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May 22, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID-19 Update: No news is good news! There are no new cases of COVID-19 in our region today (see update from KFL&S Public Health)-see below. Testing rate of positivity in KFLA is 0.6% (vs 4.2% in Ontario). We did 268 tests SARS-CoV-2 yesterday. There were 5 positive tests, 4 from the Kawartha area and 1 from Perth Smith Falls. There are also no new cases of COVID-19 in KGH. The running total for the epidemic thus remains at 62 cases in the KFL&A region, with only 1 active, outpatient, case. Our PPE supply is stable with 3 weeks reserve, at the current level of activity. 

multiple graphs showing cases by dates and demographics

Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population), positioning us to carefully reopen the city and ramp up activity at KHSC and Queen’s University (read the blog if you’re interested in hearing more re Queen’s). In contrast Toronto has a rate almost 10 times higher (278.1 cases/100,000 population). This is a reminder that the realities of, and response to, the pandemic will vary by location (see map below).

Map of Ontario showing prevalence of cases in different areas

Care for the 99%

1) When will we ramp up elective care? (Answer: we still await Ontario Health’s permission). The first wave of ramp up (which we also await) has been focused on increasing elective procedures and surgeries. Once Ontario Health’s Directive 2 is lifted we are prepared to increase operating rooms at KGH and Hotel Dieu (to 9 and 5 rooms respectively) and to increase urgent endoscopy and cardiac catheterization volumes. We have modeled this to confirm that we have adequate PPE and bed capacity to deal with this increased case volume, while meeting the Ontario Health criteria for ramp up. We are now awaiting the Provincial and regional green light.

2) 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.

How’s the epidemic going? To date there have been 81,765 cases of COVID-19 and 6180 deaths in Canada (see below). There are currently 2585 hospitalized COVID-19 patients and only 351 (14%) are in intensive care units. Nonetheless Canada has a national shortage of drugs required for patients on ventilators (like propofol, succinyl choline etc). The COVID-19 curve has flattened, with a decline in new daily cases per day. This improved epidemiology justifies the gradual reopening of the economy in many provinces, including Ontario.

Canada map and graph showing cases vs recovered

COVID-19 remains most prevalent in Quebec, particularly in Montreal. Quebec, with 22% of the population, accounts for 45,495 cases and 3800/6180 (61.5%) deaths in Canada. 

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). There have been another 25 deaths in LTCs since yesterday in Ontario. 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! 

Chart showing cases in LTC vs public health

Testing: Testing is down. Why is that? Members of the public whowish to be tested you can do so at Memorial centre, largely independent of symptom status. The disconnect between the government’s position (more testing needed) and the fall in rate of testing, is complex. Many people who feel well have no desire to get tested., even though we are now willing to test people who are not classically symptomatic. People also remember that previously we only tested folks who had traveled or were symptomatic or in contact with a case. In addition, with spring weather improving there are fewer upper respiratory track infections in the community and so there are fewer symptomatic people who are worried about what might underlie their cough/fever etc. Here’s an interview on this subject with Dr. Gerald Evans, Chair of Infectious Diseases in the Department of Medicine and head of IPAC, it’s is worth a listen (click here).

Picture of Dr. Gerald Evans on Computer

We have tested 3.9% of all Canadians (1,443,443 people, see graphic below) and are at the same rate in Ontario (4.07%). As noted in earlier discussion, we need to be doing multiples of the current testing rate so we can safely move to the next phase of reopening Canada!

graph showing number tests performed in Canada

To see where Canada stands amongst nations in the COVID-19 pandemicclick here. The case total has risen above 5 million (5,128,492) with 333,489 deaths.

wold map showing prevalence of cases in each countryAlarm Clock with smiley face

A revised reminder for people in the community 

  1. People in the community can self-refer for assessment and possible and testing. We are now on testing people for much broader indications (we are no longer requiring fever or travel as preconditions for testing). You can seek out testing at Memorial Centre in Kingston, (see instructions below). There is now a self-assessment tool you should use to see if you should be tested: click here.
Instruction card for self assessment

The Community COVID-19 Assessment Centre is located at:
Kingston Memorial Centre (please use the well-marked main entrance) 
303 York Street, Kingston, Ontario 
Monday to Friday: 10:00 a.m. - 6:00 p.m.
Saturday and Sunday: 9:00 a.m. - 12:30 p.m.

      2. 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.

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 Food 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.

Non-random acts of kindness: We in the DOM admin team are so proud of our doctors, trainees and staff that we wanted to thank them for their incredible dedication through wave 1 of COVID-19. This week they all received a second round of mini hand sanitizers and two new pairs of scrubs! They also received the necessary e-visit equipment to help them provide virtual care!

picture of scrubs, hand sanitizer and person holding webcam

Masks, Masks & More Masks!
A huge thanks goes out to Dr. Elaine Petrof and her group of “Masqueraders” who have tirelessly created hand-made original cloth masks for each member of the Department of Medicine. These cloth masks have been donated to the DOM faculty and are meant for your personal use out in public!

surgical masks

TGIF!!!!

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