September 28, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
1) KFL&A has new cases and enters the yellow zone
2) Ontario reports 700 new cases
3) School daze 3 (more data)-More data showing that children are much less likely than adults to be infected, have excellent outcomes and are usually infected by a known, infected contact. These facts should inform a change in testing policies.
4) Ontario is in wave 2 of the COVID-19 pandemic with over 400 new cases/day but no increase in mortality rate yet.
5) New ambulatory COVID-19 Testing facility: Beechgrove assessment center (click here):
6) The province has just announced today that we should not test asymptomatic people unless they have a confirmed COVID-19 contact.
1) Local COVID-19 Update KFL&A:
There have been 7 new COVID-19 cases in our region since my note last Thursday, and the total number of cases since the pandemic began is now 129 cases. Currently there are 12 active cases locally and they are recovering in the community (see update from KFL&A Public Health). As a result of the spike in cases we are now back in the yellow zone, after many months in green. The yellow zone is not as favorable as the green zone; but does reflect continued low community disease spread and indicates that we meet all the following criteria:
- Few active cases.
- Less than two active outbreaks.
- Full local hospital capacity.
- Cases and contacts reached within 24 hours of notification.
- High testing capacity, swabbing increased.
There are no cases in KHSC.
2) Ontario is in the second wave of COVID-19 with >700 cases today. (click here).
There were 700 new cases today (click here)
There were 409 new cases of COVID-19 in Ontario yesterday (up 0.8% from the day before) and over 700 today! Wave 2 is heating up. There have been a total of 48,905 cases, 5075 hospitalizations, and 2837 deaths in Ontario to date. The rate of positive SARS-CoV-2 tests was 1. 0% yesterday (unchanged from prior day). Ontario’s COVID-19 prevalence rate is 329/100,000, up significantly from a month ago, when it was 263.8/100,000. This provincial rate is much higher than in KFL&A, which has a prevalence of 56.9 cases/100,000 population. Toronto has a rate 9 times higher than Kingston (542.6 cases/100,000 population). The region with the highest prevalence of COVID-19 remains Windsor (619.3/100,000), largely because of a poorly regulated agricultural sector and suboptimal housing of farm workers.
An important difference between wave two and wave one is that while cases are more prevalent in the past 2 weeks (see below).
…there have been no increases in death rates (thus far), although this indicator may lag by several weeks because once the infection begins in one demographic (young adults who readily socialize and move through the community) it will eventually spread to older people. Older people, especially those with comorbidities, tolerate the infection poorly and likely will soon increase the demand for hospitalization.
Death rates have yet to rise in the early part of Ontario’s 2nd wave of COVID-19
Most of the active cases in Ontario, per Ministry of Health data, are in young people (< age 30 years-blue part of bar, left below) and most cases are in Toronto, Peel and Ottawa. In terms of those under age 20 years (top bar), there is a lack of granular data; but based on low numbers in day care and elementary school children, I suspect most cases are in teens and young adults.
Most active COVID-19 case in Ontario are in young adults
Our response to the second wave must include ongoing resilience, calmness and adherence to public health policies. 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). 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 in the short term.
3) School daze 3 (the sequel)-Why we should reduce testing of kids with runny noses and a reminder that in Ontario kids have rarely been hospitalized with COVID-19 and there has been only 1 death: British Columbia has taken a lead in bringing some sense to identifying the symptoms that require a child to stay home from schools and day care (click here). Although I received some push back form colleagues who care for children, it remains a fact that COVID-19 remains less common in children and their outcomes are much better, especially for toddlers and those in elementary school. As of July 2020 here are some important Ontario MOHLTC data about COVID-19 in children (and little has changed since July). These data show kids are less likely to be infected, have milder disease, and 71% of the time get COVID-19 form a confirmed contact with an infected person.
These are data only up to July that should guide our testing policy:
- Children account for a small number of COVID-19 cases (5.1% of the 36,950 confirmed cases) reported in Ontario, yet account for 21.1% of the Ontario population.
- The rate of infection among children is dramatically lower (60.4 per 100,000) than adults (298.8 per 100,000). Among children rates were highest (109.6 per 100,000) for 15 to 19 years old.
- The most frequently reported acquisition exposure type among cases in children was close contact with a confirmed case (1,353 cases, 71.4%).
- The proportion of severe outcomes, including hospitalizations, ICU admission, deaths and complications are much lower among cases in children compared to adults. One death has been reported in a child compared to 2,722 deaths reported among adults.
