May 8, 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 60 people have already recovered. There is only1 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 that the prevalence and incidence of the disease remains low in KFL&A. There are no COVID-19 patients in KGH today although 8 people are being tested. We did 304 COVID-13 tests including 7 from Perth-Smith Falls, 3 from Lindsay/Peterborough and 1 from Brockville. All tests from KFL&A were negative. Our PPE supply is stable with 3-4 weeks reserve at current level of activity. We will launch a new PPE dashboard, making stores readily visible to all, next week.
Care for the 99%: KFL&A has now received communication from Matthew Anderson, President and CEO of Ontario Health entitled, “A Measured approach to planning for surgeries and procedures during the COVOD-19 pandemic”. It outlines the rules of the road for resumption of increased volumes of care, as we begin to ramp up after the provincially mandated March 15th cessation of elective care. Our ramp up plans will need to be reviewed on a weekly basis not only within KGH but also at regional tables to ensure equitable access to care. This is true for all hospitals across Ontario. Resumption of elective work requires we meet certain metrics, including having at least a 15% bed capacity (75 beds) free at all times, in case a COVID-19 surge. The elective procedural care should only occur using supported conventional beds (not beds in hallways). In addition, the PPE supply must be adequate, reflected by a 30 day reserve in the hospital at planned rates of utilization. Finally, resumption of more elective work requires the hospitals to have adequate staff capacity to deliver the care. We now have the green light KHSC will implement its preparedness plan for the return to increased service forall of our patients, the 99% who do not have COVID-19 disease. This reactivation or ramp up will begin in 1-2 weeks (an estimate), which is just in time. We are in a window between COVID-19 peaks 1 and 2 and we need to get this care down while we can.
Clinics-where good patient care begins: The past month or two has seen a major decline not only in procedures but equally importantly a decline in outpatient visits. The graph below shows the precipitous decline in our outpatient clinic visits at the Hotel Dieu site, from normal (27,780 visits/month in January with very few telephone visits and no video visits) to 15,812 visits in April, 75% of these visits are now virtual, mostly by telephone (green). In the DOM our video visits program is ramping up rapidly, using the REACTS and OTN platforms. While virtual visits are invaluable, they do not and cannot replace hands-on, face to face care for many of our sickest patients. Clinic volumes need to rise and while this must be done in a safe and orderly way…it must be done! An ethical and reasonable approach to the pandemic should not value COVID-19 patients over other patients. The patients I am seeing in person in my clinic are sick and need physical examination to guide their rapid investigation and treatment. I am sure this is true for my colleagues and their patients.
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.
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 64,922 cases of COVID-19 and 4408 deaths in Canada (see below). Once again these numbers are heavily influenced by the epidemic in Quebec (where there have been 54% of all cases and 60% of all deaths despite the province being only 22% of the population. In Quebec and most of the country the majority of mortality is occurring in the elderly, especially those in nursing homes and retirement homes. in (click link for daily update).
Note the continued flattening of Canada’s COVID-19 curve (orange line below); good news!
The epidemic continues to vary greatly by region within Ontario. 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).
Testing: Here are our national testing data, Testing is at an all-time high (33,410 tests performed yesterday). We have tested 2.82% of all Canadians (vs 2.63% of all Ontarians). 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 achieved to date.
To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3.97 million cases and over 273,792 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 surge capacity (below). However, things are getting busier as more sick medicine (non-COVID-19) patients require hospitalization. Our apparent surplus reflects some empty beds that cannot be used for adult COVID-19 patients should they appear (e.g. pediatrics, ob-gyn etc.). We may need to parse out those beds that are truly available for non-hallway care of adult COVID patients (who require isolation). We will need to keep 15% of conventional beds free to be allowed to ramp up elective work. Note that we still have plenty of ventilators available. The dashboard shows testing results are pending for 8-9 patients in our hospital.
A reminder to all our DOM staff (physicians, residents, admins): you need to scan at KGH staff entrance upon first arrival at the hospital of each day (Watkins 2 or Connell 0). You can only be scanned at the Etherington link for subsequent access after first arrival. Thank you all for your cooperation. Be kind to our screeners, they are just doing their job and following policy!
TGIF: To my many friends and colleagues who are getting a little tired of COVID-19 24/7 and those who are worried about their health, their family, their finances (and the return of hockey!!!)…here is some advice from Mr. Churchill, which I endorse:
So have a good weekend and “keep on going”. We will get through this together!