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March 11, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

This is the 1 year anniversary of the announcement by the WHO that there was a global pandemic (click here). At that point there were 118,000 in 114 countries and 4,291 people had died. The Director General, Tedros Adhanom noted:

“This is not just a public health crisis, it is a crisis that will touch every sector – so every sector and every individual must be involved in the fight. I have said from the beginning that countries must take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimize impact. Let me summarize it in four key areas. First, prepare and be ready. Second, detect, protect and treat. Third, reduce transmission. Fourth, innovate and learn. I remind all countries that we are calling on you to activate and scale up your emergency response mechanisms; Communicate with your people about the risks and how they can protect themselves – this is everybody’s business; Find, isolate, test and treat every case and trace every contact; Ready your hospitals; Protect and train your health workers, and let’s all look out for each other, because we need each other.

At the time it seemed surreal-now it is our life. Thank you to members of my Department and the entire KHSC/Queen’s family for their diligence, dedication and innovation as we have collectively dealt with this pandemic. We have challenges ahead but there is now realistic hope of ending the pandemic in coming months. Please continue to stay well, take your vacations, follow public health guidance and be rightly proud of all you have accomplished.

birthday cake with colourful dots on it and a red #1 on topHeadlines

All patients admitted to KHSC will undergo Covid-19 testing

By mid-week universal patient masking precautions will be in place

1) Vaccines for people age 60-64 now available in local pharmacies: Emerging evidence shows Astra-Zeneca vaccine effective in people over age 70 years (click here)

2) Evidence that UK variant virus is not only more contagious, it may also be more dangerous (click here)

3) World vaccine roll-out tops 300 million people (click here)! Real world evidence that vaccination is safe and effective.

4) Vaccination of frontline health care workers at KHSC: interval to second dose will be prolonged (to as long as 16 weeks) (stay tuned for e-mail re rescheduling). 

5) All about COVID-19 Vaccines: Updated FAQs about vaccination 

6) KFL&A COVID-19 rates remain low; but there are now 100 active cases in our part of SE Ontario (see update from KFL& A Public Health)

7) Ontario infection rates rise with a 14% increase in new cases and a 9% increase in active cases. Hospitalizations have also risen 4%. Fortunately, deaths continue to decline (-30%) (click here(click here).

8) Canada’s COVID-19 epidemic continues to improve: There have been 898,574 total cases with 3,221 new cases yesterday. Rates of hospitalizations have unfortunately plateaued (click here) (click here). 

9) The global pandemic plateaus (but not in Brazil) (click here)

10) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines workingclick here

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1) Vaccines for people age 60-64 are now available in local pharmacies. Emerging evidence shows Astra-Zeneca vaccine effective in people over age 70 years (click hereVaccinations have begun for people age 60-64 in a local pilot program. This program administers (by appointment) the Astra Zeneca vaccine via local pharmacies (click here). Like much of the response to the pandemic things are confusing. As previously noted our provincial plan is largely based on risk and so started with LTC staff and residents and are working our way from those people over age 80 years down to age 60 years (in phase 2) and then on to the general population in Phase 3. However, Canada recently acquired a large supply of the Astra-Zeneca vaccine. The initial studies for approval of this vaccine only included small numbers of people over age 55 years (1418 people over age 65 years-12% of study population) (click here). While various advisory groups have therefore suggested that this vaccine not be used for older people, there is no evidence of lack of effectiveness. It is not that this vaccine doesn’t work in older people it’s that the evidence is less robust. That said this vaccine is used for people over age 65 years in the UK and many other countries. Indeed a pre-print study looking at all vaccinated people over age 70 years in the UK (click here) found substantial benefit in the elderly, noting “a single dose of either vaccine (Pfizer or Astra-Zeneca) is approximately 80% effective at preventing hospitalization and a single dose of the Pfizer vaccine is 85% effective at preventing death with COVID-19. Moreover, in people over age 70 years, the Astra Zeneca vaccine (one dose) results in protective effects within “ 14-20 days after vaccination reaching an effectiveness of 60% from 28-34 days and further increasing to 73% from day 35 onwards”. This article (see below) is awaiting peer review.

