing for SARS-CoV-2 (click here): We have tested 7.1627% of all Canadians (2,778,043 people). Nationally, 3.69% of all tests are positive (vs 2.71% in Ontario). Ontario SARS-CoV-2 testing is exceeding the national average for testing, with a rate of 8.94%.
The COVID-19 pandemic is approaching 10 million cases. The pandemic hot spots are in the Americas (Brazil and USA), Russia, Iran and India (click here). The global case total is 9,665,041 and the number of death is 490,903. The COVID-19 hot spot countries are Brazil, USA, India, Russia, Iran (click here): The table below shows (the growing list of countries with over 100,000 cases.
A special thanks to our leaders Cindy Bolton, Ashley Hendry, Mike McDonald and their team at Memorial Centre. This amazing team tested 700 people at the Memorial Centre yesterday. Day in and day out they have tested members of the community giving us the “eyes” to see the local COVID-19 landscape. KUDOS to this amazing team and best wishes as you move to new air-conditioned testing facilities in the Leon Centre.