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May 26, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID-19 Update: There is little change in the fortunate situation in Kingston. There are no new cases of COVID-19 in our region today (see update from KFL&A Public Health). The testing rate of positivity in KFL&A is 0.6% (vs 4.2% in Ontario). We did 314 tests for SARS-CoV-2 yesterday. There were 2 positive tests, 1 from the Kawartha area and 1 from Perth Smith Falls but none locally. There are also no new cases of COVID-19 in KGH. The running total for the epidemic 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. 

Chart showing COVID-19 in the KFL&A area

Kingston remains in a bubble with a low incidence of COVID-19 (28.7 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 10 times higher (302.1 cases/100,000 population). This is a reminder that the realities of, and response to, the pandemic will vary by location (see map below). Nonetheless, as the graph below shows, the number of new cases is decreasing (i.e. the curve is flattening).

graph showing COVID-19 cases by episode date in Ontario

How’s the epidemic going? To date there have been 86,614 cases of COVID-19 and 6637 deaths in Canada (see below). There are currently 2347 hospitalized COVID-19 patients but only 343 patients are in intensive care units. Most cases of late are acquired from community contact, although, just outside the KFL&A in Leeds Grenville, most of the apparent community spread actually reflect infections in LTC residents. Nationally, the COVID-19 curve has flattened, with a decline in the number of new daily cases per day (see bar graph below, right). 

Chart and Graph Numbers of COVID-19 stats in Canada

COVID-19 continues to disproportionately affect the elderly and particularly the frail 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 ~72.4% of all deaths from COVID-19! 

Summary of LTC COVID-19 cases in ON Jan-May

Testing asymptomatic people by PCR: A follow-up note on the challenges of testing asymptomatic people from yesterday’s note. There are several reasons why a swab of a healthy person (and their healthy nose) has much less predictive value than a swab of a person with nasal congestion and an acute respiratory tract infection. First, when we swab people with symptoms we get genetic material back from the swab in ~99% of cases. In contrast, when we swab asymptomatic people, 6-7% of swabs have no material on them (and thus we can neither exclude nor confirm the presence of COVID-19. This reflects the lack of mucus and cellular debris arising from the swab of a healthy nose. If there is no genetic material the test cannot be done. A second problem with testing asymptomatic people is that the negative predictive value of the test is poor (~70%). The most common reason for this is that if someone has been infected with COVID-19 but has not yet developed symptoms the burden of virus in the nose may be very low and may not yet be detectable by the current assay (whereas in a day or two as the disease progresses they may become positive). Obviously these concerns don’t invalidate the need for more broad testing but they are important limitations of PCR testing and a reminder we will need serologic testing (to identify people who have recovered) in addition. We will also need the public to understand that a negative test in a healthy person is not as valuable or reliable as a negative test in a person who has symptoms.

Testing for SARS-CoV-2: We have tested 4.2 % of all Canadians (1,550,549 people) and are at the same rate of testing in Ontario (4.35%). The rate of testing remains low in Ontario of late because there are fewer people with respiratory tract infection symptoms of cough and fever (and thus there has been less call to be tested).

Graph showing tests performed vs positives in Canada

To see where Canada stands amongst nations in the COVID-19 pandemicclick here. The global case total has risen to 5,549,131 with 348,224 deaths. America still has more cases (1,671,728) than the next 9 most affect countries combined! Here is a list of the countries with over 100,000 reported cases of COVID-19.

List of confirmed cases by country/region deaths top 12alarm clock with smiley face

A revised reminder for people in the community 

1) People in the community can self-refer for assessment and possible testing. We are now on testing people for much broader indications (we are no longer requiring fever or travel as preconditions for testing). We are now testing people who have only 1 COVID-19-type symptom or who are concerned they have been exposed to the disease. KFL&A has also suggested that health care workers should be routinely and repeatedly surveyed by nasal swabs (discussed above). You can seek out testing at Memorial Centre in Kingston, (see instructions below). Here is a link to the self-assessment tool used to see if you should be tested (although I suspect it will be updated soon): click here. (last updated May 19th)

COVID-19 self assessment instructions

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.

Staff screening and your badge: KHSC is moving this week to a more passive mode of screening (similar to that used by Customs Canada). Staff will answer a panel of questions related to COVID-19 risk. If all answers are “no”, you can proceed into the building. You will only be interacting with an in person screener if you answer YES to one of the COVID-19 questions. For this to work you must have a functional bar code on your badge. If your bar code doesn’t work you need to get a new badge at security, which is free). The program is being rolled out gradually across the hospital this week.

Dr. Archer hospital badge

Your moment of Zen: COVID-19 has provoked changes to all our lives an periodic stress relievers are welcome. Here is a lovely photo from a friend, Mr. Ted Dyke. Enjoy his amazing photography!

photo of 2 birds sitting on long blades of grass

Stay well!

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