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May 29, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

COVID-19 Update: There is no change in the fortunate situation in the Kingston, Frontenac Lennox and Addington (KFL&A) region. There are no new cases of COVID-19 today (see update from KFL&A Public Health). The positive test rate in KFL&A remains at 0.6% (vs 4.1% in Ontario), see below. The running total for the epidemic remains at 62 COVID-19 cases in the KFL&A region and all infected people have now recovered. Our PPE supply is stable with 3 weeks reserve, at the current level of activity. 

chart showing cover-19 cases in KFL&A&a region

How’s the epidemic going? To date there have been 88,856 cases of COVID-19 and 6918 deaths in Canada (see below). Nationally, the COVID-19 curve has flattened, with a decline in the number of new cases (see bar graph below, right). Also, the disease remains most prevalent in Quebec (below left), with almost half the burden of disease in all of Canada in this one province.

map of Canada showing prevalence of cases per province

To Travel or not to travel? It used to be if you wanted to travel you would consult a map and a travel agent. Now you probably talk to an epidemiologist and consult a COVID-19 website. I’m not a travel agent nor am I an epidemiologists (married to one though). Nonetheless I do get quite a few travel questions as we enter phase 2 of the COVID-19 pandemic. Here are two such questions: one between provinces, the other pertaining to travel within Ontario.

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Question 1: A Kingstonian asked me whether it is safer to visit Calgary Alberta or Montreal, Quebec. People are also asking for risk guidance on visiting other cities within a province. Let me share my approach to decision making acknowledging that there is not always a simple answer. Not only does the importance of the trip and the means of travel vary but local jurisdictions may have imposed travel restrictions (i.e. some borders are closed for tourist travel, such as is the case for PEI). Moreover, it depends on how you travel (your own car being likely a lower risk conveyance than some form of mass transportation). The answer may even depend on which direction you are going and how long you plan to stay. If you are traveling between low prevalence areas direction may not matter. However if you are going from Kingston to Montreal you may bring little risk to your hosts (but the same cannot be said if you wish to return to Kingston). 

Here are three pieces of data that shaped my answer to the Kingstonian asking about travel to Calgary vs Montreal. 

  1. First some basic population facts: Ontario accounts for 38.8% of Canada’s 37.6 million people; compare this population with Quebec (21.8%) and Alberta (11.6%).
  2. Next some COVID-19 burden data: Ontario accounts for 30% of all COVID-19 cases in Canada while Quebec accounts for 56% of cases and virtually half the Quebec cases are in Montreal. Alberta has 7.8% of all Canadian COVID-19 cases and 69% of their cases are in Calgary; however, that’s only 518 ACTIVE cases) (see below). So Montreal has a high prevalence and Calgary has a lower prevalence.
chart showing cases in Alberta

Finally l look at how the epidemic is evolving by location: For this assessment please focus on the orange trend line in each of the graphs below. It shows the total number of active cases. First we see that in Ontario-the orange line shows flattening of the curve, which is reassuring.

graph showing COVID-19 Trends in Ontario

Ontario COVID-19 trends

The graphic below shows Quebec. Note active cases continue to rise-which is concerning!

graph showing COVID-19 trends in Quebec

Quebec COVID-19 trends

What of Alberta? Clearly the number of new cases is in decline, which is reassuring.

graph showing COVID-19 trends in Alberta

Alberta COVID-19 trends

So what was my answer? I said it was safe for my heathy, young, asymptomatic friend to visit Alberta via airplane and visit their healthy family. Whether to self-quarantine upon return is warranted is a gray zone and may depend on the people encountered enroute.

Question 2: I was asked whether its safe to visit Toronto from Kingston? The logic behind my answer is the same and has nothing to do with arbitrary provincial borders, its shaped by disease prevalence. 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 (317.5 cases/100,000 population) and this rate continues to increase daily (see below). 

So the answer I would give is that it depends on direction and purpose and duration of stay. If you are leaving Kingston to go and stay in Toronto you likely get a qualified green light. You are going from a city with no active cases to a city with a 10-fold higher prevalence. You may be taking a personal risk but provided you stay put in Toronto you are neither putting people in Kingston or Toronto at increased risk. Obviously, the answers different if you are planning to return to Kingston! Likewise, if you are in Toronto and want to come to Kingston and are asymptomatic, that may be fine but you should consider 14 days of self-quarantine (this is not public health policy but may be prudent). Ideally this trip would be delayed until Toronto’s epidemic resolves. In general, back and forth travel between Toronto and Kingston is not a good idea at the moment and if elective should wait a downward trend on Toronto’s disease prevalence.

Map of GTA area with colour coded areas of COVID-19

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! There were 34 deaths since yesterday in Ontario LTCs. 

chart showing COVID-19 cases in LTC Jan-May

Testing for SARS-CoV-2: We have tested 4.42 % of all Canadians (1,631,793 people) and are at approximately the same rate of testing in Ontario. The rate of testing remains lower of late because there are fewer people with respiratory tract infection symptoms of cough and fever (and thus there has been less patient request to be tested). We are also beginning to struggle once again with limited supply chain depth and certain materials are in short supply (which will make it hard to meet the province’s goal of increased testing of asymptomatic people). 

graph showing tests performed vs positives

To see where Canada stands amongst nations in the COVID-19 pandemicclick here. The global case total has been revised down slightly to 5,867,727 and the number of deaths revised down to 362,238 deaths. Here is a list of the most affected countries. I dipped down below the 100,000 threshold to include Canada. The data remind us we have nothing to fell smug about. We have exceeded the deaths reported in China’s outbreak.

charts rating by country/region confirmed COVID-19 deaths alarm clock with smiley face

A revised reminder for people in the community (last updated May 27th)

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

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.

TGIF

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