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confirmation email of covid vaccine appt and instructions

February 22, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

All patients admitted to KHSC will undergo Covid-19 testing

1) COVID-19 variant arrives in Kingston (click here)

2) Vaccination of frontline health care workers begins at KHSC: Accepting your vaccination without guilt; waiting for your vaccination without fear

3)What is the cause of the rapid decline in global COVID-19 infection rates?

4) All about COVID-19 Vaccines (nothing new in this section-just reposting for information):

  • Perspective-the rationale for a need to accelerate vaccination prior to spread of variant virus and the need to take a global approach to vaccination (how equity serves safety).
  • Updated FAQs about vaccination 

5) Ontario’s epidemic continues to improve with 1058 new cases yesterday and a further 11% decrease in hospital rates); however, all 3 variant viruses (UK, Brazilian and South African) are present in Ontario and these variants have caused R0 to rise slightly above 1.0 (meaning infection will continue to spread)(click here).

6) Canada’s COVID-19 epidemic continues to improve: There have been 846,714 total cases with 2,351 new cases yesterday There are decreases in new cases (-12%), active cases (-15%) and hospitalizations (-11%) and deaths (-32%) (click here) (click here). 

7) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC): vaccines work!

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1) COVID-19 variant diagnosed in an international traveller (and new policies on international travel come into effect (click here) (click here): An international traveller, who is now quarantined, was diagnosed to have COVID-19. The variant of SARS-CoV-2 is not yet sequenced (and thus is unidentified) (click here). Public health officials have not announced where the person had travelled from. This is a reminder why the government of Canada has imposed strict testing and quarantining restrictions on travellers. Effective today there is a mandatory 3-day hotel quarantine stay required for most travellers landing at Canadian airports as well as mandatory testing and an additional suite of measures(click here). The goal of these measures is prevention of variants from entering the country. Until vaccinations are widespread, the best policy is to avoid nonessential international travel because it risks importing SARS-CoV-2 viral variants which are very common in certain countries, including but not limited to the UK, Brazil and South Africa.

screen shot of newspaper article

2) Accepting your vaccination without guilt; waiting for your vaccination without fear

This week we begin the exciting process of vaccinating our health care workers. This is a good news story. The order in which you are vaccinated is not dependent on an assessment of your employment status or your identity; it is entirely about your risk as identified by provincial guidelines. There will be over 2000 people vaccinated at KHSC this week. 

The order of vaccination is a sensitive subject with so many people are waiting. While no order of distribution will satisfy everyone, Canada’s recently improved pipeline vaccination will quickly move to include all frontline health care workers and then on to the rest of society. The order of vaccination is based on guidance from two documents, “Guidance for Prioritizing Health Care Workers for COVID-19 Vaccination” (click here) and Ontario’s “Ethical framework for COVID-19 vaccination distribution” (click here). These guidelines use criteria that determine vaccine order based on probable vulnerability to the virus (be that personal risk or risks to patients you interact with) and exposure risk as major criteria for early vaccination. This is why people who live in or work in long-term care (LTC) facilities were the first to be vaccinated. LTC sites account for almost 60% of all COVID-19 deaths in Ontario. Since vaccinations have been administered to the vast majority of residents and workers in LTCs, rates of infection and mortality have shown huge decreases. While we could each envision some other order of vaccine administration this is a futile exercise at this point.

Your order in the KHSC vaccine queue is not dependent on whether you are staff, faculty or traineerather it is based on where you work and the associated provincial risk ranking. All who work in an area prioritized for vaccination (be they employees, physicians, learners, contracted staff or volunteers who regularly work in or provide care in an area ) will receive an vaccine invitation at roughly the same time.

Please make sure you check your KHSC email as the vaccine team will be sending out appointment invitations by email and appointments are booked on a first come first serve basis for people within your vaccine group. For physicians the notice is sent to their “preferred” email, as listed with KHSC. I strongly urge you to take the vaccine when offered. Do it for yourself! Do it for our patients! Do it for your family. Do it so we can get back to normal as a global society!

