May 19, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: There is 1 new case of COVID-19 in our region today. This is a person returning from a higher prevalence area in Ontario and they are being managed as an outpatient. There are no new cases in KGH. The running total for the epidemic thus remains 62 cases in the KFL&A region and all have recovered. We did 254 tests/day at KHSC over the long weekend. Our SARS-CoV-2 test positivity rate is 0.7% in KFL&A vs 4.2% provincially. Our PPE supply is stable with 3-4 weeks reserve, at current level of activity.
Our low disease prevalence raises questions: When will we ramp up elective care? (Answer: we still await Ontario Health’s permission). The province has just this week commissioned a group to examine ramp up of ambulatory care. The first wave of ramp up is more focused on increasing elective procedures and surgeries. 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. The hospital is monitoring the impact of reducing accompanying people on the health and wellness of our patients.
While things continue to go well in Kingston, the landscape can change rapidly and we should not be complacent. Here is a reminder from Hamilton, Ontario. There has been a significant outbreak at the Rosslyn nursing home in Hamilton with 48 residents being infected. Fifty-two people at the 64-bed home have been transported to hospital (per St. Joseph's Healthcare Hamilton this Saturday). LTC facilities are often not properly designed, equipped or staffed to deal with infections. In many cases they lack adequate numbers of single rooms to permit isolation of sick residents and/or they are short of adequate PPE or staff. As you can imagine, this outbreak has put stress on Hamilton’s hospitals. Closer to home there have been new outbreaks of COVID-19 in nursing homes in Brockville. This wild card (infections in nursing homes) is one of the reasons why the provincial ramp-up policy requires us to maintain at least 15% bed vacancy to quickly deal with a large influx of infected patients. Today the Medicine service has 148/199 beds occupied (74%) so we have the capacity needed (for now).
Should Canada’s universities reopen in the fall?
There is an exciting plan afoot in the Faculty of Health Sciences at Queen’s University under the leadership of Dr. Stephen Vanner, with partnership from our Schools of Medicine, Nursing and Rehabilitation. This team intends to get these students back on campus through a program of repeated testing.
As I mentioned in an earlier note, it is likely that our future will see repeated testing of the population (for the virus by PCR) combined with serology (to determine who has been infected previously, and is thus immune) (click here). Visit Nobel Laureate Paul Romer’s site and see the animation he offers illustrating the predicted benefits of widespread testing. It is likely that with widespread and repeated testing the sick will be quarantined while the healthy can circulate with relative confidence in the safety of society.
Most Canadian Universities appear to be choosing to go virtual in the coming year. This will be unlikely to satisfy young learners who want an authentic, face to face experience on campus. This approach sounds safe and cautious, but is it? University age adults will be unlikely to stay sequestered in their parents homes for an entire year. It is likely that many will gradually become more adventurous as the first wave of COVID-19 wanes. They intuit that life involves risk but that the risk to them personally, as healthy young people, is relatively low.
This could be a great time for Universities to re-envision the campus experience, allowing on-site learning to continue. Imagine a campus where all residence rooms are single rooms and physical distancing is practiced. Imagine that those young people who can’t be accommodated in residence because of this are encouraged to rent in the community. Would they really be at higher risk to themselves or society than if they stayed home and undertook a virtual education?
Certainly there is diversity of opinion. Most of this disagreement is not based on the facts (which are fairly clear): 1) COVID-19 is sticking around for some time, 2) there is not enough testing material to test everyone, and 3) the economy cannot tolerate an indefinite stay at home/shelter in place policy. If one is timid and risk averse one may favour virtual everything; if one is cavalier its easy to channel the USA and open everything up. However, can one have the best of both? Could we reorganize our universities to deliver an optimal balance between quality and safety? Perhaps students could attend campus, with shifts of in-person classes alternating with on-line course (i.e. one day you’re in the class with physical distancing and the next you’re taking your turn on line). Imagine if we got each student to do daily fever checks and self-quarantine and be tested if febrile. Perhaps we could expand the experiment Dr. Vanner is championing and have more testing for students. I wonder whether students who want an in person university experience might not even be willing to co-pay for testing, an investment in their own health security? One way or the other, these young people exist and will progressively become more mobile within society. Arguably it would be better that they are at university, receiving education about COVID-19, and experiencing the benefits of improved housing and classroom practises, than that they remain frustrated at home, with the related financial and psychological consequences (and little evidence that their true risk of COVID-19 is reduced).