research abstract re the effectiveness of vaccine with BNT162b2 mRNA

My interpretation of our vaccine policy in Ontario as it pertains to the roll-out of this single dose Astra-Zeneca vaccine in pharmacies is that it is a reasonable attempt to respect age as a guide for order of vaccination while dealing with the limited published evidence in people over age 65 years. The pandemic is a challenging time and countries and people need to do the risk benefit analysis (and make no mistake there are major risks in remaining unvaccinated). My advice is that if you are eligible, take the Astra Zeneca vaccine. The totality of the evidence is that it is safe and effective (and I believe the age restrictions will soon be removed, based on the data from the UK that I cited).

screenshot of tweet listing Kingston Pharmacies giving Covid vaccines

As previously mentioned, beginning March 15th Ontario will accelerate its Phase 2 vaccine roll-out by opening 133 mass vaccination clinics by the end of March. These new clinics will account for 80% of all vaccines in Phase 2. Vaccines will also be given by additional pharmacies once the pilot program noted above shares lessons learned. 

The table below shows the sequencing of Ontario’s Phase two COVID-19 vaccination plan (due to be completed by the end of July).

colourful table outlining the phase 2 sequencing for who will get the vaccine

Ontario’s booking system for vaccines goes live March 15th, 2021 (click here). 

2) Evidence that UK variant virus is not only more contagious, but may be more dangerous (click hereA recent review of real-world data (click here) from an expert group in the UK who examined COVID-19 cases caused by the original Wuhan virus vs the new UK Variant of Concern suggest the UK variant (which now accounts for 1/3 cases in Ontario) may be more infectious and more deadly. In a BBC article they are quoted as saying “Previous work suggests the new variant spreads between 30% and 70% faster than others, and there are hints it is about 30% more deadly. For example, with 1,000 60-year-olds infected with the old variant, 10 of them might be expected to die. But this rises to about 13 with the new variant.” However, this is still uncertain and Sir Patrick Vallance, the UK’s chief scientific adviser, described the data so far as "not yet strong". My take is that the variants are simply a reminder we need to get the vaccine out to all willing people ASAP. The vaccine works against this variant (as shown in the graph below form Dr. Evans). The graph shows similar antibody levels result against the variant viruses as occurs in response to the original COVID-19 virus in the gray bar on left.

colourful bar graph showing efficacy of Pfizer vaccine vs variants

3) World vaccine roll-out tops 300 million people (click here)!The good news is our vaccines work against these variants; however, the emergence of increasing numbers of variants is a reminder of the urgency of vaccine roll-out globally. Variants emerge when large numbers of people are infected. For the undecided 20% of Canadians who are unsure they want to commit to taking a vaccine now, please believe me when I say that time is of the essence. The more the virus has to infect unvaccinated people the more time it has to mutate and develop the ability evade vaccine-induced antibodies. All approved vaccines in Canada are safe and effective.No corners have been cut in the Health Canada review of their safety. What was accelerated was their production and the duration of initial study prior to approval shortened. Vaccine production was accelerated because we can now safely use mRNA and adenoviruses, courtesy of lessons learned in the past 2 decades from the Human Genome project. While the vaccine studies for initial approval were compressed (because we are fighting a pandemic), the ongoing results are shared with the medical profession weekly. We now have unprecedented evidence of safety from the tens of millions of people vaccinated world-wide (click here). To date over 300,000,000 people have been vaccinated! So, if you are “waiting” for more safety data I would argue that all the data a reasonable person should need are there already. If you were vaccinated today you would be somewhere between the 300 millionth and 400 millionth person to have been vaccinated. We also have safety data from numerous clinical trials, which in combination with the re-world experience, should be reassuring!

colourful line graph showing how many vaccines have been given by country and cumulative

Over 300,000,000 people have been vaccinated

4) Vaccination of frontline health care workers at KHSC: 3971 KHSC health care workers have been vaccinated (and interval to second dose will be prolonged to as long as 16 weeks). As of today, KHSC has been allotted approximately 5000 vaccine doses by KFL&A Public Health. The dashboard below shows the amazing job Team Vaccine has done. They have issued 6008 invitations to health-care workers , people who are in Phases 1-5 of the MOHLTC’s priority grid. Currently they have booked 4753 people to be vaccinated by weeks end and 3971 KHSC health care workers (staff, trainees, faculty) have already received their first doses of vaccine. The interval between dose 1 and 2 will be extended for varying intervals (up to 16 weeks). E-mails will be sent out notifying people of that they will need to book a new date for their vaccine. The vaccine uptake rate (offered/accepted) is 84%. Despite the amazing roll-out, I am quite concerned that 16% of health care workers have yet to accept their invitation. KHSC is investigating the reasons for this. 