Here is a listing of the locations of people who will be in the first wave of vaccination, which starts tomorrow (groups in the next waves are listed at the end of this section).

table listing of vaccination phases

If you are in this group you will get an email inviting you to accept your vaccine. The invitation takes you to a site where you select an appointment time. You will then be asked to show up at the vaccination site (Burr gymnasium) 10 minutes before your vaccine time.

image confirming vaccination appt and instructions

The KHSC COVID-19 Vaccination Clinic is located at KHSC’s Kingston General Hospital site George St Entrance

Instructions: 

  • Please wear your mask.
  • Bring your workplace ID to verify eligibility upon arrival
  • Also Bring your: 
  1. Completed paper consent form
  2. Completed Pre-screening
  3. Health card - you are required to bring your health card or bring another form of a government issued-photo ID such as a driver’s license, passport, Status Card or other provincial health cards.
  • Please arrive on time but do not arrive more than 10 minutes before your appointment.
  • Give yourself 30 minutes to complete the vaccination process.
  • Wear a loose-fitting top or a t-shirt so that the health care provider can easily access your arm for the vaccination
  • Please review the COVID Vaccine Fact Sheet.

If you have symptoms of COVID-19, you should not attend the clinic.

Who is in the next wave of vaccination at KHSC? The list is below but since vaccine supply is a week to week process (i.e. we don’t know our vaccine supply long in advance) stay tuned for the invitations. If you are not in the first group, keep an eye on your KHSC email.

Table listing depts in phase 2, 3 &4 of vaccinationTable listing depts in phase 5,6 & 7 of vaccinationTable listing depts in phase 8 of vaccination

A few reminders about the reality of the vaccine program. The rate of vaccine roll out is largely a function of vaccine supply, rather than our capacity to vaccinate, and this will be true at least for the next 1-2 months, despite an improving supply of vaccines.

I have heard concerns from a number of high-minded physicians about concern about the ethics and optics of them receiving a vaccine before others (staff, co-workers, family members etc.). This angst is understandable. For those in the vaccine vanguard who are concerned about “going early” here is my advice:

  1. We don’t control the order of vaccination and so if you are in the first group you should definitely take the offered vaccine. Everyone will understand that you did not lobby for a vaccine; you were assigned because of your role/risk etc. In fact by following protocol you are serving as a positive role model for people, indicating your confidence in the vaccine and your willingness to abide by Ontario’s vaccine plan.
  2. Once we vaccinate all the people in your priority group we will then be authorized to go to the next priority group. Thus, by getting promptly vaccinated you are speeding things up for those in the next highest priority group.
  3. While you can decline vaccination you can’t give your vaccine to someone else. Therefore, it makes no sense to decline vaccination based on the understandable desire to “help others”.
  4. Canada’s vaccine supply is ramping up quickly and we will soon have adequate vaccine supply to vaccinate people in tiers 2-8 of Ontario Health’s vaccine hierarchy. 
  5. In 2021 all people willing to be vaccinated will be vaccinated! No person or government has a perfect strategy. Let’s celebrate the success in creating a robust local vaccine program and not focus too much on the order in which these vaccines are rolled out.
  6. It is our responsibility to promptly respond to the call to get vaccinated (i.e. once appointments begin please change your schedules to meet the vaccination schedule). Vaccination requires only 30 minutes your day and it would be impossible to customize schedules for every practitioner.

A huge thank you goes out to Joanna Noonan, Stephanie Kovala and Chris Gillies for their time and effort put forth in the coordination of the scheduling of vaccines for KHSC staff, trainees and faculty. Well Done!

2) Five reasons for the recent decline in COVID-19 rates. As with most things in the pandemic there is no simple answer and no easy cause/effect evidence.

First, it is true COVID-19 infections are in rapid decline. There have been 111,565,427 cases and 2,469,729 deaths since the pandemic began. Active case rates have been declining since the beginning of 2021 (click here) (see orange graph of daily case rates, orange bottom right). 

world map with pink dots and ranking lists of countries with the most covid

Global COVID-19, Feb 22nd 2021: The number of active cases (salmon dots on map) is declining globally (orange graph on right) 

The USA, with 28,140,927 cases and 499,186 deaths, tops the COVID-19 list and accounts for ~25.2% of the global pandemic (up from 21% pre-Christmas) but things are improving rapidly in the USA, due likely to natural immunity, vaccine acquired immunity and better adherence to public health measures. 

