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October 22, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) Dangerous fake news regarding the governments approach to combatting COVID-19 from regional politician (click here)

2) COVID volumes remain in KFL&A community (see update from KFL& A Public Health). 

3) The second wave of COVID-19 in Ontario (click here

1) Dangerous fake news regarding the governments approach to combatting COVID-19 from regional politician (click hereEarly in the pandemic I wrote a hockey-themed blog about how to deal with COVID-19 (click here). One point in the article was that in the COVID-19 pandemic we must “keep our head up”, paying attention to high quality, reliable information about your city, province and country”.

action photo of Gordie Howe

We have entered a phase in wave 2 of the pandemic where bizarre disinformation is getting more ice-time. If the disinformation is from a layperson, without a podium, it is annoying but not all that dangerous. However, if the person with the crazy ideas holds political office and has a platform to present their ideas it becomes dangerous and destabilizing, counteracting attempts to protect the public through rational public health policy. The more sensational the disinformation the more it reverberates in the social media echo chamber of bad ideas. The latest example of disinformation comes from a local politician, MPP Randy Hillier. 

screenshot of sign stating mandatory 14 days self isolation

Mr. Hillier, an independent MPP from Lanark-Frontenac Kingston is a self-proclaimed believer in Freedom Justice and Democracy (per his Twitter page). Mr. Hillier, like President Trump, has likened the pandemic to a bad flu season, and has been spreading false information that the federal government is preparing to establish mandatory "camps" for COVID patients. In an Oct. 7 exchange at Queen's Park with a Conservative party colleague, Hillier spouted the following: "I ask this government if people should prepare for internment camps. Your government must be in negotiations and aware of these plans to potentially detain and isolate citizens and residents of our country and our province. Where will these camps be built, how many people will be detained, and for what reason, for what reasons can people be kept in these isolation camps?". His “questions” are misleading and forced the government to make a rebuttal. “Canadians will not be forced into COVID-19 internment or containment camps”, said a spokesperson for Health Minister Patty Hajdu 

I am not sure what fueled Mr. Hillier’s questions; however, the federal government will be funding for voluntary quarantine sites for homeless people and will continue to assist in providing self-isolation capacity for returning international travellers without suitable places to quarantine. However, these logical and effective ways to prevent disease spread can in no way be distorted into forcing Canadians into Mr. Hillier’s fictious COVID "camps."

While we are guaranteed freedom of speech in Canada we do have responsibilities as physicians (and as politicians) to educate ourselves and to base our comments on science and data, not personal ideology. From the Great Barrington declaration (click here), a misguided appeal to let each of us manage our response to COVID-19 as we wish and to rely on infections to create herd immunity, to Mr. Hillier’s bizarre allegations, this toxic media helps spread COVID-19 by undermining public health policy and public adherence to rules that keep us safe. Until we have a vaccine, we will all be dealing with the stress, financial challenges and emotional/mental health costs of a highly contagious viral pandemic. We can limit (but not fully prevent) morbidity and mortality through rational and simple public health measures. Alternatively, strident and ill-informed voices can foment anxiety, distrust, and deviation from these practices.

These “crazy ideas” (government internment camps or ingestion of bleach to cure COVID-19) are like the SARS-CoV2 virus (contagious and lethal, especially to susceptible people). In medicine we have a name for such disease-causing beliefs, “cognogens” (click here). The next time you encounter a doctor, friend or politician afflicted with a cognogen you may want to vaccinate them by offering a polite rebuttal using science- and evidence-based information. Solid science and public health policy are to cognogens what a vaccine and effective medication will be to COVID-19-a merciful cure to a dangerous infection.

This is my personal opinion and does not reflect the views of Queen’s University of KHSC.

2) COVID volumes stabilize in KFL&A: There have been 4 new COVID-19 cases in our region since my note on Monday. The total number of cases since the pandemic began is now 174. Currently there are 7 active cases locally (down from 9 cases on Monday). All local COVID-19 patients are recovering in the community (see update from KFL& A Public Health). There are no hospitalized patients at KGH. The KHSC lab did 1321 tests over the last 3 days; 2 were positive form KFL&A and 1 from Perth Smith Falls. Thus, the latest KHSC lab rate of positive tests is 0.3%.

graph showing new covid-19 cases by date

This local stability in COVID-19 allows us to continue to provide patients with much needed health care for the many diseases other than COVID-19.

5) The second wave of COVID-19 in Ontario now matches the 1st wave. There have been a total of 66,686 cases, up 4000 cases in ~1 week! There were 790 new cases yesterday and 821 today. There have been with 5675 hospitalizations, and 3062 deaths (up 31 from Monday) in Ontario, since the pandemic began. Hospitalization rates continue to increase and are up 8.5% since yesterday (44 new hospitalizations). The rate of positive SARS-CoV-2 tests in Ontario is up again to 2.5%. Ontario’s COVID-19 prevalence rate is 448.6/100,000 population (click here). A month ago between wave 1 and 2 it was 263.8/100,000. This provincial rate is 5X higher than in KFL&A, which increased slightly since Monday to 79.4 cases/100,000 population. 