Also for those in Groups 6-8, we anticipate getting to you shortly (stay tuned for a date).

KHSC vaccination dashboard for healthcare workers

5) Here are answers to some updated FAQs with answers to common questions about the COVID-19 vaccines (most recent at the top).

grey faceless human figure holding hands to head and orange question marks swirling around head

FAQ 1) Which vaccine will/should I get? The short answer is that all vaccines effectively prevent COVID-19 death and severe adverse outcomes-so take the one that you are offered. They are all safe. That said, the vaccine someone receives will depend on your age, where you live and where you are vaccinated. The AstraZeneca-Oxford vaccine, which has an overall effectiveness of 62%-vs >90% for Moderna and Pfizer, will be administered mostly through pharmacies and primary care clinics, as will the Johnson & Johnson vaccine (I suspect). This is the case because they both can be stored safely in a regular freezer (click here). The AstraZeneca vaccine is recommended for people between 18-64 years of age. The mRNA vaccines (Pfizer/Moderna) are recommended for people over age 64 years. The advantages of getting a vaccine earlier (even if it’s a little less effective) outweigh waiting longer for a more effective vaccine. This is especially true since all vaccines seem to prevent death and severe COVID-19 complications. Emerging data show that the Astra-Zeneca vaccine is safe and effective in people over age 70 years (based on real-world data emerging from its use in the UK) (click here)

FAQ 2) Which COVID-19 Vaccines have been approved by Health Canada? Currently Canada has 3 approved vaccines: Pfizer, Moderna, and Astra-Zeneca (as of last week). The Astra Zeneca vaccine was approved on Friday and may arrive as soon as Wednesday (click here). Canada is expecting 445,000 doses of this vaccine this week. The vaccine appears to prevent COVID-19 spread and severe COVID-19 pneumonia and death; however, it has the lowest effectiveness overall (62% protection). The J&J vaccine was just approved by the FDA in the USA (click here). It has not been approved in Canada yet but this is expected to occur in the next 2-3 weeks. The J&J vaccine has several advantages. In a study with people in 3 continents one dose of J&J was 85 per cent protective against the most severe COVID-19 illness and the safety profile was as good as other vaccines. The J&J vaccine is a single shot vaccine (unlike two shots for Pfizer and Moderna). In addition it can be stored in a simple office refrigerator, allowing it to be rapidly deployed in the community. The bottom line: All approved vaccines are protective against severe adverse outcomes and I would advise you to take the first vaccine you are offered!

FAQ 3) Does the vaccine work against new variants (mutations) in the SARS-CoV2 virus? Short answer is a qualified YES. The vaccines work albeit not quite as well for the variants. In the 144,000 participants in all randomized clinical trials of vaccines to date, those receiving any active vaccine had only 3 cases of severe COVID-19 (vs 37 in the control group). There were no deaths in people who were vaccinated with any of the vaccines versus 5 deaths in the control group. Even though absolute protection is slightly less for UK and South African variants the vaccines (including the AstraZeneca vaccine and J&J) prevent serious adverse outcomes (like hospitalization and death). Thus, despite variant viruses the vaccines are lifesavers!

FAQ 4) I’m on a blood thinner, can I be vaccinated for COVID-19? Short answer YES. Here is a more detailed answer from an Canadian agency with expertise on the use of blood thinners, Thrombosis Canada

memo from Thrombosis Canada for those receiving a vaccine who are on blood thinners

FAQ 5) I have a history of allergic reactions, can I be vaccinated for COVID-19? Short answer YES. Out of ~1.8 million vaccinations there have only been 21 reported episodes of anaphylaxis (the most serious type of allergic reaction). Most (70%) of these events occurred within 15 minutes of the vaccine (which is why you will be monitored for this period of time post vaccine). There were also 83 cases of non-anaphylaxis allergic reaction after Pfizer-BioNTech COVID-19 vaccination with symptom onset within a 0–1-day risk window. Most (87%) of these allergic reactions were classified as nonserious. Thus, the risk of severe allergic reactions to the Pfizer vaccine are low and manageable. Allergy testing is NOT necessary prior to COVID-19 vaccination even in people with history of allergies. It is important note that none of the people who developed anaphylaxis after vaccination died and most did not have a prior history of anaphylaxis (see table below). The incidence of anaphylaxis is lower still with the Moderna vaccine.

