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men wearing masks walking past hospital building

November 2, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) Improved KHSC capacity: Resuming elective admissions effective today

2) Expedited COVID-19 testing for the children of health care staff and faculty at Beechgrove Community testing center began today

3) Increased outbreaks and deaths in Long Term Care facilities (LTC) 

4) COVID-19 volumes remain stable in KFL&A (see update from KFL& A Public Health). 

5) The second wave of COVID-19 accelerates in Ontario with our first day over 1000 new cases (click here

6) Join us for KHSC Open Forum: Nov 5th- staff and faculty can attend on-line to hear from Dr. Pichora and the leadership team: 1200 to 1300.

7) Good news story: KHSC receives $20 million in supplemental COVID-19 funding for new beds and elective surgery!

1) Improved KHSC capacity: Resuming elective admissions.

Kingston General Hospital (KGH) is slightly less full than last week, with 90 available beds vs 67 last Thursday and only 38 available beds last Monday. Elective work was briefly on hold at KHSC. Because there is now some capacity in the medicine program we will resume elective admissions. 

bed capacity at KHSC

Elective clinical outpatient work continues and I urge colleagues to see patients in person that require face to face visits (it remains safe to do so). When in person visits are not possible we offer video visits (using REACTS and OTN), telephone visits and e-consults (using our asynchronous, online consultation for family doctors). Both elective admissions and elective clinic visits could be put on hold if COVID-19 flares, so let’s make hay while the sun shines!

photo of sun rays in a hay field

Use the Mobile Screening Tool: Complete the COVID-19 pre-screening tool here and you will be able to “skip the line”: One way to safely expedite entry of patients into our facilities is to have all patients complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility for everyone.Reducing lines waiting to enter the clinics will be particularly important as colder weather arrives. The mobile screening tool only takes a few minutes to complete and you will receive an email with confirmation to bring with you, along with your appointment slip, in printed form or on your mobile device.

screen shot of KHSC mobile device

Screening staff will validate the confirmation at entry and you will be able to go directly to your appointment. This mobile screening must be completed a maximum of four hours before your appointment. If the screening confirmation expires, you will need to re-do the mobile screening or be screened in person (by a screener) when you arrive. With the exception of caregivers for children, this mobile screening tool is for patients only and does not give family members or caregivers an option to pre-screen because we must continue to restrict family presence for outpatients at KHSC in order to maintain physical distancing. To complete the mobile-screening in English, click here and in French, click here.

2) COVID-19 testing for the children of health care staff and faculty will be expedited at Beechgrove Community testing center beginning today.

picture of how a nasal swab covid test worksphoto of three young boys dressed up like doctors

Testing for the community has been done at Beechgrove for many weeks now. This testing is running very smoothly because it is done by appointment and we have amazing staff . Consequently, we began testing staff at Beechgrove instead of Hotel Dieu, effective today. 

Because health care workers (doctors and staff) are increasingly having to miss work because their children have been sent home from school or daycare with symptoms of a upper respiratory tract infection, we have arranged that their children will (effective Monday) be able to access expedited testing at Beechgrove . The goal of this new program is simply to allow the healthcare worker to return to work as quickly as possible for the public good. The children of staff will be tested between 1230 -1300 by appointment, 7 days/week. The new program for families applies to children up to age 18, an includes children of staff and physicians who provide clinical care and service. Staff and physicians themselves should contact occupational health to book their testing appointment. To book an appointment for a child, KHSC staff should call 613-548-2376. Testing of clinical staff and faculty and their children is processed at the KHSC lab with an average turnaround time of less than 24 hours. Great job team KHSC!!!

3) Increased outbreaks and deaths in Long Term Care facilities (LTC) safer are simple and cannot accidently incarcerate LTC residents: We have 4060 LTC beds in KFL&A. As discussed in many prior notes, most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and long term care facilities (LTC). As of today, the 1959 deaths in nursing homes (up 1938 last Thursday) account for 63% of all deaths in Ontario, click here

table of covid-19 data to date at LTC

LTC deaths in Ontario up to Nov 2nd, 2020

In the last 3 weeks the rate of death amongst LTC residents has once again begun to increase and there are 3 local nursing home outbreaks (which is defined as a single case) including: Chartwell Wedgewood retirement center in Brockville (click here), the Fairmont nursing home (click here) and the Helen Henderson LTC (click here). A reminder-outbreaks in nursing homes start with a person in the community (health worker or family) acquiring the infection in the community and importing it into the facility. Protecting LTCs is best done with a combination of reducing community spread of COVID-19 and ensuring single occupancy rooms in LTCs (as well as appropriate pay for PWS workers, provision of PPE and rapid testing capacity).

