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May 7, 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 and 57 people have already recovered. There is 1 COVID-19 patient in our region and they are an outpatient. The SARS-CoV2 positive test prevalence is 1.1% in KFL&A. This contrasts with a ~5 % rate of test positivity for the province as a whole, a reminder of our low local incidence. Thus, the prevalence and incidence of the disease remains low in KFL&A. There are no COVID-19 patients in KGH today although 6 people are being tested. We did 330 COVID-19 tests yesterday. There were 5 positive tests, with 3 of these being from Perth-Smith Falls and 2 from Lindsay/Peterborough. All tests from KFL&A were negative. In person visits at Hotel Dieu clinics are down by 75% (down from 30,000 visits to 10,000 visits in April), fortunately, telehealth has dramatically ramped up. This is a testimony to the innovative spirit of all involved with our telephone, OTN and REACTS initiatives. A special thanks to the KHSC IT team and our own experts, Drs. Apireddy and Srivastava, for supporting rapid expansion of these programs. Our PPE supply is stable with 3-4 weeks reserve at current level of activity and we will launch a new PPE dashboard, making stores readily visible to all next week.

Care for the 99%: KFL&A is better positioned than the rest of the province to ramp care back up once given permission by Ontario Health, likely later today. The approach will likely be based on regional resources, epidemiology etc. We are already slightly expanding our surgical and cardiac volumes to deal with urgent cases and to meet critical wait time metrics (again non elective care). This is being done with a close eye on PPE availability and mindful of limitations in follow-up and home care resources. As the ramp up occurs, we will be required to maintain adequate bed capacity for surges, as might be required when a second peak of disease occurs. Stay tuned for a date to commence a gradual ramp up that is customized to our regions local epidemiology, the status of COVID-19 in local LTC facilities and a hospital’s local supply chain. Once given the green light KHSC will implement its preparedness plan for the anticipated and necessary return to increased service for all patients, the 99% who do not have COVID-19 disease. 

alarm clock with smiley face

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.

community instructions for COVID-19 testing

How’s the epidemic going? The COVID-19 epidemic is beginning to relent in Ontario. Although the COVID-19 curve has flattened, with a decline in new daily case numbers, 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. 

To date there have been 63895 cases of COVID-19, up 1437 from yesterday and 4280 deaths in Canada, up 169 from yesterday (see below). Once again these numbers are heavily influenced by the epidemic in Quebec and by the mortality in nursing homes across the country. (click link for daily update). 

Canadian COVID-19 outbreak tracker

Note the flattening of Canada’s COVID-19 curve (orange line below); good news!

graph of Canadian covid-19 curve

Here are some Ontario data that I find helpful:

There have been 19,121 confirmed cases of COVID-19 in Ontario reported to date. This represents an increase of 399 confirmed cases from the previous report. 

It’s no surprise that COVID-19 is disproportionately affecting the elderly, especially those over 80-years of age. 43.7% of cases are 60 years of age and older.

graph showing COVID-19 deaths by age and sex in Ontario

The epidemic continues to vary greatly by region within Ontario. COVID-19 incidence remains high in Toronto and Ottawa. However, the highest rate of disease in Ontario is nearby, in Leeds/Grenville/Lanark with Windsor being second in disease incidence (on a per capita basis). However numerically, most COVID-19 cases are in the Greater Toronto Area 60.8% of all cases (see map below). 

Map of Ontario

Finally, it is noteworthy that the sex distribution in the disease has changed. Now there are more females than males infected. It may be that this relates to the fact that females live longer than males (in general) and thus disproportionately populate LTCs. Thus this may not be a gender preference by the virus; but the viruses clear preference for infecting the elderly, more of whom are female (see graph below). 

graph of COVID-19 cases by age and sex in Ontario

The graph below shows Ontario data. Ontario also shows a continued flattening of the COVID-19 curve with a decrease in the rate of accruing new active cases versus last week. This reflects the benefits of physical distancing, testing and closing of schools, daycares and non-essential businesses. Ontario is heading in the right direction.

graph showing Ontario COVID-19 data

Long term care facilities (LTC): The Ontario epidemic remains dire in LTC facilities. The ~77,000 residents of LTC facilities in Ontario continue to account for a hugely disproportionate disease burden 2831/19,121 (15% of COVID-19 cases) and 1111/1477 (75%) of COVID-19 deaths in Ontario (see Table below).

Chart showing Long term care cases vs public health

Testing: We have now tested 2.6% of all Ontario residents and, after a brief dip, the testing rate is again well over 10,000/day (see below). That said, we likely need to prepare for a future in which testing is recurrent and occurs in the entire population. If this is correct we will need to do 10-times more tests/day than we have ever achieved to date.

COVID-19 tests performed vs positive

To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3.86 million cases and over 266,213 deaths globally. There is however continuing evidence that the global incidence of COVID-19 is flattening (blue and gold graphs at bottom of Figure).

Global COVID-19 numbers cases vs deaths vs recovered

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 6-7 patients in our hospital.

KGH bed capacity

Stay well!

 

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