The adverse effects of the COVID-19 vaccines in clinical trials are similar in vaccinated people vs people who got a placebo-saline injection except for: local pain at the vaccine site and increased muscle ache and headache, all of which were more common with the vaccine but were short-term (see below). This is a very good safety profile relative to other vaccines.

chart listing side effects of Pfizer vaccine vs placebo

The CDC does advise against the use of the two mRNA vaccines for a very select group of people with the following allergy histories (click here):

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine or any of its components
  • Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19 vaccine or any of its components (including polyethylene glycol [PEG])*
  • Immediate allergic reaction of any severity to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)*

FAQ 6) I’m immunosuppressed, should I get vaccinated? This question has a less clear answer. First, be reassured is no virus (dead or alive) in the Pfizer or Moderna vaccines so it is not possible for a person to get infected from the vaccine. However immunosuppressed people were not included in the initial clinical trials. That said, they probably are safe to be vaccinated but this is more a matter of expert opinion. In Canada the National Advisory Committee on Immunization (NACI) currently advises that the COVID-19 vaccine should not be offered to populations excluded from clinical trials “until further evidence is available.” However, they also say “an immunosuppressed person or those with an autoimmune disorder can still be vaccinated if a risk assessment deems that the benefits of vaccine outweigh the potential risks for the individual.” (click here).

The British Society for Immunology recently issued a statement indicating that vaccination is safe in immunosuppressed people (click here), albeit the resulting immune response may be weaker. They remind us that because there is no virus in the vaccine there is absolutely no risk of acquiring COVID-19 from the vaccine. Dr. Mike Beyak (gastroenterology) nicely summarized evidence from a registry of ~4500 patients who were immunosuppressed for their inflammatory bowel diseases (Crohn’s disease and ulcerative colitis). There was no increased risk of contracting COVID-19 in these 4500 patients. Apart for patients on prednisone, there was also no increased complications from COVID-19 when it occurred. Interestingly, some biologic therapies (antibody treatments for IBD) actually appear to reduce adverse outcomes in IBD patients who contracted COVID-19. This is not surprising since the truly bad outcomes in COVID-19 seem to occur in people who mount a hyper-aggressive immune response. Overall these data are good news for our many patients with rheumatoid arthritis, asthma and IBD who are on immunosuppressive therapies. However, since these people were not included in the vaccine clinical trials, it is advised they consult the physicians/clinic that is managing their care to inform their vaccine decision.

FAQ 7) How long can I wait after my first dose to get a second vaccine dose? It appears a second dose at day 42 is as effective in producing a neutralizing antibody response as when the dose is given at day 21 (the normal interval from dose 1). This more lenient 42-day protocol has been approved by Health Canada.

syringe with needle drawing vaccine from a bottle

FAQ 8) Can I get COVID-19 from the vaccines? This answer is simple-NO! None of the approved vaccines in Canada contain the virus itself. They do not contain live virus; they do not contain dead virus. Canada’s approved vaccines (from Pfizer and Moderna) contain only the messenger RNA (genetic code) to allow you cells to make the viral spike protein which then triggers your immune cells to build anti-spike antibodies which protect you. The Astra Zeneca vaccine is much the same but delivers the SARS-CoV-2 spike protein gene via a chimpanzee adenovirus-vector. Again, there is no virus (not dead; not alive) in this vaccine (click here). So, while you might get a sore arm or a fever from vaccination this is just your immune system responding as it should; there is no chance of getting COVID-19. Obviously one could contract COVID-19 around the time of vaccination the normal way, before the vaccination’s protection develops (i.e. in the first 2 weeks after vaccination). 

FAQ 9) Are vaccines safe? Yes, serious adverse effects of vaccines are rare (occurring in only 167 of 1.4 million Canadians vaccinated). Most people get (at worst) sore arm at the injection site, fatigue, or fever, all signs the immune system is being activated. Based on the clinical trials and experience in millions of people who have been vaccinated world-wide we can be reassured of vaccine safety and efficacy. All the side effects (called adverse events and abbreviated AEFI) are tracked and reported by the government of Canada (see below). (click here) (last updated Feb 26th).

