December 10, 2021 - 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

| 13 December 2021

1) KFL&A update: Wave 4 rising with over 104 new cases, 507 active cases, positive test rates of over 6% and a surge in local Omicron variant cases

2) New rules for health care worker who plan international travel (including the USA) or who will receive visitors (including those from the USA).

3) Ontario’s 4^thwave rising: New cases (7382 cases in the past week) up 24% with an 8% rise in hospitalization

4) Who qualifies for a 3^rddose of vaccine in Ontario?

5) Canada’s COVID-19 4^thwave on the rise again: A 15% increase in both new cases and an 18% increase in active cases with a 2% decrease in hospitalizations (click here) (click here)

6) World vaccine roll-out tops 8.35 billion doses; but low-income countries lag behind. Vaccine safety record remains excellent (click here)

7) The global pandemic is not yet controlled: ~269 million cases and 5,292,503 deaths to date with most deaths in the past month in the USA, Germany UK, Russia and France

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1) KFL&A update: Wave 4 rising with over 104 new cases, 507 active cases, positive test rates of over 6% and a surge in local omicron variant cases

As you can see the rate of new cases in KFL&A is unprecedented, with over 100 new cases daily. The most commonly infected people are those aged 18-29 years, because they are more socially active (pie graph below). Most of the serious illnesses with COVID-19, in contrast occur in people over age 60 years.

pie chart KFLA breakdown of cases by age

Latest infections are predominantly in young adults (red)

The rate of positive tests in our area is the highest its ever been (over 6%)-see green line on graph below for KFL&A (orange line is the province as a whole). This means we need to socially distance, wash our hands, wear masks, and ensure we are vaccinated. Currently, 82.7 % of people over age 5 are vaccinated with 2 doses (including 89.3% of people 12 years of age and over).

Red and Green line graph showing test positivity rates for KFLA and Ontario

Positive tests rates for KFL&A and Ontario

There has been a recent outbreak of COVID-19 due to the omicron strain ( a presumptive diagnosis thus far based on early sequencing data). This outbreak likely began in a local bar and spread to patrons including university students. Omicron may not be more lethal than the delta variant; but it is more contagious, spreading rapidly. The graphs below show the rapid rise in presumptive cases of Omicron variant in KFL&A. The only good news about omicron, based on early data from South Africa, is that it may be less lethal than the delta variant. It also appears to be somewhat less vaccine-responsive, although Pfizer has announced (based on a very small amount of data) that people with the booster shot are well protected.

Rapid rise of cases due to presumptive omicron variants of SARS-CoV-2 in our region. Definitive diagnosis of this variant awaits complete sequencing data

KHSC remains very busy with 19 admitted COVID-19 patients including 8 in ICU and the balance cared for by Medicine (see Figure below). The Medicine service is very busy with 196 admitted patients.

various graphs showing bed management in KHSC

In patient services are busy and include 19 patients with COVID-19

2) New rules for health care workers who plan international travel (including the USA) or receive visitors (including those from the USA).

As the holiday season approaches, I understand the family desire to travel. I know that this is tiresome, and here we are at the end of 2021, still talking about COVID, and still talking about whether we should travel or not over the holiday season. You have all done a fine job keeping up morale during the pandemic and worked incredibly hard; I know this topic is a bit of a downer. Still, it is my responsibility to bring this to your attention. Understanding everyone has their own reasons and their own decisions to make, at this point I do feel compelled to offer my two cents and strongly encourage against international travel during the holiday season. The main issue with international travel is that even for double vaccinated individuals, there are dynamic rules for testing upon return, isolating until the airport return test comes back, and providing a quarantine plan upon return just in case…. And it is all subject to change without warning. See the below links for the most up to date info: COVID-19: Travel, testing and borders - Travel.gc.ca

https://travel.gc.ca/travel-covid/travel-restrictions/covid-vaccinated-travellers-entering-canada#entry-vaccinated

Here are the new rules for health care workers at KHSC:

New rule 1) Any staff, physician, student or volunteer who returns from international travel (including the United States and regardless of vaccination status) must adhere to the following:

Be on work isolation. The only exception is for individuals who travelled to the U.S. for less than 12 hours.
Have a negative PCR COVID-19 test no earlier than 48 hours prior to travelling home.
Perform daily rapid antigen tests for 10 days after returning to Canada:

o AFTER return from travel obtain test kits from Occupational Health, Safety & Wellness (OHSW) Monday through Friday 0700-1600, from the HDH main entrance screening station (until 8 p.m.) or from KGH Kidd-Davies 1 main entrance screening station 24 hours/day. Note: If you use the HDH or KGH main entrance, you can just ask the screener for a test kit and then leave (i.e., saves you a trip to OHSW).

o If you have a positive rapid test, do not report to work and immediately contact OHSW.

New rule 2) staff, physician, student or volunteer must be on work isolation if you live with someone who has returned from international travel in the past 14 days.

New rule 3) re if you have visitors from USA) Any staff, physician, student or volunteer must be on work isolation if they have a visitor from the USA BUT they don’t have to do rapid tests.

New rule 4) Any staff, physician, student or volunteer must self-quarantine if you have a household contact with a confirmed COVID-19 positive individual, regardless of your vaccination status. Do not report to work and contact OHSW.