Reasons for decline 1) Vaccination

Some countries have a high prevalence of vaccination (like Israel, USA, and the UK) whilst others have low vaccine rates (Canada, Brazil India for example) (click here).

colourful line graph ranking countries with the highest vaccinations given

Higher rates of vaccination in Israel, US, UK versus Canada, China, Brazil, China and India (click here

Countries with a high prevalence of vaccination (like the USA, UK and Israel) appear to be seeing steeper rates of decline in COVID-19 than those with low rates of vaccination (Canada, India and China) (see below) (click here).

colourful line graph showing countries with a decline in covid cases

Let’s consider America. Between vaccination, diagnosed infection and undiagnosed infections there are now a lot of Americans with immunity to SARS-CoV-2. In the USA 64.2 million vaccines had been administered, as of Feb 22, 2021 (click here). At the current rate of vaccination the target of 75%, likely what is needed to achieve herd immunity, will be achieved in ~10 months. However, globally things are not going well. The map below shows continents with little vaccination (e.g. Africa). At the current vaccination rate it is estimated that it will take 4.8 years to vaccinate the world’s population (click here).

world map with green shading showing 92 countries who have received vaccinations

2) Natural immunity acquired from infection: In addition to those vaccinated, another 28 million Americans are known to have been infected, which makes them immune as well (we assume). As discussed in earlier notes, 5-80% of people with a positive SARS-CoV-2 test are asymptomatic (click here). Thus, globally there may be another 5-80 million people globally who have been infected but undiagnosed. If we assume that for every diagnosed case there is another undiagnosed case then there have been 56 million Americans infected (and thus immune). When one adds to this number the 64 million vaccinated Americans, one can estimate that ~37% of Americans might be immune. This is in the range of immune prevalence where one might reasonably see herd immunity beginning to exert a detectable suppressive effect on the spread of infection. Remember herd immunity is not all or none; the more immune people the harder it is for the virus to spread. Whether due to better mask adherence, rapid vaccine roll out, post-infection immunity or seasonality, the USA has seen a continued reduction in positive test rates for over a month (with rates now at 4.8%, the lowest since June 2020, click here; see below). 

line graph over bar graph showing decline in positive covid cases in USA

Continued improvement in positive test rates in the USA (currently 4.8% positive), Feb 22nd 2021

Reason 3) Public health measures work: In the absence of plentiful vaccinations Canada has made progress in reducing COVID-19 through lockdowns and adherence to public health measures (click here)! The graph below shows the collapsing of wave 2 in Ontario which coincided (within days) of a provincial lockdown (beginning Dec 26th 2020).

coloured line graph

Ontario’s lockdown correlates with the decline in , Feb 18th 2021

If you are a public health skeptic Canada offers a lesson. Each province had its own peak case rate in wave two and each administered lockdown asynchronously. The benefits of lockdown occurred in the absence of vaccine in each case within ~ 2 weeks of a lockdown. See the examples of Alberta and Manitoba, below. Nonetheless, we need vaccines to protect society long-term because a strategy based primarily on ongoing lockdowns and rigorous masking etc. is not desirable/sustainable.

colourful line graph showing decline in cases in AlbertaColourful line graph showing decline in active cases in Manitoba

Orange lines show new cases in Alberta (left) and Manitoba (right)

Lockdowns in Alberta (Nov 24th, 2020) and Manitoba lockdown (Nov 10th, 2020) resulted in a reversal of the rise in COVID-19 infections that had been occurring in these provinces. This is all pre-vaccine!

Reason 4) There is less testing being done so we maybe are under counting new cases: Another possibility is that we are no longer being vigilant in looking for COVID-19. Since most cases are mild (or minimally symptomatic) it’s easy to miss the disease in young people if you don’t do a COVID-19 test. Testing rates are down in most countries (see below). Thus, the wave 2 decline could (in part) be a failure of surveillance. COVID-19 fatigue and under testing however is unlikely the whole story.