FAQ 10) Is it safe to increase the time span between dose 1 and 2 of the COVID-19 vaccine? Most vaccines are given with an initial dose and a booster dose 3 months later. The reason the COVID-19 vaccine regimen initially specified a shorter interval was simply the rapid pace of the clinical trials which compressed the vaccination interval. Regulators approved the vaccine based on the information that came from these trials. With time it is now clear that spacing out the interval to 40 days (and longer) is safe and effective. This longer interval between vaccines allows more people to get the first dose asap and as the data have shown, the first dose yields substantial immunity within 1-2 weeks.

6) KFL&A COVID-19 rates remain low with 21 active cases in our region (8.4/100,000 in past week) and 1 case in prison (see update from KFL& A Public Health)The total number of cases in KFL&A since the pandemic began is 746, not counting the prison outbreak. This is up 7 cases since Monday and another new case caused by a variant of concern (i.e. mutant virus) (see below). There are 21 active cases in the region. There are a total of 6 variant virus cases in KFL&A. The case rates are rising in SE Ontario, particularly in Leeds-Grenville county. 

three graphs on top of each other

There has only been one death of a KFL&A resident since the pandemic began. There are no COVID-19 patients hospitalized at KGH. However, there are now a total of 100 active cases in South Eastern Ontario, up 23 from 2 weeks ago.  There is one new outbreak in our region, related to Queen’s University. Active cases in our SE region are rising back to levels seen in mid-January, a cause for caution.

Since Monday the KHSC lab ran 2598 tests and 25 were positive, 9 positives from Leeds Grenville and most of the others from the Kawartha area. Our regions rate of positive tests (1.1%) is roughly half of the provincial rate.

7) Ontario infection rates have risen significantly with a 14% increase in new cases and a 9% increase in active cases. Hospitalizations have also risen 4%. Fortunately, deaths continue to decline -30%) (click here(click here).

salmon bar graph showing cases in Ontario

Ontario’s COVID-19 prevalence new case rates show recent increase (March 11th)

The rate of test positivity is at a plateau of ~2.5%, see orange line below. This is roughly double the level seen in KFL&A, in blue (see graph from Dr. Evans, below).

blue and orange bar graphs showing test positivity in Ontario and specifically in SE Ontario

There were 1092 cases yesterday (up from a week ago but better than earlier this week). We have done 11.55 million COVID-19 tests thus far and the current rate of test positivity is 2.4%. Positive tests are due to N501Y mutation variants in 30-35% of cases. This is not the case in KFL&A (thus far), where mutants remain rare.

8) Canada’s COVID-19 epidemic continues to improve: There have been 898,574 total cases with 3,221 new cases yesterday. Rates of hospitalizations have unfortunately plateaued (click here) (click here). 

map of Canada green white and blue

There have been 22,360 COVID-19 deaths thus far (up 121deaths from Monday) and a cumulative national case mortality rate of ~2.01%. Canada has performed 26 million COVID-19 tests with a cumulative test positivity rate of 3.44%.

various Canadian covid data shown in bar and line graphs

COVID-19 in Canada March 11th 2021: Hospitalizations have plateaued at a high rate

salmon coloured bar graph showing decline in Canadian cases since Dec 2020

Improvement in wave 2 continues: March 11th 2021 (click here).

PEI remains a hotspot (relatively speaking) (click here) and its new case rate has not yet begun to decline. Rates of infection remain at a low plateau in all other provinces and territories, as a result of introduction of more aggressive public health measures. 

various coloured line graphs showing increase in cases in PEI

Spike in cases in PEI (orange line) has not yet resolved yet after 3 days of lockdown-March 11th

Canada’s vaccination roll-out is accelerating with ~ 1 million vaccine doses arriving this week(click here):To date, 3,877,470 doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered. This is an increase of ~1 million doses since Monday! Thus far, 69.4% of delivered doses have been administered (reflecting a surge in supply). 2,103,254 Canadians have received at least one dose of an approved COVID-19 vaccine (see below). 586,736 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack with only 5% vaccinated (see below).

horizontal colourful bar graph showing amount of people who have received the vaccine by country

7) The global pandemic is again on the rise, although daily deaths (click here) and rates of positive tests rise in the USA decline (click here):

satellite image of earth from spaceglobal map with yellow dots highlighting areas with high covid and ranking of countries on the left and right of map

