May 14, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: Happy Nurses Week. Thanks to all our nursing colleagues for their calm professionalism throughout the epidemic! You have provided great care for our mutual patients and through your dedication make KHSC a great place to work!
Connell 10 staff in their stylish T-shirts
As for the past 2 weeks 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 0.8% % in KFL&A. This contrasts with a 4.6% rate of test positivity for Ontario as a whole. There are no COVID-19 patients in KGH today although 4 people are being tested. We did 281 COVID-19 tests yesterday and 5 tests were positive, 2 from Lindsay and 3 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. Our low disease prevalence and incidence raises questions: When we will ramp up elective care? (Answer: soon but we await Ontario Health’s permission) When we can relax visitor restrictions? (Answer: not sure yet). Visitor restrictions have kept the hospital environment safe; but are hard on our patients, who rely on family for comfort, decision making, and emotional support.
Three segments are on hiatus to avoid repetition: Care for the 99%, Capacity at KGH, and A daily reminder for people in the community re COVID-19 testing and the safety of accessing the hospital. These 3 segment will reappear when new information arises. Suffice it to say we will be ramping up our elective volume soon. In addition, community COVID-19 testing continues to be done at the Memorial Centre. Our hospitals and clinics are safe places to receive care. I was in clinic yesterday and all is well! Currently we are focused on providing urgent care that cannot be postponed. Finally, although inpatient services and the Emergency Dept are getting busier (as illness accumulates in the community) we still have plenty of ventilators and adequate bed capacity available.
How’s the epidemic going? To date there have been 72,538 cases of COVID-19 and 5337 deaths in Canada (see below). The COVID-19 curve has flattened, with a decline in new daily case numbers/day (top right panel below).
The disease is most entrenched in Quebec (bar graph, above, left panel) and the disease there has not plateaued. Why Quebec is most heavily affected? Part of the answer is that their spring break was earlier than in Ontario and unidentified cases were returning to the province in large numbers prior to effective travel restrictions. I suspect other factors, relating to the governance and public health systems in Quebec, are also relevant. To see the impact of travel check out the chord diagrams (below). They show where individuals came from, prior to being confirmed to have the virus in their place of residence. This reminds us that SARS-CoV2 is being spread by people travelling in airplanes and boats around the globe.
These busy graphs show the deluge of cases from foreign and domestic travellers to Montreal (top graph-below). The influx of infected travellers to Montréal was far greater than for Toronto. The bottom graphs also highlight the relatively low volume of travel into Eastern Ontario, which likely has protected Kingston and KFL&A. I’m not sure whether Quebecers travel more than do Ontarians but a survey by Development Counsellors International (DCI) in 2018 showed that Canadians in general travel a lot. 67% of Canadians (vs 41% of Americans) have passports. This survey showed that Quebecers were more likely to have gone on romantic getaways (24 per cent) and multi-generational trips (10.5 per cent) versus the overall population.
Where did infected people in Montréal originate? (i.e. where did they contract COVID-19)
Where did infected people in Toronto originate? (i.e. where did they contract COVID-19)
Where did infected people in Eastern Ontario originate? (i.e. where did they contract COVID-19)
These data raise two other points. First, we are expecting a second peak in COVID-19 and it too will likely be driven in part by travel. Thus, it will likely not be safe to fully reopen the US border until their epidemic is controlled. I say this with sadness, having 2 of my children and half my friends living in the USA. Second, it shows there is no scientific basis for Quebec leading the country in reopening. Quebec is arguably least well positioned to reverse its physical distancing policies.
In addition to Quebec’s unique situation there are two other important exceptions to the general improvement in the epidemic in Canada.
First, COVID-19 remains a huge problem in long term care facilities (LTC) (see today’s data below). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they account for 723% of all deaths from COVID-19! Senior care needs to top our government’s “Must Do” list as we build a post-pandemic Canada 2.0!
Second, the incidence of COVID-19 varies markedly by region (low locally; high in Toronto). The Ontario case rate is 144.6 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). Toronto is most affected, numerically and per capita, (7215 cases and 231.2 cases/100,000 population, click to see map).
Testing: We have tested 3.3% of all Canadians (1,224,804 people). In Ontario we are on roughly the same pace, having tested 3.4% of the population (see graphic below).
An update on the first serological test approved for use in Canada, the Liaison Sars-Cov-2 S1/S2 IgG, assay.
1) This is not a test for acute diagnosis (rather it tells us who is recovered from COVID-19).
2) At the moment the reagents to perform this test are not available in Canada.
3) Tests like this may ultimately be useful in demonstrating who is immune from reinfection and help us rationalize the return of people to work in a safe but accelerated manner (i.e. if you’re immune based on a serologic test you can likely return safely to work).
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The case total has risen to 4.387 million with 298,392 deaths.
This graph shows active cases of COVID-19 globally (yellow circles proportional to number of cases per capita-middle panel). This makes it clear that the first wave has largely plateaued (see log curve of cases in bottom right); however, as discussed yesterday, this varies by country with the USA being far from its plateau!
The Department of Medicine is organizing a Food Drive from May 11 – May 22nd to collect donations for the Partner’s in Mission Foodbank in Kingston.
Please consider picking up a few extra items to donate or check your cupboards to see what you might already have! Money is also welcome! If you choose to donate, please drop off your items with the DOM admin team or your divisional admins before May 22nd! We welcome contributions from folks who are not officially part of the DOM.