colourful line graph showing decrease in covid testing per country

Reason 5) Seasonality. We saw a major decrease in COVID-19 in the warmer summer months and it could be the virus has a preferred season (just like influenza, which rises in the fall and winter). Seasonality is not just a function of outdoor temperature and humidity. Winter in the northern hemisphere alters human behaviour and brings us indoors and into closer proximity. Winter’s dry mucous membranes, coughing and sneezing don’t help! It is well established that being indoors and in close proximity to others promotes the spread of coronaviruses. For more on this see this interesting article in the Atlantic (click here). While you can see the summer dip in COVID-19 in Canada in 2020, (click here, see below), it hard to argue for seasonality as a cause for the January decline in infection in Canada. It is much more likely this reflects the lockdowns that occurred in almost all provinces. Indeed, each provincial lockdown resulted in a province wide decline in case numbers within 1-2 weeks of the implementation of stricter public health policy.

orange bar graph showing decline of covid cases last summer in Canada

2020s summer reprieve from wave 1 of the COVID-19 pandemic

So in summary: Wave two is improving and the answer to the question “why” is multifactorial, a mixture of acquired immunity (from vaccines and from infections), adherence to public health measures, possible failures of case surveillance (under-testing) and perhaps seasonal variation. There is no question however that we need to accelerate global vaccination to create high levels of immunity around the world before more infections and lethal variants arise that have the ability to reinfect and thwart the immunity of both natural infections and vaccinations.

Canada’s vaccination roll-out update-million person vaccinated mark passed (click here): Canada’s roll out of vaccine has been slow; but vaccine supply has markedly improved this week. To date, 1,851,710 doses of COVID-19 vaccines (including both Moderna and Pfizer-BioNTech) have been delivered. Thus far, 82.3% of delivered doses have been administered. 1,055,288 Canadians have received at least one dose of an approved COVID-19 vaccine (see below). 468,510 Canadians are fully vaccinated (click here).

map of Canada with each province labelled and the number of vaccines given per province

Number of vaccinations in arms as of Feb 22nd 2021

Adverse effects of vaccines are rare (occurring in 0.078% of people vaccinated): Based on the clinical trials and experience in millions of people who have been vaccinated world-wide we can be reassured of vaccine safety and efficacy. All the side effects (called adverse events and abbreviated AEFI) are tracked and reported by the government of Canada (see below). (click here).

table with side effects from vaccine and numbers listed

3) All about COVID-19 Vaccines: 

  • Perspective-the rationale for a need to accelerate vaccination prior to spread of variant virus and the need to take a global approach to vaccination (how equity serves safety).
  • Updated FAQs about vaccination effectiveness against viral variants and safety of vaccination for people on blood thinners, with allergies or people who are immunosuppressed 

Perspective on why we need to vaccinate quickly (and globally): Rich countries have vaccines; poor countries do not. In Canada we are understandably frustrated by the slow vaccine rollout; but we can be fairly confident that we will be vaccinated sometime this year. People in low income countries are not so fortunate. This is unacceptable for several reasons, one related to social justice and the other to the nature of viral infections. Canada is appropriately under pressure to vaccinate its residents not just to save lives but also to allow reopening of society. There is also time sensitivity, because the longer we have huge swaths of society susceptible to the virus the more damage the new highly infectious viral variants (mutants) can do. The risk of the rapidly evolving and mutating SARS-CoV-2 is real.Just in the last week or two there is yet a new mutation of the already mutated “British variant” of the virus. This new mutation is called E484K, and is also found in the highly contagious Brazilian and South African variants (click here). This mutation makes it easier for the virus to bind to human cells and evade antibodies. These mutations don’t defeat the vaccine but do slightly reduce its effectiveness.

The South African variant has three or more mutations and is more resistant to existing vaccines than the original SARS-CoV-2. Early reports related to the newer vaccines from Novavax and Johnson & Johnson, reportedly show less effectiveness against these mutant viruses. Their study included 50% of people infected with the UK variant virus (click here). Whilst the vaccine was 95.6% effective against the original COVID-19 strain it was only 85.6% effective against the UK variant strain. This vaccine is also effective against the South African variant, however once again less so than against the original coronavirus, offering only 60% protection in a population where most infections were caused by the South African mutation variant (unpublished data (click here). Also in unpublished data, Johnson & Johnson said the level of protection of its new vaccine is 72% in the United States, 66% in Latin America and 57% in South Africa (click here). These effectiveness numbers sound low but it there is some good news from the Phase 3 ENSEMBLE trial (conducted in eight countries across three continents including 34% (N= 14,672) of participants over age 60). The study shows that the J&J vaccine offers complete protection against hospitalization and deaths, 28 days post-vaccination (click here). So, while there may still be risk of infection the vaccine eliminates the really bad infections!

