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two nurses doing pushups

May 15, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Happy Nurses Week. In honor of nurses week the docs in the Department of Medicine donated a basket…thinking it would be distributed via some benign process like a draw! But-no, our nurses are too keen for such a passive process. Instead they engaged in a “Director’s push up challenge” (not sure if this is legal-LOL) and Kidd 10 nurses emerged triumphant. On a serious note: Thanks to all our nursing colleagues for their calm professionalism throughout the epidemic! You have provided great care for our mutual patients and make KHSC a great place to work!

photo of 3 nurses holding a gift basketphoto of 2 nurses doing push ups

Kidd 10 staff win basket donated by the DOM: Photographic evidence that there’s no free lunch (or basket either apparently)!

COVID-19 Update:  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. Our PPE supplyis stable with 3-4 weeks reserve, at current level of activity. Our low disease prevalence and incidence raises questions: When will we ramp up elective care? (Answer: soon but we await Ontario Health’s permission) When can we relax visitor restrictions? (Answer: not sure yet). Visitor restrictions have kept the hospital environment safe; but have been hard on our patients, who rely on family for comfort, decision making, and emotional support.

Three segments of my daily briefing 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 segments 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. 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 at KGH.

How’s the epidemic going? To date there have been 74,532 cases of COVID-19 and 5553 deaths in Canada (see below). The COVID-19 curve has flattened, with a decline in new daily cases/day (top right panel below).

graph showing the cases in Canada

The disease is most prevalent in Quebec (bar graph, above, left panel) and has not plateaued there. COVID-19 continues to disproportionately affect the elderly and particularly the frail and residents of 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 ~72% of all deaths from COVID-19! Senior care needs to top our government’s “Must Do” list as we build a better Canada post-pandemic.

chart showing COVID-19 cases in LTC vs public health

TestingWe have tested 3.37% of all Canadians (1,224,804 people). In Ontario we have tested 3.4% of the population (see graphic below).

Graph showing Canada tests vs positives

An update on serological (antibody) testing for COVID-19:  I had mentioned that the only approved for use in Canada is the Liaison Sars-Cov-2 S1/S2 IgG, assay. Apparently an Abbott ARCHITECT serologic machine is also available in our lab. It measures IgG and has a throughput of 100-200 tests/hour. This test is Health Canada approved but the reagents are not yet available in Canada (the joys of a pandemic). We are also acquiring a new instrument made by Euroimmun which measures both IgG and IgA antibodies and can run 20-30 tests per hour. It is FDA approved for clinical use and reagents available in Canada (but it is not yet approved by Health Canada).Special thanks for this new information to the KHSC lab and Dr. Yanping Gong, from the KHSC laboratory!

Let’s talk COVID-19 antibody testing: When infected by SARS-CoV-2 our bodies produce 3 major types of antibodies: IgG, IgM, and IgA. Classically IgM appears first and then we make IgG, providing long-lasting immune memory and protection form reinfection. Measuring these antibodies is called “serological testing”. Dr Huan Ma et al from the University of Science and Technology of China, Hefei, Anhui 230001, China have issued a pre-publication (still awaiting peer review) on the time course, sensitivity and specificity of the serologic response to COVID-19 infection (click here). They obtained blood from 87 COVID-19 patients and 483 negative control subjects. They tested the time course of all 3 antibodies. They also evaluated antibodies directed at two parts of the SARS-CoV-2 virus: 1) the nucleocapsid protein, which is the most abundant protein and thus is often used as a diagnostic marker and 2) the viruses’ RBD protein spike, which is the part of the virus that binds to the major host receptor ACE2, allowing it access to our cells.

They report several interesting findings. First the antibodies begin to appear only after 4-10 days (so this is not a replacement for the viral PCR diagnostic test). Second, they found that the sicker the patient the higher the antibody levels were (so it is some measure of disease severity). They also found that measuring both IgA and IgG antibodies gave the most sensitive and specific diagnostic results (see Table below).

Chart showing IgA and IgG antibodies outcomes

If you are a Medicine geek like me you might enjoy the graph below which show the time course of the best performing antibodies (those against the RBD spike)

show the time course of the best performing antibodies (those against the RBD spike)

In their cohort combined RBD-specific IgA and IgG kits had a sensitivity, specificity and overall agreement of 99·1%, 100%, and 99·7%, respectively. If confirmed, this IgG/IgA serological testing would be very useful test.

So in summary, serological tests are useful but are not yet locally available. They will be coming soon to KFL&A. They 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).

serological test symbol blue circle

To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The case total has risen to 4.594 million with 306,530 deaths.

chart showing global cases vs deaths vs recovered

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.

DOM foodbank drive poster

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.

TGIF!

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