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March 30, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID update: We have confirmed 40 cases of COVID-19 in our region as of today. These cases reflect the results of 800 tests in our region, representing a 5% positive rate. There are currently 2 COVID-19 patients admitted at KGH. Both have been cared for by Medicine and ICU services. There are 3 health care workers in the region who have tested positive for COVID-19 and they are community acquired cases. Contact tracking suggests that no patients were affected related to these cases. So far all cases in Kingston (including healthcare workers) were acquired abroad or in the community. So, while we need to protect health care workers in our hospitals, it is noteworthy that thus far, the hospital has not been a major site of infection. The COVID-19 incidence curve appears to be flattening in BC, reminding us (all Canadians) of the need to persist with our physical distancing efforts. 

Thank you KHSC staff! Dr. Chris Smith (GIM) and Michelle Matthews (POD Medicine) and I visited Connell 3 which opened as our new COVID-19 ward on Thursday. We dropped off a thank you basket of treats.

Connell 3 medical staff

Our amazing staff on Connell 3, strategically spaced 6 feet apart, are staffing our new COVID-19 ward at KHSC. Here they are seen receiving a thank you basket from the Department of Medicine. The CTU attending regulates admission to this floor to ensure we are not over-run by cases with relatively low index of suspicion of COVID-19. The floor is separated into COVID-19 and non-COVID-19 halves for now. Kidd 10 is being held in reserve for future patient influx.

Also a big Thank you to our COVID-19 screeners!  Please be truthful and do not come to work if you have an acute respiratory illness. I visited our screeners at the urgent care centre in Hotel Dieu. They and Dr. Dagnone, from the Department of Emergency Medicine, were busy doing an amazing job calmly screening and processing staff and faculty who required COVID-19 testing. 

Don’t take business as usual for granted: On behalf of denizens of Etherington Hall I offer a big thanks to our manager, Ms Anita Ng, who managed to negotiate restoration of our 5-day/week mail service/pick up and prevented Etherington from being locked down entirely. She also ensured that we are getting regular PPS cleaning and garbage pick up again! Well done!! 

eVisits: We are rapidly gearing up for an intensified video visits program to manage patients who can safely be seen virtually during this epidemic, rather than in person. Despite the Department of Medicine proactively ordering the IT equipment required for video visits, this is now significantly delayed due to supply chain issues. Luckily, many of our faculty members use Apple products with built in camera and speaker or microphone and this will permit timely roll-out for those users. A reminder though that the video visits platform (which is called Reacts) requires users to utilize Google Chrome as their browser. KHSC is using the Department of Medicine as a beta-site for Reacts deployment. Emails from Reacts that allow you to activate your accounts are being sent now (today/tomorrow) to your KHSC accounts. DOM physicians, please check your KHSC account to activate your Reacts accounts. Finally, If telephone consults work for you and your patients, this time-tested modality is perfectly acceptable way of providing care.

The need for professionalism in the COVID-19 epidemic: Relevance to our PPE policies

“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.

Nelson Mandela

In pandemics, wars or other crisis conditions it is key to acknowledge one’s own concerns and fears but at the same time maintain discipline, order and follow coordinated policy. We will be well served if we can balance our personal views and fears, with a focus on data and evidence, always keeping an eye on achieving the greater good. One example of behaviour that was not evidence-based was the observation that KGH saw a 30% increase in PPE usage before we had a case! To reassure you, KHSC has a 4 stage PPE expansion plan in place which will see expanded use of PPE as the epidemic evolves. A recurrent theme is that the epidemiology is not yet the same here in Kingston as it is in Toronto or New York City. As the risk of COVID 19 increase I expect we will ultimately reach the point where all health care professionals will be in PPE, but we are not there yet! We currently have a 1-week supply of PPE in hand (but only if we follow our current guidelines). New supplies will come next week. The major supply limitation relates to masks; 3-D printers can make the plastic visors. To be very clear, KHSC can afford all the PPE purchases we require, the issue is a global supply chain disruption. IPAC has developed a clear framework that lays out when and how escalating COVID-19 patient volumes would trigger changes to PPE practices and protocols. Stay tuned as the framework will be finalized and published this week. 

Professionalism: Here is a simple request from Dr Fitzpatrick and Mike McDonald, which I fully support.“Professionalism is critical for our teams to deliver the care that our community will need during the upcoming weeks or months of COVID-19 pandemic activity. We simply cannot afford lapses in professionalism at this important time. We are depending on everyone to play their part in keeping each other safe and healthy by respecting the screening process and using PPE responsibly.” 

I remind myself daily of the following as I address our current reality : “We are more often frightened than hurt; and we suffer more from imagination than from reality.”— Seneca (Roman philosopher & statesman).  

As a leader I am know that your trust must be earned. If I want you to follow our Departmental and hospital policies I need your trust and you must have confidence that I have your back. This was nicely put by the late Grace Hopper, a US Navy Rear admiral whose work led to the first computer languages, COBOL. I consider you all to be my colleagues and “crew”.

Photo of Rear Admiral Grace Hopper

So feel free to let me know how things are going and suggest ways that the DOM, in general, and I, in particular, can support you.

FAQ: Once a healthcare worker with COVID-19 recovers when can they return to work? Currently diagnostic testing by PCR is focused on diagnosis of new cases, rather than confirming a negative result in a recovered person. Viral shedding in COVID-19 infections lasts on average 8-10 days, although in some case this can be as long as 3 weeks. For now, return to work of COVID-19 infected health care workers will be determined case by case by Occupational Health.

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