Toronto remains Ontario’s hotspot for COVID-19 (758.8 cases/100,000 population, up from 711 on Monday), a rate 9 times higher than Kingston. Windsor no longer has the highest prevalence of COVID-19 (649.9 cases/100,000 population), having been surpassed by Toronto. Ottawa is also a hot spot at 589 cases/100,000 population (see incidence map for Ontario below).

map of Ontario showing areas of high prevalence of COVID-19

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 (gray on graph below) (click here). There is a sustained rise in hospitalizations in Ontario in the past 2-3 weeks (shown by the black line in the graph below), although this has plateaued. At the peak in May, Ontario had just over 1000 hospitalizations whilst currently we have 260 hospitalized people (vs 278 people in hospital, including ICU, on Monday (See below).

graph showing active and hospitalized patients with COVID-19

What we should do in wave 2 of the COVID-19 pandemic. With careful attention to public health measures we can flatten the second wave without shutting down schools, businesses and society. To address wave 2 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 neighbourhoods). 
  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 shut down schools and businesses. 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.

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 screening tool

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.

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).

animated photo of a COVID- 19 nasal swab test

A reminder: 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.

Requirements if you need to be tested

1) A valid Ontario health card or a piece of photo identification.

2) 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. 

photo of two young boys in 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 more quadrupled over the past 2 weeks (increasing from 236 to 920 cases, see table below). 

table of covid-19 data in school aged childrenpicture of a female toddler

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 also a very low COVID-19 burden (see table below). The rise in cases has been modest in these young children. 204 children in Ontario’s licensed childcare facilities have been infected to date (up from 65 cases 2 weeks ago-see table below).

table of covid-19 data for children in licensed child care facilities

The reforms required to make our 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 1910 deaths in nursing homes (up 4 from Monday) account for 63% of all deaths in Ontario, click here. In the last 2 weeks the rate of death amongst LTC residents has once again begun to increase. There was an outbreak at Fairmont nursing home last week with 1 infected staff member (click here). The definition of an “outbreak” in a nursing home is quite strict and only requires 1 case to qualify as an outbreak.

The reforms required to make our LTCs safe are simple to understand but expensive to implement: single rooms for all residents, proper funding of PSWs so they only work at a single site, availability of COVID-19 testing for residents and staff and adequate supplies of proper PPE. 

We want to protect residents of LTC facilities but we can’t do this by locking them up and denying them access to family members and loved ones. The emotional trauma, despair and grief caused to people in LTCs in wave 1 is a story that is not yet fully told. In wave 2 we need to do better. LTC residents must be allowed to have ongoing access to their families in friends, with proper screening, PPE and in reasonable numbers. If we fail in this the consequences are as bad as failing to control COVID-19 infections in these facilities.

COVID-19 Hotspots in Toronto:

picture of the Toronto skyline with CN tower

More than half of Toronto’s neighbourhoods are COVID-19 hotspots with prevalence of over 1000 cases/100,000 population (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 241 cases of COVID-19/100,000 residents whilst Weston has 2757 cases/100,000 (see map below). Rates in both in low and high prevalence neighbourhoods, have increased each day for the past month. More than half of Toronto’s neighbourhoods have a very high disease prevalence of over 1000 cases/100,000 population (each dot is a neighbourhood on the map below and all dots to the right of the one highlighted (New Toronto) have >1000 cases/100,000 population). 

map of Toronto high covid-19 prevalence by neighbourhood

COVID-19 in Toronto by neighbourhood Oct 22nd 2020

Canada’s second wave of COVID-19: We have had 207,201 cases of COVID-19 in Canada and 9838 deaths (see below) since the pandemic began. Most cases (86%) are resolved. However it is clear the country is well into a second wave of COVID-19, which exceeds the first wave in terms of case number but not yet in hospitalizations. 

data and a map of Canada showing covid-19 stats as of Oct 22

COVID-19 in Canada as of Oct 22nd 2020.

Quebec remains a hot spot for COVID-19 as has been the case throughout the pandemic. Their 2nd wave is shown below (click here). 

graph tracking Quebec's covid-19 curve

Since the start of the pandemic, there have been 97,321 confirmed cases, 47% of all Canada’s cases. Quebec accounts for only 22% of Canada’s population. Montreal is the epicenter of the pandemic and is in the red zone (with much of the economy shuttered, temporarily). Fortunately, with a recently intensified public health response it appears things are stabilizing in Montreal (click here). Nonetheless the 2nd wave is having major adverse effects on the wellness and mental health of young people in Quebec.

screen shot of news article and photo of Dr. Mylene Drouin at press conference

COVID-19 testing: Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average of 26.2%, with 33.1 % of Ontarians tested to date ( click here). Our overall positive test rate in Ontario still remains low (1.4%) vs 2.1% nationally ( although the national rate had spiked to 3% last week). Another important caveat to our relatively favorable test positive rate is that in some areas, such as certain neighbourhoods in Toronto, positive test rates exceed 10%. This is a reminder COVID-19 is global but its impact varies greatly even from one neighbourhood to the next.

The COVID-19 global pandemic exceeds 1 million deaths and over 41 million cases (up 1 million from Monday!): There are now 41,396,754 cases globally and there have been 1,133,699 deaths. The number of cases has more than doubled since July 27th 2020 when there were 16,296,635 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 8,354,300 cases and 222,416 deaths tops the COVID-19 list and accounts for ~20% of the global pandemic. India has the second largest number of cases.

ranking of covid-19 cases and related deaths by country

Countries with more than 200,000 COVID-19 cases

Positive event of the day: See tweet below. The DOM hosted our new Dean, Dr. Jane Philpott at Medical Grand Rounds this morning. We showed her an array of our new programs of distinction by playing the old-fashioned game, Operation. These programs and the people that comprise them are allowing people in southeastern Ontario to receive state of the art tertiary care close to home. These programs also bring the best and brightest to Kingston and also support excellence in research, education, and quality improvement.

screen shot of text and photo of the game operation

Stay well!

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