Is the idea of reopening universities crazy and reckless? I don’t think so (I speak now as a private citizen and physician, not for Queen’s University or for KHSC). Certainly some serious Universities, like Notre Dame University, are choosing to fully open in the fall. These schools are in locations with much higher disease prevalence than Queen’s, which for the moment is in a happy bubble, with low disease prevalence. The leaders of these schools are not ignorant of the risks nor are their heads in the sand. They recognize the risk but chose to accept and mitigate it. The Notre Dame principal equivalent, Rev John Jenkins, compared reopening the campus to “assembling a small city of people from many parts of the nation and the world, who may bring with them pathogens to which they have been exposed.” Here is a list a list of other schools that plan on opening this fall- it includes some fairly serious institutions, like Harvard University.
The decision to reopen for in person classes should of course reflect local epidemiology. However, if the local prevalence is low, then with attention to nonpharmacological interventions (students in shifts, single occupancy rooms and testing with quarantine of the sick) a return to something nearer normal is possible. Canadian society will need to accept that there will soon come a day when we collectively and individually need to balance risks and benefits of increased association. It is unlikely that there will be a COVID-19 vaccine in 1 year. It is also unlikely the disease will disappear, despite wishful thinking by some US presidents. Thus, society will need to balance the need for education of our young people and the restoration of commerce with a reduced, but non-zero, risk of localized COVID-19 outbreaks on campus.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The case total has risen to almost 5 million with 321998 deaths.
Pandemic pay: Frontline health care workers are awaiting news on when the province’s promised pandemic pay will show up in their paychecks. This is a government (not KHSC) administered program and we are still awaiting clarifications as to when the money will be delivered (and to whom).
Buy local! It has become a badge of honor to shop locally. Supporting our local restaurants and businesses not only makes you feel good, it also ensures that Kingston remains vibrant as we emerge form COVID-19’s 1st wave. The first business I featured was Coffee Way, and today there is a shout out to Melt & Grill.
However, in the interest of a balanced diet let me mention that Tony Deodato & Sons (locally owned & operated since 1923) a vendor of fresh fruits and veggies now delivers to your house Here is the link for on-line orders. Remember, if you eat your veggies you can have another donut!
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.
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 segment will reappear when new information arises. Suffice it to say we: a) will be ramping up our elective volume soon b) continue to perform community COVID-19 testing at the Memorial Centre and c) are confident that our hospitals and clinics are safe places to receive care.
How’s the epidemic going? To date there have been 78,072 cases of COVID-19 and 5842 deaths in Canada (see below). The COVID-19 curve has flattened, with a decline in new daily cases/day.
COVID-19 remains most prevalent in Quebec (bar graph, above, left lower 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 ~74% 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.
Testing: We have tested 3.7% of all Canadians (1,377,705 people). In Ontario we have tested 3.8% of the population, up 0.4% from last week (see graphic below).
If you badge barcode is not working it needs to be fixed to allow us to efficiently screen as you enter the facility. We will soon be testing an app to accelerate screening of staff and faculty. If your badge does not work please go to the Security office on Dietary 1 at KGH during daytime hours.
Random act of kindness: A “hot off the grill” thanks to the good folks at Melt & Grill (292 Princess Street, Kingston). They donated a truckload of grilled cheese sandwiches, macaroni salad and poutine for the docs and staff in the Department of Medicine. I would type more words of thanks but I am in a postprandial coma!