4) COVID volumes remain stabe in KFL&A: There have been 2 new COVID-19 cases in our region since my note last Thursday. The total number of cases since the pandemic began is now 184. Currently there are 2 active cases locally (up 2 since my note last Thursday). All local COVID-19 patients are recovering in the community (see update from KFL& A Public Health). There are no hospitalized patients at KGH. Between the hospital and the community testing center at Beechgrove we are averaging between 500-600 test per day (upper graph is total, including KHSC; lower graph is just at community evaluation centers).

2 graphs showing covid-19 tests completed and patients swabbed

The KHSC lab did 1336 tests over the last 4 days; 2 was positive (from Perth-Smith Falls). In terms of nearby active cases, there are 7 cases in Hasting-Prince Edward County and 22 cases in Lanark Leeds Grenville county, mostly in the north, close to Ottawa. This is highly relevant, since we are the tertiary care medical center for these areas. 

5) The second wave of COVID-19 in Ontario now exceeds the 1st wave with positive test rate at new high of 4% (and it has not begun to plateau): There have been a total of 77,655, diagnosed cases since the pandemic reached Ontario, up over 4000 cases from last Thursday.. We had 948 new cases since yesterday (click here). There have been with 6040 hospitalizations, and 3152 deaths in Ontario, since the pandemic began (up 7.8% and 4.1% since yesterday, respectively). The rate of positive SARS-CoV-2 tests in Ontario has increased to a new high of 4.0%!

This provincial rate (522.4/100,000 population) has doubled in the past month and is now 6X higher than in KFL&A (84.1 cases/100,000 population). Toronto remains Ontario’s hotspot for COVID-19 (882.8 cases/100,000 population, up from 711 one week ago), a rate 10 times higher than Kingston. Ottawa is also a hot spot at 681.6 cases/100,000 population (click here). Despite 3 weeks of increased provincial restrictions, wave 2 has not begun to plateau.

The majority of infections in Ontario are in young adults age 20-29. While most cases are in people under 60 year of age, almost all deaths are in people over the age of 60 years, on left (click here). Deaths and hospitalizations have begun to increase in wave 2 -on right (See below). 

graphs showing active resolved and deaths by agegraph of covid-19 related hospitalizations

Cases in the young/deaths in the old (upper); Increases in hospitalizations and deaths in Ontario’s second wave of COVID-19 Oct 29th (above)

What we should do in wave 2 of the COVID-19 pandemic. To address wave 2 we must acknowledge the one constant to our lives will be change. When and where the pandemic flares we will need to respond with local intensification of public health measures. This challenges us to think globally but act locally. We should:

  1. Use good public health practices: handwashing, physical distancing, use of masks in all indoor venues when physical distancing not possible
  2. Prioritize who we test and ensure rapid availability of test results. Turnaround times for COVID-19 test results that exceed 24 hours make case management difficult.
  3. Focus on testing and educating key demographics who tend to get infected (young adults, migrant workers, low income neighborhoods) 
  4. Continue to respect our social bubbles and avoid socializing in large groups
  5. Protect our essential workers, including health care workers, so they can protect society). 
  6. Fact check and have skepticism about media stories that offer sensationalistic perspectives, including new “miracle cures” or anti-public health policy rhetoric (e.g. the Great Barrington declaration, as discussed last Thursday)

What we should not do in wave 2: We should not broadly shut down schools and businesses and this is not being proposed by public health or the government. The unintended consequences of shutting down society for the 99.9% are huge and not readily reversible (click here to read more on this topic). Rather, we need to manage outbreaks and hot spots with good public health policies, as are in place currently in KFL&A. This may involve intermittent closures of affected facilities and operations in affected regions; but should not require a general shut down of the economy at the level of the country, province or cities.

toronto skyline with CN tower

Neighbourhoods, race and local variation in COVID-19: half of Toronto’s neighbourhoods are COVID-19 hotspots with prevalence of over 1000 cases/100,000 population and Weston exceeds 3000 cases/100,000 (click here). Toronto remains a collection of neighbourhoods with vastly different COVID-19 realities due to differences in social/economic, racial and health circumstances. For example, the Beaches has 260 cases of COVID-19/100,000 residents whilst Weston has 3079 cases/100,000, up dramatically from 2423 cases/100,000 1 week ago. Rates in both in low and high prevalence neighbourhoods, have increased for the past 2 months. As previously noted the rate of diagnosed COVID-19 infection is more common in Arab and Middle Eastern people (4% of population vs 11% of infections) and Black people (9% of population and 23% of population) than in White people (48% of population vs 18% of cases).

graphs comparing ethno racial groups with covid and toronto

KHSC visitor policy: One of the hardest aspects of COVID-19 care in the hospital is the need to restrict visitors to ensure we don’t import COVID-19 into the hospital. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected, as happened in Foothills hospital in Calgary and in Toronto. KHSC has a clear visitor policy, which has been in place for many months. All details on the policy can be found using this link (click here). 

