May 4, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
COVID-19 Update: 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. The SARS-CoV2 positive test prevalence is 1.3% (1.3% of all local tests were positive). Thus, the prevalence and incidence of the disease remains low in KFL&A. There are no COVID-19 patients in KGH today. We did 883 COVID-19 tests from Friday to Sunday. There were 21 positive tests, with 12 of these being from Perth-Smith falls, 8 from the Peterborough-Haliburton area and 1 from Belleville. All tests from KFL&A were negative. PPE supply continues to improve but we are still committed to reprocess PPE to ensure a solid supply chain as we look to ramp up care volumes. We have continued to be successful with decanting ALC patients to partner facilities. There are currently ~ 38 ALC people in KHSC today. This leaves KHSC with excellent surge capacity should it be needed for COVID-19 cases.
How’s the epidemic going? It depends on where you are! The COVID-19 epidemic is beginning to relent in Ontario. Although the COVID-19 curve has flattened in Ontario, with a decline in daily cases numbers (see orange bar graph below), there are at least two important caveats.
First, COVID-19 remains a huge problem in long term care facilities (LTC) and second, the distribution of the disease varies markedly by region.
First, the impact on LTC residents: This table summarizes the impact of COVID-19 disease in LTC facilities in Ontario (up to date as of yesterday).
The 2751 active cases and 972 deaths that have occurred in LTC homes constitute a huge percentage of all disease prevalence and mortality burden in Ontario. In the entire province there are 4332 active COVID-19 cases in total and there have been 1216 deaths. Nursing home and LTC residents account for 64% of all cases and 80% of all deaths. I believe there are ~78,000 LTC beds in Ontario (people at risk) versus the provincial population of 14.57million. This means that although LTC residents account for less than 0.5% of the population they account for 80% of all COVID-19 deaths.
I discussed why COVID-19 spreads so readily in our LTCs on Friday. In addition to this, the high comorbidity burden of LTC residents is a major reason for the lethality of infections in residents of these facilities. Here are the comorbidities of people in Ontario’s LTC facilities?
- 90% have some form of cognitive impairment
- 86% of residents need extensive help with daily activities such as getting out of bed, eating, or toileting
- 80% have neurological diseases
- 76% have heart/circulation diseases
- 64% have a diagnosis of dementia
- 62% have musculoskeletal diseases such as arthritis and osteoporosis
- 61% take 10 or more prescription medications
- 40% need monitoring for an acute medical condition
- 21% have experienced a stroke
The second caveat to our otherwise improving situation in Ontario is the great regional variation in disease activity (see map below). While there is little community COVID-19 in KFL&A, this is not the case in an around Toronto and Ottawa (see map below). This information may guide your travel plans. It is also a challenge for the province, as we begin to plan ramping up the health care system while some regions (including our two largest cities) are still in the midst of outbreaks.
Care for the 99%: KHSC has a preparedness plan for the anticipated and necessary return to increased service for all patients, the 99% who do not have COVID-19 disease. We await permission from Ontario Health as to when/how to ramp up the system. This will be based on local/regional conditions, including: local epidemiology, the status of COVID-19 in local LTC facilities and a hospital’s local supply chain. Based on these three criteria, KHSC should be ready to begin a gradual ramp up as soon as we receive the green light from Ontario Health. On a positive note, our PPE availability is the best it has been since the epidemic began.
A daily reminder for people in the community re COVID-19 testing and seeking health care in our hospitals: People in the community can self-refer for assessment and possible and testing. We are still focusing on testing symptomatic people (since the test for COVID-19 is likely not as specific in asymptomatic people) or people with confirmed COVID-19 contacts. There will soon be increased testing of certain vulnerable populations, stay tuned. If you are symptomatic with a new cough, fever, sore throat etc. please self-quarantine and seek out testing at Memorial Centre in Kingston, (see instructions below).
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.
Understanding an epidemic requires good data: To date there have been 59,474 cases of COVID-19 and 3682 deaths in Canada. Once again these numbers are heavily influenced by the epidemic in Quebec (more on this below) and by the mortality in nursing homes across the country. (click link for daily update). Aggregate data (below) from ministries of health, show the ongoing impact on COVID-19, with 30,871 active cases and 2958 hospitalized people, including 501 in intensive care units. So, while we are heading in the right direction… it’s not over yet!
The graph below offers a more granular view of the national data. Quebec remains the epicentre of the epidemic with half the cases and more than half the deaths (top left). In the top right panel it appears that the number of cases/day has apparently risen abruptly! This relates to both increased testing and more importantly to the one time correction of reporting error in Quebec.
The special case of Quebec: Adding a month’s worth of missing data back to the public record: Note the hug spike in reported ( orange) and active (red) cases on the bar graphs above. Your first thought might be, &*&*%^$%!!! I thought the epidemic was resolving, what is this! In short this is what happens when the Quebec government made a one-time correction for computer error that resulted in 1,317 missing positive COVID-19 cases between April 2-30. This was combined with an announcement of crease of 892 new COVID-19 from Saturday.
This new, more accurate snapshot of COVID-19 in Quebec is concerning since Premier Francois Legault has announced May 11 as reopening day for schools and daycares (outside Montreal, with Montreal to follow by May 19th). Stores will also open by mid-May. Ideally one wants to reopen these public spaces, with maintained physical distancing, only when new cases numbers and hospitalizations are declining or absent. So while the spike in Quebec is to some extent correction for poor data management, the reality remains very concerning, particularly as borders are just imaginary lines, which do not constrain the flow of viruses.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3.6 million cases and over 250,277 deaths globally. There is however continuing evidence that the global incidence of COVID-19 is flattening (blue and gold graphs at bottom of Figure).
Capacity in KGH: KGH continues to have good surge capacity (below). Note that we still have plenty of ventilators and beds available. The dashboard shows testing results are pending for 3-4 patients in our hospital.