April 17, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Dr. Archer's Updates on COVID-19

General DOM News & Events

| 17 April 2020

COVID-19 Update: The COVID-19 incidence and prevalence remain stable in Kingston and KFL&A. There are no new cases locally today. There remains only 1 COVID-19 patient in KGH and they are in ICU. This is consistent with a message I have been conveying since the first note: While we stand with our colleagues globally we are guided by local/regional evidence. The evidence regarding our “version” of the epidemic is clear.We are not Italy, we are not New York City and we are not even Toronto”. This reminder is not meant to convey smugness nor do we take our good fortune in KFL&A for granted; but this low local incidence and prevalence does guide our PPE policies and other policies. There is of course nuance to this statement. We are part of the province and part of the country-and thus need to comply with rulings from Ontario Health and the Federal government. For example, reactivating elective care would likely be safe; but one must consider the optics of unilaterally ramping up elective work when local business and schools are closed and the provincial COVID-19 burden remains high. For now, our elective patient care is primarily being limited by lack of PPE reserves. I remind our patients that the hospitals and clinics are safe and you should not delay accessing care that is demed critical or semi urgent care (this would be dangerous). If a patient’s condition requires attention in the next hours, days or weeks, they should not be afraid to seek help. They will be seen in the appropriate venue. We have capacity to do this in the Emergency Department, on our hospital wards and in our clinics.

Physical distancing: We remind all faculty and staff to respect physical distancing rules (staying 6 feet apart) upon entry to the facilities. Also, please cooperate with the screeners. The questions they ask are part of the mechanism we use to exclude people with acute respiratory illnesses from inadvertently bringing disease into the hospital. KHSC will be adding additional staff to try and enhance the efficiency of allowing us all into the building in a timely manner (which can be a challenge at peak hours).

COVID-19 testing update: Nationally 505,643 tests have been done and 5.95% are positive (below). Here are the results of testing in Ontario.

graph of Ontario COVID-19 tests performed

Canadian COVID-19 epidemiology: 4% mortality rate in Canada

There are currently 30,106 cases and 1195 deaths related to COVID-19 in Canada. (click link for daily update). The national trends are shown below. While the disease curve has flattened in BC and is beginning to become less steep in Ontario, which is great news, we have not yet turned the corner. This is in part because of the high incidence and prevalence of COVID-19 in Quebec where there are 15, 857 cases, roughly half of all of Canada’s cases.

Graph showing early flattening of the curve in Ontario

Early flattening of the curve-slowing of Ontario’s rate of rise in active cases (orange)

PPE: We have received a new supply of 50,000 + surgical masks (but have not been resupplied with additional N-95 masks). Thus, commitment to safe PPE use for our staff and patients remains our priority. This is coupled with the need for ongoing efforts to conserve PPE by using them only when and where they are needed.

Restricting access to long term care (LTC) facilities-a new policy which raises some concerns: The following is my opinion, not the position of KHSC. There is a new ruling this week that precludes discharge of patients from hospitals, including KGH, to LTC facilities. There are 5 discharges will not happen today from the Medicine service because of this new policy. We had planned to protect our local LTC facilities (which are not having COVID-19 outbreaks, unlike facilities elsewhere in Ontario and Quebec) by testing all patients scheduled for discharge to prove they were COVID-19 negative (however unlikely that was). While we need to respect rules and policies I want to reassure staff that there would be no risk to LTC facilities should we send them COVID-19 negative KGH patients. Indeed, it is untested LTC residents that would more likely bring COVID-19 infection to KGH-not vice versa. Were this externally mandated policy to continue, we would compromise our hard-won capacity to deal with a potential COVID-19 surge. Incident Command is aware of this concern and is in dialogue with provincial leadership.

Capacity in Kingston and beyond: KGH continues to have good surge capacity, as seen on today’s graphic indicator (below). Note that we have 59 available ventilators and 123 available beds.

TGIF Good News Story: Doing What we can do makes a difference.

Canadians are resilient. I see this not only in health care field but also in broader society. I admire the spirit of those who serve cheerfully in grocery stores, remove trash, provide utilities, perform lawn care, or serve as mechanics. There are many to admire in this pandemic era-a reminder that we should not allow the pandemic and its adversity to define us. Here is a story which is inspirational and reminds us that when we are given lemons we need to make…PPE! I am a proud Maritimer and Stanfield’s is an iconic, 5^th generation manufacturer of underwear (hold salacious comments and stop tittering). When COVID-19 hit, this Truro, Nova Scotia company was forced to lay off all its employees. It could have folded. Instead they decided to be part of the solution and reinvented themselves. They retooled to make PPE and quickly landed a $24 million federal contract to supply 2.6 million gowns — 100,000 gowns per week. They have already called 70 employees back to work and are looking to hire more. This quote from their CEO, Jon Stanfield, was in the Globe and Mail this morning and it touched me: “I know we’re only sewing gowns, but it’s what we can do, and it’s what Truro can do, and its what Stanfield’s can do”. I love that spirit. If in this pandemic each of us adapts and does what we can do we will not only be fine, we may be better people than we were pre-pandemic!