Community Assessment Center at Beechgrove: (click here): All COVID-19 test must be scheduled appointments (versus walk in). Appointments can be scheduled by telephone or by our new Eventbrite on line scheduling system. This is working well and we are doing 250 tests/day. In addition to this we are doing Queen’s testing and this volume is down too. This relates to more targeted testing guidelines form the province. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). We are still working on our on-line system (it will be available shortly).

Per Ontario Health guidelines we do not test asymptomatic people unless they have a confirmed COVID-19 contact and we do not recommend testing children with runny noses as their sole symptom (click here). The Beechgrove Complex is south of the King St. West/Portsmouth Avenue intersection. Signage will direct people through the Complex to the Recreation Centre building at 51 Heakes Lane for walk-in testing. Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily. To be tested you will require: A valid Ontario health card or a piece of photo identification. You must also wear a mask and maintain physical distancing at all times while in the walk-in line.

COVID-19 in toddlers and young children: (click here). 

Fortunately kids remain much less likely to be infected by SARS-CoV2 and when they are infected they usually become much less ill (click here). The vast majority of upper respiratory tract infections in kids in Ontario are caused by other viruses, like rhinovirus and RSV. Thus, health policy makers and parents of young children should recognize that while children are not immune from COVID-19 infection, infections are relatively uncommon and outcomes are usually excellent for those who are infected. Nonetheless, we are about to prioritize children of healthcare workers for testing at KHSC so we can return the parents to work when children with symptoms (which will rarely prove to be COVID-19) are sent home from school or daycare.

2 school aged boys in a  classroom

Children are usually infected by an adult, usually in their home, rather than by other children. That said, the number of cases in school age children (which includes teenagers) has increased to 1238 up from 985 cases a week ago. 

covid-19 table showing data of school aged kids in schoolfemale toddler holding an apple

Amongst younger children and toddlers COVID-19 remains relatively rare. In Ontario’s 5,500 licensed child care centres and over 120 licensed home child care agencies there is a very low COVID-19 burden (see table below). The rise in cases has been modest in these young children. 243 children in Ontario’s licensed childcare facilities have been infected to date (up from 209 cases 1 weeks ago).

table summarizing covid cases of children in licensed daycares

Canada’s second wave of COVID-19: We have had 239,069 cases of COVID-19 in Canada and 10,202 deaths (see below) since the pandemic began. It is clear the country is well into a second wave of COVID-19, with hotspots noted on the map below. Ontario remains the province with the highest amount of testing and A cumulative positive rate 1.49%. However, the rate of positive tests in Ontario yesterday was ~4% yesterday. Canada’s cumulative positive test rate is 2.23%.

map of Canada  highlighting covid data

COVID-19 in Canada Nov 2nd 2020.

The COVID-19 global pandemic exceeds 1 million deaths and over 46 million cases (up 2 million from Thursday!): There are now 464,734,454 cases globally and there have been 1,203,011 deaths. The number of cases has increased almost 3-fold since July 27th 2020 when there were 16,296,494 cases globally. The pandemic hot spots are in the USA, India, Brazil, and Russia ( (click here). There are approximately 40 countries that have had a total of more than 100,000 cases. Below I show a list of countries with more than 200,000 cases. The USA with 9,240,261 cases (up 340,000 from last Thursday) and 231,181 deaths tops the COVID-19 list and accounts for over 20% of the global pandemic. India has the second largest number of cases (see global map of COVID-19 Nov 2nd-below). 

world map highlighting global covid data

 

Happy thought of the day: KHSC receives $20 million to increase elective surgery bed capacity (click here).

men wearing masks walking past a hospital building

Kingston General Hospital and KHSC will receive almost $19 million to fund ~ 100 additional transitional care beds, 45 additional hospital beds and two extra intensive care unit beds. The hospital will also receive close to $700,000 to pay for MRI and CT scan costs to help clear a backlog of surgeries postponed because of the pandemic.

Stay well!

 

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