Global COVID-19, March 11th, 2021: The number of active cases (yellow dots on map) has begun to increase again (orange graph, bottom right) 

There have been 118,222,254 cases and 2,623,286 deaths since the pandemic began. Active case rates were declining but have now hit a plateau, which is concerning (click here) (see orange graph of daily case rates, bottom right). Daily death rates are continuing to decline. The USA, with 29,158,244 cases and 529,377 deaths has roughly the same total number of cases as the next four most affected countries combined (India, Brazil, Russia and the United Kingdom). The USA has accounted for ~25.2% of the global pandemic but things are improving rapidly in the USA, due likely to natural immunity, vaccine acquired immunity and better adherence to public health measures (in some states). 

Brazil: Sadly leadership matters. Cases have skyrocketed in Brazil (mostly caused by the highly infections P1 variant strain). Brazil has recently seen daily death rates of >2200 people (with a total of over 270,000 deaths). Their hospitals are full, especially in the south of the country. New cases are rising rapidly (see below).

light and dark blue bar and line graph

COVID-19 in Brazil

This new wave is not solely the fault of their leader (Mr. Bolsonaro-below); but he is certainly in the camp of COVID-19 minimizers/deniers and has interfered with effective implementation of local public health measures, much as Mr. Trump did in America. He may be regretting telling his citizens that they should not be “sissies” (click here), when it came to COVID-19. The major driver of the case rise in Brazil is the many public gatherings that have continued to happen (click here), coupled with a poor national response in terms of public health measures. Brazil’s vaccine roll out has also been slow.

screenshot of Brazilian leader holding his hands to his face

Further evidence that leadership matters? Mr. Biden has vaccines flowing and advocates masking as a public service…and the situation in America is improving. America now has a 3.5% positive test rate, down from 6%, on Monday (click here; see below). Unfortunately, in states with populist governors, like Texas and South Dakota, rates remain high (Texas now has a positive test rate of 8.7%). South Dakota (though improved from its 30%+ rate 2 months ago) is still at a plateau of 11%. Leadership matters! The state to state variation in positive test rate runs hand in hand with the state’s adherence to public health policy. This epidemiology is a testimonial of the importance of adherence to public health measures while we await completion of mass vaccination (which in the USA should be May 2021).

bar and line graph showing decrease in USA covid cases

Test rates in the USA (currently >3.5% positive), March 11th, 2021

8) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines workingclick here

three senior citizens sitting at a table all wearing masks

Most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and LTC facilities. While LTC residents account for only 5.3% of all cases in Ontario, click here, they account for 52.7% of all 7109 deaths in Ontario. As of today, the 3,749 deaths in nursing homes (up 1 death since Monday) account for ~57% of all deaths. There are ~ 51 active COVID-19 cases in LTC residents and 137 active cases in LTC staff, the lowest numbers in months. These numbers continue to decline, which is very encouraging! For example a month ago we were seeing death rates of >100/week; now it is <5/week; still too many but heading in the right direction rapidly. The graph below shows the beneficial impact of the province’s decision to prioritize its limited initial vaccine supply of health care workers and residents of Ontario’s LTCs. Note the rapid decline in both staff (yellow) and resident (orange) COVID-19 case numbers coincident with vaccination!

line graph showing positive impact of vaccine in LTC

Vaccines crush COVID-19 in LTCs

Regular reminders

KHSC bed capacityBed capacity is adequate with 91 beds available (up from 62 beds on Monday) and good ventilator capacity (62 units). Critical care beds are never plentiful but there is still better reserve than we have seen in the past month, with beds on Davies 4, CSU and Kidd 2. Medicine remains busy with our doctors caring for people in 165 beds, not including ICU beds on Davies 4 staffed by the Medicine program. 

We are committed to providing care to the 99.9% of patients in SE Ontario who do not have COVID-19 (if you’re interested in learning more read this). In addition to acute care for heart attacks, strokes and trauma etc., we are continuing to provide elective care. We recognize that the term “elective care” is really a misnomer. Many “elective” patients have chronic pain and disability or suffer from cancer and other serious diseases and will not tolerate delay in care. We continue to encourage physicians to optimize the use of e-health visits to augment (not replace) in person care. We are also reminding patients who are coming to clinics in person that unless it is essential (and approved) they need to come alone, to minimize crowding in our clinic waiting areas. That said, it remains VERY safe to attend appointments at our clinics or to come to hospital for needed care!

