May 11, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: There are no new cases of COVID-19 in our region today. The running total for the epidemic thus remains 61 cases in the KFL&A region and all have recovered. The SARS-CoV2 positive test prevalence is 0.9% % in KFL&A. This contrasts with a 4.66% rate of test positivity for the province as a whole, a reminder of that the prevalence and incidence of the disease remains low in KFL&A. There are no COVID-19 patients in KGH today although 8 people are being tested. We did 642 COVID-19 tests over the weekend and 13 tests were positive most from Lindsay/Peterborough or Perth-Smith Falls, with 1 each from Belleville and Brockville. All tests from KFL&A were negative. Our PPE supply is stable with 3-4 weeks reserve, at current level of activity. We will launch a new PPE dashboard later today.
Care for the 99%: KFL&A has received communication from Matthew Anderson, President and CEO of Ontario Health entitled, “A Measured approach to planning for surgeries and procedures during the COVOD-19 pandemic”. It outlines the rules of the road for resumption of increased volumes of care, as we begin to ramp up elective care. However, this increase in activity will take several weeks to begin. Ramping up begins with provincial approval and is not something KHSC can undertake unilaterally. That said, our procedural volumes and general activity are increasing as we deal with an rising volumes of urgent and non-elective patient care.
A daily reminder for people in the community re COVID-19 testing and seeking health care in our hospitals: People in the community can self-refer for assessment and possible and testing. We are still focusing on testing symptomatic people (since the test for COVID-19 is likely not as specific in asymptomatic people) or people with confirmed COVID-19 contacts. There will soon be increased testing of certain vulnerable populations, stay tuned. If you are symptomatic with a new cough, fever, sore throat etc. please self-quarantine and seek out testing at Memorial Centre in Kingston, (see instructions below). Our hospitals and clinics are safe places to receive care (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). You should not delay accessing care that you or your doctor deem to be urgent.
How’s the epidemic going: influence of Quebec and LTC facilities on the morbidity and mortality The COVID-19 epidemic is beginning to relent in Ontario and nationally. Although the COVID-19 curve has flattened, with a decline in new daily case numbers/day (see below), there are remain two important caveats.
First, COVID-19 remains a huge problem in long term care facilities (LTC) and second, the distribution of the disease varies markedly by region. To date there have been 69,156 cases of COVID-19 and 4906 deaths in Canada (see below).
These numbers remain heavily influenced by the epidemic in Quebec (top line in graph below). Quebec accounts for 55% of all cases and 60% of all deaths in Canada, despite the province being only 22.5 % of Canada’s population. In Quebec and most of the country the majority of mortality is occurring in the elderly, especially those in LTC facilities and retirement homes.
The epidemic continues to vary greatly by region within Ontario. The highest rate of disease in Ontario is nearby, in Leeds/Grenville/Lanark (340+ cases) with Windsor being second in disease incidence (on a per capita basis). However numerically, most COVID-19 cases are in the Greater Toronto Area (see map below).
Myths and allegations regarding COVID-19 in young people: Although media attention is high whenever a child or young person is affected by COVID-19, it is worthwhile to realize this is uncommon.
There may be an increase in young children of a poorly understood, inflammatory condition involving the gut and blood vessels in the heart called Kawasaki disease. This condition is a rare vasculitis and usually improves spontaneously (in 75% of children). Kawasaki’s disease (which long predated COVID-19) is believed to be the result of inflammation caused by one or more viruses, so it makes sense COVID-19 could cause this. However, the actual incidence of COVID-19 associated Kawasaki’s disease is unknown. While vigilance is required this is not a common problem, despite the 4 million plus cases of COVID-19 globally.
Perspective about the risk faced by young people is important, not to deny parental concerns but to put the relative risk for children and school age children in perspective, as societies begin to reopen. Let’s look at the data to see the influence of age and sex on two very different aspects of the epidemic-infection vs death.
The graph above (which shows data for males and females) makes it clear that people over the age of 50 years are most often the folks infected. Infections are rare in children and teenagers. However, many young adults have become symptomatic and have been shown to be infected with SARS-CoV-2, both in Ontario (and globally). However, contrast this with the graph below, looking at deaths. A very different demographic picture emerges. The deaths are almost all in the those over 70 years of age, particularly those over age 80. Amongst younger people, COVID-19 death is extremely rare. Those younger adults most at risk of bad outcomes with COVID-19 often have pre-existing risk factors, such as obesity, hypertension and race.
Testing: We have tested 3.1% of all Canadians (1,144,650 people). We likely need to prepare for a future in which testing is recurrent and occurs in the entire population. If this is correct we will need to do 10-times more tests/day than we have achieved to date.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here.
However, I am showing a different graph today. This graph starly shows the difficult situation faced by our American neighbours. Although their epidemic began later than Europe, it is clear that despite political rhetoric the USA is in trouble. The rate of rise in COVID-19 cases after the first 10,000 cases had been identified is MUCH higher than in Europe’s worst hit countries (like Spain and Italy). This likely reflects public policy choices. Canada is not shown on this graph.
Capacity in KGH: KGH continues to have surge capacity (below). However, things are getting busier as more sick medicine (non-COVID-19) patients require hospitalization and more urgent procedures are performed in surgery, cardiology and interventional radiology. Note that we still have plenty of ventilators available. The dashboard shows testing results are pending for 8-9 patients in our hospital.
A reminder to all our DOM staff (physicians, residents, admins): you need to scan at KGH staff entrance upon first arrival at the hospital of each day (Watkins 2 or Connell 0). You can only be scanned at the Etherington link for subsequent access after first arrival. Thank you all for your cooperation. Be kind to our screeners, they are just doing their job and following policy!