April 29, 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

| 29 April 2020

COVID-19 Update: There are no new cases of COVID-19 in our region today leaving the running total for the epidemic at 59 cases in the KFL&A region. There are no COVID-19 patients in KGH today. Locally we did 309 tests and 4 were positive, with 3 of these being from Perth-Smith falls and 1 from the Peterborough area.

False positive tests: There were 4 COVID-19 tests from a commercial lab (not our lab) which were proven to be false positive by our local public health experts False positive PCR tests commonly result when the PCR signal is extremely low. At KHSC we know that when only one of 2 SARS-CoV-2 genes we amplify is detected or when the signal does not appear until after many PCR cycles( >38) the test is not likely to be a true positive. We are fortunate that our lab has superb quality assurance and has largely avoided these false positive tests.

Expanded testing: In collaboration with the province KHSC and IPAC are considering the broadening of testing in vulnerable populations, such as cancer and dialysis patients and people living in communal situations, such as nursing homes. There have been no decisions taken yet on precisely which of these populations will be subject to the expanded testing-stay tuned. We are however, testing workers in long term care (LTC) facilities routinely now and Memorial centre will begin testing LTC staff to expand access for these health care workers.

Nursing homes are the epicentre of the COVID-19 epidemic. In or near Scarborough, the Canadian military has been engaged in supporting the outbreaks in such facilities, as has already happened in Quebec. Likewise in the Ottawa Champlain area there are many outbreaks in long-term care facilities. Hospitals in these areas have been supporting LTC facilities with IPAC, management and frontline staff.

Testing for SARS-CoV-2, the virus that causes COVID-19: Nationally we have done 784,850 tests, meaning we have tested 2.1% of all Canadians. The test positivity rate is 2.13%. In Ontario we did 10,852 tests yesterday (see graph below). Ontario has tested 1.83% of all residents and 6.08% of tests were positive.

graph showing tests performed vs positives

PPE: Our PPE supply chain is somewhat improved. We have a 3-4 week reserve at the current rate use, up from 2-weeks. This includes N-95 masks. However this reserve depends on using our pandemic supply, the store of last resort.

Advice to people in the community re COVID-19 testing: People in the community can self-refer for assessment and possible and testing. We are still focusing on testing either symptomatic people (since the test for COVID-19 is likely not as specific in asymptomatic people) or people with confirmed COVID-19 contacts. In either circumstance please self-quarantine and seek out testing at Memorial Centre in Kingston, see instructions below.

Instructions for testing in the community

A daily reminder: Advice to our patients Our hospitals and clinics are safe places to receive care (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). You should not delay accessing care that you or your doctor deem to be urgent.

Canadian COVID-19 epidemiology-some good news: To date we have had 50,373 cases of COVID-19 and 2904 deaths. Interestingly half the cases and 1682 of the deaths (58% of the Canadian total) have been in Quebec, which has only 22% of the Canadian population.

Some good news. If you look at the colored bar graphs at the bottom of the page one can see the number of active cases/day is decreasing (orange), as are the number of deaths (yellow). At the same time the number of people recovered (green) is increasing. This is what happens when the curve has flattened. (click link for daily update).

To see where Canada stands amongst nations in the COVID-19 pandemic, click here. To date there have been over 3.1 million cases and over 220,000 deaths globally. There is continuing evidence that the global incidence of COVID-19 is flattening (blue and gold graphs at bottom of Figure).

Capacity in KGH: KGH continues to have good surge capacity (below). Note that we still have plenty of ventilators and beds available.

Question of the day: One of our faculty members, Dr. Mike O’Reilly asked, “Why not measure the other acute respiratory infections from the same swab we use for COVID-19? Can we not simultaneously test for influenza A, parainfluenza, respiratory syncytial virus etc?

picture of puzzle pieces with a question mark on them

A: First, let me say that it is technically feasible (using multiplex PCR) to detect multiple viruses simultaneously. One would just need to add the primers for these other viruses to the PCR mix. A multiplex test for multiple viruses would also yield useful results . It would tell the doctor what the patient has, rather than just say that they don’t have COVID-19. However, the Provincial Health Labs are swamped with the huge ramp up in testing for COVID-19 (now ~11,000 tests/day) and they simply don’t have the bandwidth (reagents, people, PCR machine time) to run the 10-12,000 multiplexed PCRs that would be required. When we rebuild Canadian health care post COVID-19, this expanded testing capacity should be a priority for public health and KHSC labs. Thanks to Dr. Gerald Evans (ID) for his assistance with this answer.

The Medium is the message-two items from the desk of the DOM manager, Ms Anita Ng:

Different types of communications platform require different communication security levels and this means different platforms. We use OTN or REACTS to interact with patients (because they are the most secure). We use Microsoft Teams for clinical teaching (see message below) and ZOOM for almost everything else (notably sharing images of pets and cool outer space backgrounds-LOL).

Microsoft Teams As mentioned at the DOM meeting, KHSC has cleared Microsoft Teams for the use of clinical teaching, as long as Patient Health Information is not shared. All Queen’s faculty members should be able to access Microsoft Teams for free.

https://www.queensu.ca/its/microsoft-office-365/teams

Zoom can continue to be used for any non-clinical use (like team meetings).

2. Research HR Workforce Planning

As mentioned in the DOM meeting this morning, please reach out to Dr. Vanner and Anita Ng if you need guidance on options for research staff if you anticipate COVID-19 challenges that will affect funding and workload. Every situation is different, every timeline is different, and we will assist on a case-by-case basis. Options include a temporary reduced period of responsibility, using vacation time (but may not be feasible if no funds), or a leave without pay. For the temporary reduced period of responsibility (i.e. reduced hours), we should keep in mind the eligibility rules for the Canada Emergency Response Benefit (CERB). Lastly a reminder to have open, honest and transparent conversations with your research staff, which can go a long way!

Stay well!

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

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