May 12, 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 4.4% rate of test positivity for the province as a whole, a reminder that the prevalence and incidence of the disease remains low in KFL&A. There are no COVID-19 patients in KGH today although 6 people are being tested. We did 237 COVID-19 tests over the weekend and 7 tests all from Perth-Smith Falls. All tests from KFL&A were negative. Our PPE supply is stable with 3-4 weeks reserve, at current level of activity. We launched our new PPE dashboard.
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 COVID-19 pandemic”. It outlines the rules of the road for resumption of increased volumes of 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. 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: The COVID-19 epidemic continues to gradually ebb in Ontario and nationally. The COVID-19 curve has flattened, with a decline in new daily case numbers/day (see below).
There remain two important exceptions to the improvement in the epidemic. First, COVID-19 remains a huge problem in long term care facilities (LTC) (see today’s data below). Older people do much worse with COVID-19 than younger people, being more likely to be infected and, if infected, more likely to be hospitalized or die (especially once over 80 years of age).
Second, the incidence of COVID-19 varies markedly by region. To date there have been 70,342 cases of COVID-19 and 5049 deaths in Canada (see below).
Canada’s COVID-19 numbers are heavily influenced by the magnitude of the epidemic in Quebec. 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.
The epidemic also varies greatly in intensity 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). The Ontario case rate is 140.7/100,000 population with a total of 20,907 cases. Our region (KFL&A) has amongst the lowest rates of infection.
Testing: We have tested 3.18% of all Canadians (1,175,868 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 have been performed to date.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. This graph shows active cases of COVID-19 globally. This makes it clear that the first wave has largely resolved in China and is now hitting America with full force.
An interesting story: The USS Theodore Roosevelt .
In March 2020 this aircraft carrier captained by Brett Crozier was deployed in the Pacific ocean. On March 5th they made a 4 day port of call in Da Nang, Vietnam. Some sailors had stayed in a hotel where there had been cases of COVID-19. These sailors were quarantined and later tested negative. On March 22nd the first positive test was reported and infected sailors were quarantined on the ship and then evacuated to Guam. On March 26th the aircraft carrier was ordered back to Guam and docked there. The crew was restricted to the boat and pier. One week later Captain Crozier sent an email to 3 admirals requesting permission to: evacuate all non-essential sailors, quarantine known COVID-19 cases, and sanitize the ship. The letter was leaked and published in the San Francisco Chronicle.
Note Captain Crozier’s comments on the impossibility of quarantine on the ship and his assessment that sacrificing the lives of his sailors was unacceptable in times of peace. Good leader!
Within 2 weeks there were 100 infected sailors. By April 1st the ship was evacuated, except for a skeleton crew. By April 2nd Navy Secretary Modly relieved Crozier of his command, incorrectly justifying this by accusing Crozier of sending his letter “out of the chain of command”, which he had not. Modly then visited the ship on April 5th and made a harshly critical speech regarding the Captain to his troops over the Roosevelt’s PA system. He called Crozier’s request to dock and clean the ship a “betrayal”. His speech was leaked and by April 7th he had resigned.
So what of the Roosevelt’s crew?
By April 8th , 416 were tested positive and one was in ICU, having been found unconscious in his quarters. Still 2500 sailors remained on board.
By April 16th most of the ship was cleaned.
By April 20th most of the 4500 person crew was evacuated. There were 678 positive tests. The Navy began nonetheless to plan redeployment of the ship.
However, sailors continued to test positive and by May 5th 1,156 crew members, 26% of the crew, tested positive (see below).
Time course of the infection on the USS Theodore Roosevelt
So what is the message:
- In a confined space SARS-CoV2 will infect a substantial proportion of health young adults (25% in a month in this case).
- 50% of those who tested positive were asymptomatic
- Not all people become infected despite (almost certain) exposure, despite lack of PPE. Interestingly the Roosevelt’s crew had no PPE, apart from latex gloves and homemade masks.
- The incubation period for the infection was longer than the standard 2 weeks (which is the time we use for quarantine), with cases showing up 3-4 weeks after presumed exposure.
- The mortality rate in infected young, healthy adults was very low (1/1156 in this case).
- This is a case study in good leadership (and bad). Regarding Captain Crosier-Preparation for a principled stand should include a calculation of one’s willingness to be dismissed/punished (the principle here being that “No good deed goes unpunished”). He made the right call, did the right thing and hopefully will be reinstated. As for Secretary Modly, he yielded to Washington politics, did the wrong thing and was naive in believing the truth would not get out. For him a reminder that all controversial emails and speeches will eventually surface!
Postscript: On 24 April, Gilday and acting Navy secretary James McPherson recommended to Secretary Esper that Crozier be reinstated.
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 Department of Medicine will be organizing a Food Drive from May 11 – May 22nd to collect donations for the Partner’s in Mission Foodbank in Kingston.
As you are aware, many people in our community are facing very difficult times during this pandemic. Next time you are out doing your weekly grocery shop please consider picking up a few extra items to donate or check your cupboards to see what you might already have!
In Demand Items:
- Canned meat & fish
- Peanut butter, jam
- Stews, canned tomatoes
- Baby food, formula, diapers
- Rice & pasta
- Tea, coffee, sugar
- Money (your dollars contribute to higher purchasing power)
If you choose to donate, please drop off your items with the DOM admin team or your divisional admins before May 22nd!
Thank you for your support!