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screenshot of healthcare workers and people lined up for testing

October 5, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

headlines
  1. COVID volumes continue to increase in KFL&A
  2. The second wave of COVID-19 in Ontario now matches the 1st wave, with 732 new cases yesterday (click here)
  3. Private clinics offer COVID-19 testing for a fee
  4. CLARIFICATION: Exposure to infectious respiratory illness and return-to-work policy at KHSC
  5. Booking a COVID-19 test at Beechgrove is required: Kingston’s community assessment center (click here):

1) COVID volumes continue to increase in KFL&A related to a community cluster at Queen’s University: There have been 13 new COVID-19 cases in our region since my note last Thursday. The total number of cases since the pandemic began is now 148. Currently there are 27 active cases locally (up from 18 last week) and they are recovering in the community (see update from KFL&A Public Health). Almost all cases are Queen’s University students, most infected after attending a party together. Thus, while the province is in a second wave, locally we are more accurately characterized as being back where we were with the Binh’s nail salon cluster. Adjacent Hastings county has 6 active cases and Lanark county has 15 cases. There are no cases hospitalized in KHSC. 

As in the rest of the province the most infected population demographic are young adults age 20-29 with a female preponderance. We did 4000 COVID-19 tests in the past 4 days at KHSC, with only 5 positive tests (4 positive tests were from the Kawartha area).

COVID-19 graphs for KFLA data

A COVID-19 cluster in KFL&A

2) The second wave of COVID-19 in Ontario now matches the 1st wave, with 732 new cases yesterday (click hereCOVID-19 cases numbers have doubled in Ontario ~ every 2 weeks. Modeling suggests that there may be 1000 cases/day by mid-October (click here). 61% of all positive tests are currently in young adults or children; however, there is starting to be an increase in infection rate in middle age people. The graph below shows that the majority of infections in Ontario are in young adults age 20-29 (blue and green below). In contrast virtually all deaths are in people over the age of 60 years (gray on graph below).

bar graph showing covid 19 active, resolved and deaths by age

Also note the concerning, recent rise in hospitalizations in Ontario (shown by the black line in the graph below).

graph showing Ontario active cases vs hospitalized

There have been a total of 52,980 cases with 5205 hospitalizations (an almost 10% increase compared to last week), and 2927 deaths in Ontario, since the pandemic began. The ICU admission rate is also beginning to rise. 1096 people have been in ICU since the pandemic began and this rate rose 2.1% recently. The rate of positive SARS-CoV-2 tests declined to 1.3% yesterday.

Ontario’s COVID-19 prevalence rate is 356.4/100,000, up significantly from a month ago, when it was 263.8/100,000. This provincial rate is 4X higher than in KFL&A, which has a prevalence of 64.4 cases/100,000 population. Toronto has a rate 9 times higher than Kingston (597.2 cases/100,000 population). Windsor has the highest prevalence of COVID-19 (625.7/100,000), largely because of a poorly regulated agricultural sector and suboptimal housing of farm workers.

A Map of COVID-19 prevalence in Ontario Oct 5th 2020

A Map of COVID-19 prevalence in Ontario Oct 5th 2020

Most active cases of COVID-19 are in Toronto, Peel, Ottawa and York (click here), see graph below. Toronto is the site of most COVID-19 deaths in Ontario, with 19,115 of Ontario’s total deaths (2927).

graph of cases by cities in Ontario

Strategy for the second wave must include ongoing resilience, calmness and adherence to public health policies. As the pandemic progresses we may soon start to see more hospital admission and then an increase in mortality rates. This is not however an unavoidable outcome. With careful attention to public health measures we can flatten the second wave without shutting down schools, business and society. To address wave 2 we should prioritize who we test and ensure rapid availability of test results. We need to limit indoor assembly to the permitted group size (<10). We should focus on key demographics who tend to get infected (young adults, migrant workers, low income neighbourhoods) and protect our health care workers (so they can protect society). We all need to continue practicing simple and effective public health measures (physical distancing, mask use indoors, frequent hand washing). However, 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.

