May 13, 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 (stable X 2 weeks) The SARS-CoV2 positive test prevalence is 0.8% % in KFL&A. This contrasts with a 4.7% rate of test positivity for Ontario 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 4 people are being tested. We did 346 COVID-19 tests and 4 tests were positive, 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.
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 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 nationally. The COVID-19 curve has flattened, with a decline in new daily case numbers/day (see below). To date there have been 71,57 cases of COVID-19 and 5169 deaths in Canada (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). Residents of Ontario’s LTC facilities are <0.5% of the population but account for 72% of all deaths from COVID-19!
Second, the incidence of COVID-19 varies markedly by region. The Ontario case rate is 142.9 cases/100,000 population with a total of 20,907 cases. Our region (KFL&A) has amongst the lowest rates of infection (28.2 cases/100,000 population). One of the highest rate of disease in Ontario is nearby, in Leeds/Grenville/Lanark (189 cases/100,000 population = 328 cases) with Windsor being second in disease incidence (172 cases/100,000 people). However numerically and per capita most COVID-19 cases are in the Greater Toronto Area (7170 cases and 229.8 cases/100,000 population, see map below).
Testing: We have tested 3.2% of all Canadians (1,195,890 people). In Ontario (see graphic below) we are on roughly the same pace, although COVID-19 testing rates have fallen off in the past 2 days. 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. In addition we will need to do antibody tests (serological tests) to see who has been infected (and who may be immune). To date, Health Canada has approved 18 COVID-19 diagnostic testing devices (see Health Canada's website) This list includes many nucleic acid-based tests, which are used to diagnose an active infection. Yesterday the first serological test was approved. It is the Liaison Sars-Cov-2 S1/S2 IgG, Liaison Control Sars-Cov-2 S1/S2 IgG assay. This graph (from their website) shows how antibody tests become positive only ~2 weeks into the infection-during convalescence (recovery)). It is likely, but unproven, that IgG antibodies confer immunity. It remains to be seen how this assay performs when it is rolled out for use in the community!
COVID-19 testing in Ontario
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 plateaued; however, as discussed yesterday, this varies by country with the USA being far from a plateau!
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.
We are not all in the same boat: Below is a blog that Dr Jennifer Flemming (gastroenterology) wrote, highlighting the challenges women face during the COVID-19 pandemic. Women in Medicine are trying to combine their formal employment with a so called “second shift” at home, at a time when support systems have collapsed (click here). This can create stress, guilt and fatigue and often impairs academic productivity. As a male, these are challenges I did not fully appreciate. I am planning on writing a follow-up piece which focuses on female staff. I hope this blog gives you pause for thought (as it did for me).
Eutopia for realists-thinking beyond foodbanks: When I published the call for foodbank support yesterday I received a thoughtful note from Dr. Elaine Power in Kinesiology. She is an expert in food security (see her article in The Conversation Canada-click link). She reminded me that while supporting the foodbank now, we should work toward a future where food security is more a right or at least an expectation for all people, making reliance on foodbanks less critical. After talking with her by email I did some reading. I learned that13% of people in the KFL&A have food insecurity (see graphic below and imagine you earn the minimum wage and have 2 children). Your family would not have money to buy the food they need without making other sacrifices in vital areas, like housing. The cost of food for a family in our area is $955 per month. So when you think about donating and wonder if it will be meaningful…be assured it will be (although I agree with Dr. Power, we do need a better long-term solution).
In other words foodbanks are to food insecurity what parachutes are to airplane safety; great for emergencies but not part of a normal flight (hopefully).
With this in mind here is a book you might enjoy:
This book makes a good argument for a living wage. Perhaps in the aftermath of COVID-19 Canada could continue the Canada Emergency Response Benefit (CERB) as the source for a living wage, ultimately making food banks less necessary, since people would have money and with money they would have choice. However, for now, for today, your foodbank donation would be appreciated and would help people in our community. Some of you will already have given to the foodbank, which is amazing; however, giving via the DOM, is a statement of our Departmental values, including altruism. Whether you are a physician, technician, administrative staff or nurse, I believe a donation like this is something we will all be proud of when this pandemic ends.
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.
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, cereal, 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! Since we published the call yesterday we have received overwhelmingly positive feedback on this initiative! Even if you’re not from the DOM, feel free to join us!!!
Thank you for your support!