Use the Mobile Screening Tool to expedite clinic visits: Complete the COVID-19 pre-screening tool here and you will be able to “skip the line”: All patients should complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility. The mobile screening tool only takes a few minutes to complete and you will receive an email with confirmation to bring with you, along with your appointment slip, in printed form or on your mobile device. To complete the mobile-screening in English, click here and in French, click here.

screenshot of pre screening tool of index finger scrolling on iPhone

KHSC visitor policy: Details on our visitor policy can be found using this link (click here). This is one of the hardest aspects of COVID-19 care in the hospital. Nurses in particular bear the burden of fielding numerous requests for visitation and while many requests tug on the heart strings we need to keep our hospital safe so it can function for the good of all residents. There are exceptions made to allow visitors under exceptional circumstances, particularly for palliative or dying patients. These exceptions are usually for a single visit. Our policy is necessary to prevent importation of infection to the hospital which would impair our ability to care for all patients. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected. 

COVID-19 testing at Beechgrove Community Assessment Center: (click here): 

Update March 8th: The center has been very busy, especially testing children < 12 years old (in light of school outbreaks). They have been doing over 600 tests/week in these children, KUDOS Team Testers! They also continue to test asymptomatic individuals who are going to and from LTCs and for essential visitors to hospitals. 

All COVID-19 test must be scheduled appointments (versus walk in). Appointments can be scheduled using our on line scheduling system. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily. To be tested you will require: A valid Ontario health card or a piece of photo identification. You must also wear a mask and maintain physical distancing at all times while in the walk-in line (click here).

animated photo of female getting nasal covid swabthree young boys dressed up as doctors wearing white coats and stethoscopes

Because health care workers (doctors and staff) are increasingly having to miss work because their children have been sent home from school or daycare with symptoms of a upper respiratory tract infection, we have arranged that their children can access expedited testing at Beechgrove . The goal of this service is simply to allow the healthcare worker to return to work as quickly as possible for the public good. The children of staff will be tested between 1230 -1300 by appointment, 7 days/week. The new program for families applies to children up to age 18, an includes children of staff and physicians who provide clinical care and service. Staff and physicians themselves should contact occupational health to book their testing appointment. To book an appointment for a child, KHSC staff should call 613-548-2376. Testing of clinical staff and faculty and their children is processed at the KHSC lab with an average turnaround time of less than 24 hours.

COVID-19 in toddlers and young children: (click here). It has remained true throughout the pandemic that children in general are less severely affect by the virus and young children are somewhat less infectious (perhaps because they are less sick). Rates of infection are very low in preschool children. 

The situation in Ontario schools remains stable. The good news is the reopening in the 7 areas where it was permitted has not resulted in major increases in new cases. Below is the new baseline report for school age children in publicly funded Ontario schools. School boards report every weekday from Monday to Friday. In person classroom education is back in Toronto, Peel and York. With more kids back in school we are seeing more infections (although not at alarming rates). There have been 7090 students with COVID-19 since the pandemic began with 1210 new cases in the past 2 weeks. This is a continued increase compared to last week, consistent with more young people being back in school. 17% of Ontario schools have reported at least one active case (see below).

chart outlining school related covid casesfour teenagers, 2 male 2 female sitting on a bench holding iPhone, iPad and book

Here is the parallel data from licensed child care facilities in Ontario-where there have been 1553 children infected since the pandemic began, 220 new cases in the past 2). This relatively stable number of infections in the licensed child care facilities is a reminder that it is the older school age children (>10 years old) not the toddlers, who are contracting COVID-19 most often.

young children sitting on a classroom floor

Final thoughts: Taking the vaccine is safe and it’s the right thing to do. I am one of the 300,000,000 people globally that have been vaccinated. It was an experience like all other vaccines I have had (uneventful). I recommend that when you are called you confidently roll up your sleeve and help us end the pandemic! I would also advise taking whatever vaccine you are offered as the benefits in preventing severe adverse outcomes (death and mechanical ventilation) are provided by all approved vaccines. The Astra Zeneca vaccine being offered at pharmacies is safe and effective. In addition, by “going earlier” (rather than waiting for your vaccine of choice) you are accelerating the creation of herd immunity and protecting the public at large.

Stay well! 

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