I am not proposing we ignore our children! However, without some balance the testing of children with runny noses will swamp our testing capacity. For example, in the community setting results may not be available 96 hours, in some centers. Once COVID-19 testing times extend beyond 24 hours the value of testing begins to deteriorate, as people have to quarantine for excessive periods while awaiting results, increasing absenteeism from work, and/or we risk that infected people continue to expose themselves to society and spread infection.
The data since July continue to show low levels of infection in school children in Ontario. There have been 3 new cases in school age children in the past week, and this includes high school kids (click here). I realize there is late breaking news of more cases but as I write this the data are not confirmed on the websites I use.
The table shows only 137 Ontario school students have been infected to date.
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 relative to young adults (see table below).
Only 58 children in Ontario’s licensed childcare facilities have been infected to date (6 cases since last week).
The vast majority of upper respiratory tract infections in kids in Ontario are currently 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 the graphs below which show rare hospitalizations and only 1 death to date in the pandemic, which has seen over 48,000 cases in Ontario.
Few hospitalizations due to COVID-19 have occurred in children thus far in Ontario (click here)
1 death due to COVID-19 has occurred in a child under age 19 to date in Ontario
4) New ambulatory COVID-19 Testing facility: Beechgrove assessment center (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 and will mark the route cars must travel for drive-through testing on September 26 and 27.
What Stays The Same
- Prior to visiting the Assessment Centre, patients and parents of young children are encouraged to complete an online self-assessmentto determine if they need to come in for a test.
- Walk-in patients will continue to be seen. Infants under 6 months of age should be taken to the Children’s Outpatient Centre at our HDH site or the Emergency Department for assessment.
- 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.
- Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily.
- Drive-through swabbing: To help address the immediate need for more testing in our community, a drive-through option will be available Saturday, September 26 and Sunday, September 27. In-car testing will be limited to 4 persons per car and individuals being tested must bring a valid Ontario health card.
- Feedback tool: The public can now send their concerns, questions and comments to COVIDAC@kingstonhsc.caand every effort will be made to provide a response within two business days.
Kudos to the amazing KHSC team, led by Cindy Bolton, that runs our community testing centre-they work hard. I would encourage any of you to send them a note of thanks!
5) A reminder: Ontario just announced today that we should not test asymptomatic people unless they have a confirmed COVID-19 contact.
In response to a testing backlog of 50,000 case, the Associate chief medical officer of health Dr. Barbara Yaffe has announced that testing needs to be reserved for people with symptoms, or those who have come into contact with someone who has COVID-19 (click here). There may be capacity at some pharmacies where people can make appointments for COVID-19 testing (not sure there are any in Kingston-stay tuned).
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. This should cause policy makers to recognize that intervention needs to be focused on LTC facilities if we expect to reduce mortality. The reforms required to make our LTCs safe are simple (but expensive): 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.
The rate of deaths from COVID-19 in Ontario has slowed in residents of Ontario LTCs with 15 deaths in the past weeks
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 134 cases of COVID-19/100,000 residents whilst Weston has 2079 cases/100,000. Thus, there is no single “Toronto”, as seen through a COVID-19 lens; it’s a diverse patchwork with a 19-fold variation in disease prevalence. Half of Toronto’s neighbourhoods have very high disease prevalence (each dot to the right of the one I highlighted is a neighbourhood that has a rate of over 1000 cases/100,000 population-dark areas on map)!
Canada’s epidemic at the beginning of the second wave: We have had 153,825 cases of COVID-19 in Canada and 9269 deaths (see below) since the pandemic began. Most cases (87%) are resolved. However it is clear there are hot spots, like Ontario, Quebec and Winnipeg (see map below).
COVID-19 in Canada as of Sept 24th.
COVID-19 testing: Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average of 20.7%, with 26.6 % of Ontarians tested to date ( click here). Our overall positive test rate in Ontario still remains low (1.31%).
SARS-CoV2 Testing in Ontario as of Sept 28th 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 5.0% (up slightly again) (click here). The US-Canadian border will remain closed for routine travel at least until the end of October.
The COVID-19 global pandemic exceeds 33 million cases ( a jump of more than a million cases over the weekend): There are now 33,173,176 cases globally and there have been 998,867 deaths. The number of cases has doubled since July 27th 2020 when there were 16,296,635 cases globally. The pandemic hot spots are in the Americas (Brazil, Mexico, Peru, Chile and USA), India and Russia (click here). There are approximately 37 countries that have had a total of more than 100,000 cases and I can no longer capture the screen on one page! The USA with 7,122, 754 cases and 204,825 deaths sadly tops the COVID-19 list and accounts for 22% of the global pandemic. India now 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:
The Pandemic accelerates: Sept 28th 2020