3) Ontario’s 4^th wave rising: New cases (7382 cases in the past week) up 24% with an 8% rise in hospitalization

There are now over 1000 cases per day in Ontario. Both new and active cases are up, by 24% and 25% respectively. This will ultimately drive increased hospitalizations and deaths (usually over the coming 2-4 weeks) (see graph below).

salmon coloured bar graph with 4 text boxes underneath

It’s hard to predict the next month but it is estimated that if we increase public health measures (limiting travel, assembly in groups, and pay attention to the use of masks and hand washing) we can flatten this rise in cases (see graph below).

This also requires ongoing vaccination of kids 5 years of age and older. In this best-case scenario the 4^th wave could flatten (following the green line). If we don’t change anything we are headed from an ongoing increase in cases (and the new omicron variant only makes the red line scenario worse !

So what to do? Ensure you and your children are vaccinated if eligible, get the 3^rd dose booster shot if you are eligible, and engage in good public health measures, including physical distancing, hand washing and use of masks.

4) Who qualifies for a 3^rd dose of vaccine in Ontario?Starting on Monday, December 13, 2021 at 8:00 a.m., individuals aged 50 and over will be eligible to schedule their booster dose appointment through the COVID-19 vaccination portal, by calling the Provincial Vaccine Contact Centre, through Indigenous-led vaccination clinics, select pharmacies and primary care settings. Appointments will be booked for approximately six months (168 days) after a second dose. In addition the already approved groups (seniors, health care workers, and immunosuppressed people) remain eligible.

5) Canada’s COVID-19 4^th wave on the rise again: A 15% increase in both new cases and an 18% increase in active cases with a 2% decrease in hospitalizations (click here) (click here)

map of Canada and it's surrounding waters

salmon coloured bar graphs with 4 text boxes underneath

Cases in Canada are rising again

Canada’s part of the pandemic is worsening with 4267 cases yesterday and 433 people in ICUs despite reasonable (but not stellar) vaccination rates (77% of people 12 years of age and older vaccinated) (click here) (click here). Canada has had 1.83 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.6% with 29,893 deaths. We administered a total of >62.5 million vaccines!

map of Canada with yellow and blue arrows and numbers showing surging covid cases

COVID-19 Cases surging in NB, PEI, Ontario and Quebec.

Canada still has room for improvement in vaccination with 23% of eligible people over age 12 years still not vaccinated-this is the kindling that fuels wave 4.

6) World vaccine roll-out tops 8.35 billion doses administered but low-income countries lag behind. Vaccine safety record remains excellent (click here)

Canada remains near the top of the international pack when it comes to vaccinating its population. However, vaccination rates are appallingly low in low-income countries. These vaccine deserts cause human death and suffering and allow the virus fertile ground to mutate and create new variants.

colourful horizontal bar graph showing global vaccination

Global vaccination continues to increase

world map with different shades of green to show COVID-19 vaccine doses administered

Low-income countries have barely begun vaccination:This is the main explanation for why omicron variants emerged from South Africa-lots of susceptible people and no vaccines!

Vaccines are safe: You may be interested in this recent blog, “Vaccines for COVID-19: Why are some Canadians allergic to the truth?”. This blog that reminds us how effective vaccines are (see graphic below) and how rare true allergic reactions are.

Thanks to Drs Badawod and Ellis for co-authoring this useful blog!

In addition to many clinical trials showing safety, the safety record of vaccines has been established in the real world (see item 1 in today’s note). The complication rates remain very low based on Canadian data showing that vaccines are safe (click her for Canada’s safety data), as well as being effective against all forms of the coronavirus. Getting vaccinated reduces your risk of hospitalization from COVID-19 33-fold! Vaccination carries a very small risk of serious adverse reactions (8/100,000 vaccines given) and virtually no risk of death.

The serious complication rate in Canada remains low (8 serious adverse events/100,000 vaccines administered). Data as of December 3rd, 2021

7) The global pandemic is not yet controlled: ~269 million cases and 5,292,503 deaths to date with most deaths in the past month in the USA, Germany UK, Russia and France (left column below)

satellite image of earth taken from space

Here is today’s map of the global pandemic. Daily cases are rising (red graph), as are deaths (white graph). Vaccine administration is at a plateau (green graph).

world map with red dots and various graphs and ranking of countries

Global COVID-19, December 10^th, 2021

Final Thoughts

People are a bit discouraged, tired and frayed. This 4^th wave has inundated an already tired population of Canadians. I remain 100% confident we will get through this and emerge intact and proud of all we have accomplished.

Tonight the members of the Department of Medicine and their families will celebrate the holidays and faculty achievement in our on-line version of the annual holiday party. Ever resourceful, we have online trivia, cookie decorating competitions for the kids and a dance competition! Fun can still be had!!!

The doctors in critical care and the DOM recently chipped in to by a comfy chair for our nursing colleagues on Davies 4! Kindness can still be found!!!

Please encourage your friends and family to get vaccinated! Unvaccinated people not only put themselves at risk; but when they fall ill, risk overwhelming our hospitals, blocking care for the 99% of people who do not have COVID-19. Unvaccinated people are also a major pool in which the virus can circulate. This source of virus can potentially infect our children (under age 5 years), who are not protected since they are not yet eligible for vaccination.

Stay well!

December 10, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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December 10, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program