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March 23, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID-19 case update: Per Dr. Evans there is still no community spread locally. We have 8 cases (4 new)-still 1 in hospital; rate of increase are beginning to flatten in Ontario (still more cases but not increasing as rapidly as last week). We have been actively resting for COVID-19 in Canada. With almost ~99,000 tests done ~1400 are positive. Canada has ~2000 cases of COVID-19 disease and nationally there have been ~24 deaths to date. Half these deaths are in BC (approximately).

Communication in times of crisis communication is key. I want to reassure you there KGH incident command meets daily, and I am being kept in the loop. The Medicine program meets daily and Dr Smith and I are in the close communication with Michelle Matthews POD and the team of managers form the Medicine program. In addition, the DAC has weekly virtual meetings each Tuesday by ZOOM to share policies and practices amongst our Division leaders. Finally we have a weekly Wednesday 0800 DOM update by ZOOM to pass on the latest news and answer you questions.  I hope to resume Medical Grand Rounds by Zoom in the not too distant future. Research and Education and a sense of community need to continue despite COVID-19 and can do safely as long as we are smart and situationally aware.

Feeling anxious?: If you are feeling anxious or nervous about what is happening with COVID-19, any Queen’s employee/faculty, their spouse, or dependent who is experiencing anxiety or nervousness during this time is encouraged to contact Homewood Health Services, the University’s Employee and Family Assistance Program at 1.800.663.1142. Also, let me reinforce I am always happy to talk or email with you. 

Preparation for opening Connell 3 as a dedicated (sole purpose) COVID-19 ward: KGH needs to make room for anticipated influx of patients with COVID-19. Most will go to the Medicine service, with ¼ likely being sick enough to go to the ICU. Currently we have 69 ALC patients in KGH. These are people who, by definition, do not need to be in any hospital; rather, based on their lack of an acute illness, they should be in seniors residence or long-term care facilities. ALC people have effectively been stranded at KGH, many for months. We are beginning a program to move ALC people to appropriate sites. This includes plans to move ~10 ALC people to Trillium by the end of week, with 4 going to Providence Care Hospital. In meantime, some Connell 3 patients will be moved to Davies 5. This will make room for a COVID-19 ward on Connell 3. Once staffing for a repurposed Connell 3 was (and the other wards) is arranged (which is no small task), Kidd10 will return to being a regular medical unit.

Memorial centre open for COVID-19 screening: There is a new screening centre open in the Memorial Centre and it currently does 30-40 screenings/day. This is self-referral centre to evaluate symptomatic people in the community who are not health care workers. Health care workers are to be seen at KHSC screening centre. KUDOS to Dr. Kieran Moore and his Public Health team!

Evolving criteria for testing: We are doing increasing amounts of testing for COVID-19. Dr. Evans have advised me that once we have a more abundant supply of swabs for PCR testing (within a week) the criteria for who will be tested will be liberalized and likely all symptomatic people (those with cough/fever/dyspnea) will be offered testing. Stay tuned for more on this topic next week.

Provincial incident control table being established to make responses nimbler across Ontario: The government of Ontario is establishing an incident control centre to enhance our provincial agility in dealing with this epidemic. The SELHIN will likely be a cluster in this system with Dr. Pichora and an administrative counterpart playing lead roles. This incident command model will allow the system to exert a more directive nature to care coordination. This more top down model will help in rapidly implementing good public and hospital policies. The usual cumbersome reliance on a collaborative/goodwill approach is too slow and prone to veto when making tough decisions. This provincial initiative is timely.

Appropriate chain of command for questions/new ideas: We in the DOM and Medicine program welcome questions and ideas; however, they should not be communicated by mass email.  Questions and ideas should be raised with your Division Chair or program director (if you are a trainee) and/or with me (as Dept Head and program medical director for Medicine).  I will happily deal with your questions and ideas. Those that merit wider circulation will be taken to either to the Department’s DAC or directly to the Clinicals Operations Committee at KHSC (chaired by Dr. Michael Fitzpatrick).

Personal Protective Equipment (PPE): We are in good shape at KHSC in terms of PPE supply (basically, if you need it, we have it). That said, consumption reduction is necessary to preserve supply until the effect of vendors, like 3-M, ramping repletes provincial/national stores. We are receiving new supplies of PPE and swabs for testing in the coming week.

New KHSC visitors policy: In light of the epidemic, KHSC changed its visitor policy to drastically reduce visitors to the hospital (for their own safety). Per Dr. Smith and the nurse managers in the Medicine program this has been rolled out smoothly with the vast majority of families understanding the wherefores and the whys of this decision. Family presence is permitted ONLY in the following circumstances (and only if the family member passes screening):

  • Patients who are actively dying or being palliated, as defined by MRP, may have < 2 family at a time
  • Paediatric patients (including children/youth in mental health program, on all inpatient units, NICU) are permitted to have 2 adult caregivers present;
  • Surgical patients and those undergoing minimally invasive procedures (e.g. stemi, procedure under sedation) may have 1 adult caregiver for the duration of their surgical/procedural experience;
  • Cancer and renal patients who require assistance may be accompanied by one adult caregiver;
  • Women giving birth may be accompanied by one adult caregiver.

Things on my radar screen which are awaiting definitive answers:

Can a family member accompany a patient to a clinic visit: We are trying to markedly reduce visitors to outpatient facilities. We are discussing how best to manage those patients who require nonelective procedures/out-patient visits and who require an accompanying person. My preference is that the MRP be given discretion to allow 1 accompanying person to accompany the patient to their appointment/procedure (assuming both pass screening). This request (and advice about how it is best implemented) is under review by KHSC.

Housing for health care workers: There is discussion about repurposing Queen’s facilities to provide short term residences for health care workers who want to avoid returning home after working in the hospital. While the risk of conveying COVID-19 for people working safely in the hospital is very low, I understand the emotional appeal of this option. We will update you on progress on this front, as it occurs. We have engaged FHS and KHSC and Queen’s leadership on this issue.

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