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March 19, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Thursday, March 19, 2020

Dear colleagues:

Another busy day and another day where your diligence, professionalism and commitment to the health of our patients was on full display.

Some updates:

  1. We admitted a person with COVID-19 pneumonia. The team on Kidd 10 handled the care professionally and calmly, as did the ICU team, when transfer of care occurred. KUDOS!
  1. We have moved the site of secondary screening for COVID-19 to Section C in the Emergency Department.  This has made screening/testing services for those who are sick more readily available. Thanks Dr. Messenger for arranging this.
  1. Our clinics and procedure suites are open. We are postponing all elective clinical work. Physicians’ offices are required to contact patients to reschedule care or, when appropriate, offer video visits. It is important that all physicians in the DOM work in coordination with their Division Chairs and the Department to ensure urgent follow-up care is provided to patients and that care for people with nonelective clinical and procedural needs is provided in a timely manner. We are defining non-elective patients as those who, in the physicians best judgement, require care within 3 months to avoid harm. 
  1. We are working with KHSC and SEAMO to roll out the REACTS video visits platform as a pilot program in the DOM that will be broadened to other groups subsequently.  Between OTN and REACTS platforms will be used for video visits will help decant elective cases from our clinics, allowing us to patients who have urgent and nonelective conditions that require our services in clinics and procedural suites. Thanks to Dr. Appireddy for his leadership in this program.
  1. We are reinforcing that we expect faculty and staff to be present at work to deliver service, unless they are ill. If an employee is ill, this should be managed as it would normally be handled by their managers or Division Chairs.

Clarifications from the news/literature:

  1. A letter in the NEJM has created some confusion re: how COVID-19 is transmitted.  I am “channeling” Dr. Gerald Evans in the following paragraph. COVID-19 is primarily spread from the upper respiratory track via large droplets. This means that spread requires proximity of ~3 feet to an infected person. This is different from infections that primarily effect the lower airway, which are spread by aerosol (small droplets suspended in air). Aerosol spread is much harder to control and requires more extensive personal protective equipment (PPE). In a recent NEJM letter van Doremalen artificially created a droplet preparation of the virus using a special rotating drum that removed the effect of gravity. Thus, we view that their finding that the virus can survive in aerosolized lab settings is not directly relevant to the patient or community setting. We continue to view COVID-19 as being a disease transferred by large droplets from infected people in close proximity. Practically this means that the current advice regarding the type of PPE we recommend  remains valid. We have already developed and disseminated a well-defined list of Aerosol Generating Medical Procedures to all the relevant groups in KHSC (but this is not relevant to the normal clinical interaction with a nonintubated patient). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 Neeltje van Doremalen et al This letter was published on March 17, 2020, at NEJM.org
  1. There are some early reports suggesting that hydroxy chloroquine (±azithromycin) may be of benefit for people with confirmed COVID-19 infection, speeding reduction of the viral carriage. Dr. Evans will be monitoring this literature and advising when/if this therapy should be considered. Currently the data supporting this is non-blinded and comes from single centres with small sample size. “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open label non-randomized clinical trial” by Philippe Gautret et al, International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949.
  1. On a lighter note: I refer you to this hockey themed blog on how we might best handle the COVID-19 pandemic.

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