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October 29, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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1) COVID-19 testing for the children of health care staff and faculty will be expedited at Beechgrove Community testing center beginning next Monday

2) Increased outbreaks and deaths in Long Term Care facilities (LTC) safer are simple and cannot accidently incarcerate LTC residents

3) COVID volumes remain in KFL&A community but we are surrounded by regions with rising COVID-19 prevalence (see update from KFL& A Public Health). 

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

5) Open KHSC forum Nov 5th-staff should attend on line to hear from Dr. Pichora and the leadership team: 1200 to 1300.

6) Happy thought of the day-see end of article

1) Effective next Monday we are moving staff swabbing to Beechgrove Community testing center from HDH and children of staff will be able to get expedited testing (to allow their parents to return to work)

photo showing nasal covid-19 swabpicture of three young boys dressed as 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 will begin testing staff at Beechgrove instead of Hotel Dieu to Beechgrove, effective next Monday. 

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. Whereas staff and physicians themselves should contact occupational health to book their testing appointment, the testing of their children is handled differently. We will provide KHSC staff/physicians (shortly) with a telephone number that they can call. They will be given an appointment between 1230 and 1300. 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!!!

2) 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 1938 deaths in nursing homes (up 17 from Monday) account for 63% of all deaths in Ontario, click here

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.

table of covid-19 data to date in LTC

LTC deaths in Ontario up to Oct 29th, 2020

3) COVID volumes stabilize in KFL&A: There have been 6 new COVID-19 cases in our region since my note Monday. The total number of cases since the pandemic began is now 182. Currently there are 7 active cases locally (unchanged from 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 1461 tests over the last 4 days; 1 was positive (from Kawartha). In terms of nearby active cases, there are 6 cases in Hasting-Prince Edward County and 19 cases in Lanark Leeds Grenville county. This is highly relevant, since we are the tertiary care medical center for these areas. There are 3 local nursing home outbreaks, including a new one at the Helen Henderson LTC (click here). 

graph of positive covid-19 cases

4) The second wave of COVID-19 in Ontario now exceeds the 1st wave There have been a total of 73,819 diagnosed cases since the pandemic reached Ontario. We had 934 new cases yesterday (click here). There have been with 5906 hospitalizations, and 3118 deaths in Ontario, since the pandemic began (up 8% and 4.2% since yesterday, respectively). The rate of positive SARS-CoV-2 tests in Ontario remains high at 2.9%! Ontario’s COVID-19 prevalence rate continues to climb and is now 496.6/100,000 population (click here). A month ago, it was roughly half the current level, at 263.8/100,000. 

This provincial rate is 5X higher than in KFL&A, which increased slightly since Monday to 84.1 cases/100,000 population. Toronto remains Ontario’s hotspot for COVID-19 (843.3 cases/100,000 population, up from 711 one week ago), a rate 10 times higher than Kingston. Windsor (661.2 cases/100,000 population) no longer has the highest prevalence of COVID-19 having been surpassed by Toronto. Ottawa is also a hot spot at 645.6 cases/100,000 population (click here)

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 (click here). Deaths and hospitalizations have begun to increase in wave 2 (See below). 

graphs showing deaths and hospitalizations due to COVID-19

Increases in hospitalizations and deaths in Ontario’s second wave of COVID-19 Oct 29th

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 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 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

More than 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 250 cases of COVID-19/100,000 residents whilst Weston has 3024 cases/100,000, up dramatically from 2423 cases/100,000 on Monday(see map below). Rates in both in low and high prevalence neighbourhoods, have increased for the past 2 months. 

map of Toronto highlighting neighbourhoods with high COVID-19 prevalence

More than half of Toronto’s neighbourhoods have a very high disease prevalence of over 1000 cases/100,000 population (each dot below the map above is a neighbourhood on the map below and all dots to the right of the one highlighted (Oakwood Village) have >1000 cases/100,000 population). 

4) Limited KHSC capacity: A need to put a temporary hold on elective admissions.

Kingston General Hospital (KGH) is slightly less full than on Monday, with 67 instead of 38 available beds. Elective work is on hold at KHSC and elective admission are temporarily curtailed). We have substantial ventilator capacity.

graph of KHSC beds and ventilators available

Because there are few beds available in medicine or surgery and because of shortages in nursing staff and other staff, despite aggressive attempts to recruit new staff and offers of overtime to existing staff, we have temporarily paused elective admissions. A similar request is being made to our surgical colleagues. Meanwhile, KHSC is pursuing solutions that may assist our bed crunch, including: a) deciding how best to move people that have ALC status from our hospital (either to home or to more appropriate locations), b) activation of new beds in the Hotel Dieu site and c) having frank conversations with partner hospitals in southeastern Ontario to ensure cases are distributed appropriately. KGH has a short-term capacity issue that is likely exacerbated by the fall season, which always has a high bed census. 

Elective clinical outpatient work will continue for now. Patients should see their doctors and continue to seek healthcare as needed.

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.

screenshot of prescreening tool at KHSC

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).

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.

photo of two young school 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 increased to 1157, from 985 cases on Monday. 

picture of young 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 a very low COVID-19 burden (see table below). The rise in cases has been modest in these young children. With 236 children in Ontario’s licensed childcare facilities infected to date (up from 209 cases on Monday).

Canada’s second wave of COVID-19 and death total now exceeds 10,000 people: We have had 227,55 cases of COVID-19 in Canada and 10,067 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 (total of 4,991,378 tests done and cumulative positive rate 1.46%-although almost 3% yesterday).

map of Canada and graphs of current covid-19 data

COVID-19 in Canada as of Oct 29th 2020.

The COVID-19 global pandemic exceeds 1 million deaths and over 443 million cases (up 1 million from Monday!): There are now 44,684,011 cases globally and there have been 1,176,011 deaths. The number of cases has increased over 2.6-fold 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 8,881,087 cases and 227,968 deaths tops the COVID-19 list and accounts for ~20% of the global pandemic. India has the second largest number of cases.

Happy thought of the day: While the virus rages there are many stories of dedication and maintained good humor. Here are some results of our pumpkin carving contest. Scientists in the Archer lab and QCPU scientists, who are working to develop treatments for COVID-19 (as well as their usual research on pulmonary hypertension, the ductus arteriosus and cancer), competed this morning for the Stanley Pumpkin prize.

pumpkin inside stanley cup

Stanley Pumpkin Prize (courtesy of Mr. Jeff Mewburn)

 

                                      covid-19 pumpkinscovid-19 pumpkin

COVID-19 pumpkins

 

knitted pumpkins

Bespoke Persian pumpkins

 

pumpkin carved as face of family dog

Sentimental favourite (Steve McQueen the noble dog)

 

pumpkin in the shape of a heart valve

Pulmonic stenosis pumpkin (runner up)

 

pumpkin carved of the face of Edgar Allen poe

Edgar Allan Poe Pumpkin (our winner)

Stay well and Happy Halloween! 

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