3) Private clinics offer COVID-19 testing for a fee (click here)

“For-profit clinics serve individual patients as well as companies that require employees to test negative for the coronavirus before returning to work. Individuals pay anywhere from $50 to $250 for a test”, as reported in the Globe and Mail by Graham Hughes. This new practice is a complex issue. On one hand, companies can’t afford to wait for slow return of results from Ontario’s swamped public health testing facilities (average wait 4 days). For example, Ontario’s public health lab network, which processes swabs from the province’s 153 COVID-19 assessment centres, had ~ 79,000 samples waiting to be processed on Saturday, almost double its daily processing capacity of ~40,000. On the other hand, Canada has a universal health care system and this private testing does nothing for those most affected by COVID-19, low income people and racialized people. 

screen shot of nurses talking to people in COVID-19 testing line up

In my opinion, we need to stick with public testing through our universal care system but that puts the onus on the government to provide sufficient testing capacity to achieve a 24 hour turnaround of results.

4) CLARIFICATION: Exposure to infectious respiratory illness and return-to-work policy at KHSC. With the volume of COVID calls we are receiving; we have created a process of screening that should streamline the process. We are therefore asking staff not to contact us for work isolation approval per say, and only contact us if they have questions about work isolation. At KHSC, screening question #5 asks if you have had close/household contact with someone sick with symptoms of a potentially infectious respiratory illness (e.g., child with runny nose). If you answer ‘yes,” then:

  • ·if you are not symptomatic, you can be at work on Work Isolation; follow the handout given to you by the screener
  • ·your ability to deliver or support patient care is NOT affected
  • ·you are NOT required to contact Occupational Health, Safety & Wellness (OHSW).
  • Each day you are on Work Isolation you must answer “yes” to question #5.  Once your contact tests negative or is informed that their illness is not COVID-19, then you can discontinue Work Isolation. 
  • If your contact has a positive COVID-19 test, you are NOT permitted in the workplace. At that point, please contact OHSW.

The KHSC policy differs from the Queen’s Faculty of Health Sciences policy, which says asymptomatic individuals in close contact with someone sick with respiratory illness may not come to campus unless that person is undergoing COVID-19 testing.

5.  In the last 14 days have you had close unprotected contact with, or are you a household contact of, someone with infectious respiratory illness or someone who has returned from international travel?

If Yes

YOU CAN BE IN THE WORKPLACE BUT MUST BE ON WORK ISOLATION

Where the staff member’s close contact or household contact is sick with symptoms of a potentially infectious respiratory illness, they are permitted to be at work but MUST be on work isolation. Similarly, if they have a household contact who has returned from international travel, they are permitted to work but must be on work isolation

The screener is to provide the Work Isolation document to the staff member which provides all instructions.

Once the close contact or household contact with the respiratory illness tests negative, or is informed that their illness is not COVID-19, the staff member can discontinue work isolation.

If the close contact/household contact has a positive COVID-19 test, the staff member is not permitted in the workplace and must contact OHS. A household contact carries the highest risk of transmission

Close, unprotected contact is defined as having provided care, had similar close physical contact, or had lived with or otherwise had close, prolonged contact without appropriate PPE.

5) New policy: All COVID-19 tests must be scheduled appointments (versus walk in) 

Beechgrove: Kingston’s community assessment center (click here): The province has mandated that all tests be done by appointment as of tomorrow. First 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).

A reminder: The ministry announced that 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 lies just 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. We do not have drive through testing yet but are considering this possibility. 

Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily.

Feedback tool: The public can now send their concerns, questions and comments to COVIDAC@kingstonhsc.ca.

Requirements

  • People are required to bring a valid Ontario health card or a piece of photo identification.
  • People must wear a mask and maintain physical distancing at all times while in the walk-in line.

