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March 25, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Greetings to our trainees, administrative colleagues, nurses and DOM faculty. Here is an update on our program and Department for March 25th.

Update on the local COVID-19 burden (myth busting): There are 14 cases of COVID-19 in the SELHIN today.Regionally 2% of the 500 tests done locally are positive (much lower than rates of positive tests in New York). Although you will read in the media about community spread of COVID-19, this varies greatly by region. Most community transmitted COVID-19 in Canada thus far is in British Columbia and Ottawa, with little if any community spread in the SELHIN (thus far). One patient is in KGH and is recovering on the Medicine service. Thus, we (Canada) are not in the same situation as Italy or the USA. We are saddened by their suffering but our disease approach has been somewhat more proactive with earlier social distancing and better testing assay. We should not be smug, but likewise will (hopefully) be on a somewhat different disease trajectory than Italy or New York State.

Capacity: Kudos to the ICU and Medicine teams, frontline staff, and the Incident Control team for helping restructure the hospital and creating capacity for the anticipated influx of COVID-19 patients in the future. The bed occupancy at KGH is at an all-time low (<400), in preparation for influx of COVID-19 cases. We have created a second ward for COVID-19 patients, Connell 3, which has capacity for 35 cases and will replace Kidd 10 in this capacity when cases emerge. Connell 3 is ready when required and I’m so impressed with the flexibility all staff have shown in accommodating their new deployments. Well done team KHSC! By slowing elective surgical procedures we have increased ICU capacity with 15 spots available. Thanks to the Department of Surgery and other surgical Departments. By the end of the week we will have moved 45 ALC people from KHSC (thanks to Providence Care Hospital and Trillium for accepting these individuals and to Mike McDonald and Michelle Matthews for their leadership in this regard). We have capacity for up to 80 ventilators at KGH, should they be required.

Provincial Incident Command: KHSC is in close contact with East Regional lead and a Provincial Incident Management approach is being solidified. In the East region there are 5 clusters and ours is in essence the SELHIN, with KHSC and Dr. Pichora as the hospital lead. Cynthia Martineau a SELHIN VP is the administrative co-lead.

PPE: KHSC has an adequate (but limited supply) of PPE. More is coming next week and in the meantime we have policies to extend the use of components of the PPE (read on). At KHSC our policies are in line with latest provincial guidelines. We now advocate the extended use of the components of PPE that are for the protection of the health care workers (i.e. your mask and visor). These items can be worn for multiple patients encounters. Thus, we advise clustering patient care that requires PPE so that these items can be conserved for multiple usage (assuming they are not contaminated). Gowns and gloves (in contrast), which are for protection of the patient, should still be changed between each patient. 

Testing for COVID-19: Our test is excellent and we are running the test twice a day to accelerate return of results. The negative predictive value in symptomatic people is >95%. In contrast the role of the test in asymptomatic individuals is less clear (unless it is done for epidemiological surveillance studies). 

Be kind to our residents: Our residents remain a key part of health care system. Their diligent care of patients is essential both for the hospital to function and for the residents to complete their training. Their participation as trusted partners through the COVID-19 crisis will define their self-image as physicians for their entire careers. They understandably have stressors with reductions in educational opportunities, postponed convocation and a delay in their Royal College exams. So if you see a resident or fellow in any of our many training programs: Thank them for their service!

Research: As requested by the VP Research Dr. Smith in alignment with Queen’s University policy we have closed our research labs or will have them closed by Friday. We are doing this in an orderly manner. We are also providing Dr. Smith with inventories of our PPE and PCR reagents/equipment. Although we consider research an essential service this 2 week closure with staff working from home is considered by me to be prudent. There are some exceptions for essential research that must continue, for example patients receiving research therapies that are vital to their health. These activities must be inventoried and approved by Dr. Steve Smith’s office.

TMED program: I want to reinforce my support for our Translational Medicine grad students (TMED)and will ensure they are paid, supported and educated. Dr. James is doing a stellar job in this regard and has my full support. Dr. Mark Ormiston has kindly agreed to be Interim Co-Director of the Translational Medicine Graduate Program.

DOM ZOOM meeting: We had a great ZOOM meeting this morning with >100 participants online. This included updates on our impatient service (Dr. Chris Smith), the COVID-19 epidemic (Dr. Gerald Evans), Research shutdowns (Dr. Stephen Vanner), Video Visits (Dr. Ramana Apireddy). I thanked our Department for its diligent and calm patient care and reminded them to stay tuned to the changing nature of our response to the epidemic.

We are not in the same situation as Toronto or Ottawa today (with no known community spread in Kingston) but that will likely change. Our policies are guided by local epidemiology, not headlines in newspapers. That said our policies will change as our local reality changes. I urged all members to reassure students and staff that their positions are secure.

We continue to expect clinical personnel to attend work and practice social distancing, supplemented by good hand hygiene.

Finally, I reminded attendees that many in the community are struggling with unemployment, debt and have less information and financial support than the DOM family. It is our role to role model calm and be guided by evidence. Our calmness, like the virus, is transmissible, to the benefit of our friends, families and broader society.

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