KHSC capacity-preparing for an anticipated need for hospital admission: We have 62 ALC people and the hospital is quite full. We anticipate COVID-19 admissions in coming weeks and thus are focused on optimizing patient flow. By opening additional beds on Connell 3, our COVID-19 response ward, we have been able to decrease congestion in the Emergency Department. That said, we are expecting COVID-19 admission and most of these patients are admitted to Medicine beds. Retaining capacity to rapidly deal with admission on the Medicine service will remain a priority. As you can see below KGH has adequate bed capacity for a COVID-19 surge (with 62 available beds) and we have good ventilator capacity. In the event of a COVID-19 hospitalization surge and/or quarantine of wards we will need to expeditiously transfer ALC people form the institution to more appropriate sites.

KHSC Bed management chart

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. Children are usually infected by an adult, usually in their home, rather than by other children. Here are some data supporting this assertion, first for school age children and then for daycare age children.

photo of 2 young boys in classroomcovid-19 data of school aged children

There have been 262 COVID-19 cases in Ontario school students to date (up from 137 2 weeks ago from last Thursday).

photo of a female toddler

Amongst younger children and toddlers 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). 87 children in Ontario’s licensed childcare facilities have been infected to date (up from 58 cases 2 weeks ago and 8 cases since last Thursday).

covid-19 data in toddlers

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. Further reassurance for parents of young children comes from Ontario wide data which show rare hospitalizations and only 1 death to date in the pandemic (click here).

The reforms required to make our Long term care facilities (LTC) safe are simple (but expensive): 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, deaths in nursing homes account for 66% of all deaths in Ontario, click here. There were have been 3 new deaths since my Thursday note in our LTCs. 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.

summary data of covid-19 cases in LTC since January

The rate of deaths from COVID-19 in Ontario has slowed in residents of Ontario LTCs with 3 deaths since last Thursday.

17 or more neighbourhoods in Toronto have a COVID-19 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 162 cases of COVID-19/100,000 residents whilst Weston has 2351 cases/100,000. These rates, both in low and high prevalence neighbourhoods, have increased each day for the past month. 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 have >1000 cases/100,000 population). 

map of covid-19 prevalence in Toronto area

Canada’s second wave: We have had 166,155 cases of COVID-19 in Canada and 9481 deaths (see below) since the pandemic began. Most cases (86%) are resolved. However it is clear there are hot spots, like Ontario, Quebec and Winnipeg, Manitoba (see bottom left below). It is also clear we are well into a second wave (top center-upward deflection of orange curve).

several graphs showing current info for Covid-19 in Canada

COVID-19 in Canada as of Oct 5th 2020.

COVID-19 testing: Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average of 22.2%, with 28.2 % of Ontarians tested to date ( click here). Our overall positive test rate in Ontario still remains low (1.33%). However, there is an important caveat! In some areas, such as certain neighbourhoods in Toronto, positive test rates exceed 10%:A reminder COVID-19 is global but its impact varies greatly even from one neighbourhood to the next.

graph showing COVID-19 testing in Ontario

SARS-CoV2 Testing in Ontario as of Oct 5th 2020

American data of COVID-19 testing: In contrast with Canada’s 2.0% rate of positive tests, the USA has an average rate of positive COVID-19 tests of 4.6% (stable) (click here). The US-Canadian border will remain closed for routine travel at least until the end of October. 

graph showing covid-19 testing vs positives in US

The COVID-19 global pandemic exceeds 1 million deaths and 25 million cases (a jump of almost a million cases for the second week in a row): There are now 35,252,679 cases globally and there have been 1,038,307 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. The USA with 7,423,328 cases and 209,857 deaths tops the COVID-19 list and accounts for ~20% of the global pandemic. India has the second largest number of cases (see list of countries with the most cases below left). Here is a map of the pandemic as seen today:

global map highlighting and ranking countries with most cases

Stay well!

 

 

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