If we could mass vaccinate globally viral spread would stop and with it mutation generation. This would quickly end the pandemic. But will rich countries share vaccine? In a recent Nature paper, Canada doesn’t look great in this regard. We have more secured vaccine per person than any other country (click here).

horizontal bar graph ranking countries with most vaccine supply

Canada has done well to secure vaccines-it will do well to share them!

The article notes, “Low- and middle-income countries are let to rely on contributions from COVAX, a joint fund for equitable distribution of COVID-19 vaccines led by Gavi, a funder of vaccines for low-income countries based in Geneva, Switzerland, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations (CEPI) in Oslo” (click here). They have secured 700 million vaccine doses so far and want to provide 2 billion by the end of 2021. They have the goal of supplying 20% of the population of participating countries. More than 189 countries have signed up to COVAX, including wealthy economies that have joined to subsidize vaccine access.” 

In addition to compassion for our fellow humans, vaccine disparities represent a problem. As long as large groups of people (billions) are unvaccinated, the virus will thrive and mutate. Ultimately our own greed/apathy would come back to bite when these future mutants might well evade vaccines and reinfect people in rich countries. So, we need to do right by all people. Canada has recently drawn criticism by being the first country to use some of the vaccine it had offered to COVAX for our own domestic use (done because our domestic supply chain was disrupted) (click here). Once we get our momentum in domestic vaccination, we need to share our (anticipated) vaccine wealth; not for charity, nor for praise, but because it is both ethical and a part of the solution to end the pandemic.

Here are answers to some updated FAQs with answers to common questions about the COVID-19 vaccines.

FAQ 1) Does the vaccine work against new variants (mutations) in the SARS-CoV2 virus? Short answer is a qualified YES. The vaccines work albeit not quite as well for the variants. In the 144,000 participants in all randomized clinical trials of vaccines to date, those receiving any active vaccine had only 3 cases of severe COVID-19 (vs 37 in the control group). There were no deaths in people who were vaccinated with any of the vaccines versus 5 deaths in the control group. Even though absolute protection is slightly less for UK and South African variants the vaccines (including the AstraZeneca vaccine) prevent serious adverse outcomes (like hospitalization and death). Thus, despite variant viruses the vaccines are lifesavers!

FAQ 2) I’m on a blood thinner, can I be vaccinated for COVID-19? Short answer YES. Here is a more detailed answer from an Canadian agency with expertise on the use of blood thinners, Thrombosis Canada

memo from Thrombosis Canada for those receiving vaccine

FAQ 3) I have a history of allergic reactions, can I be vaccinated for COVID-19? Short answer YES. Out of ~1.8 million vaccinations there have only been 21 reported episodes of anaphylaxis (the most serious type of allergic reaction). Most (70%) of these events occurred within 15 minutes of the vaccine (while the patient is still being monitored, as summarized in a Jan 6th MMWR CDC article). There were also 83 cases of non-anaphylaxis allergic reaction after Pfizer-BioNTech COVID-19 vaccination with symptom onset within the 0–1-day risk window. Most (87%) of these allergic reactions were classified as nonserious. Thus, the risk of severe allergic reactions to the Pfizer vaccine are low and manageable. Allergy testing is NOT necessary prior to COVID-19 vaccination even in people with history of allergies. It is important note that none of the people who developed anaphylaxis after vaccination died and most did not have a prior history of anaphylaxis (see table below). The incidence of anaphylaxis is lower still with the Moderna vaccine.

The adverse effects of the COVID-19 vaccines clinical trials are similar in vaccinated people vs people (in the clinical trial who got a placebo-saline injection) except for local pain at the vaccine site and increased muscle ache and headache, all of which were short-term (see below). This is a very good safety profile relative to other vaccines.

chart listing side effects for Pfizer vs placebo

The CDC does advise against the use of the two mRNA vaccines for a very select group of people with the following allergy histories (click here):

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine or any of its components
  • Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19 vaccine or any of its components (including polyethylene glycol [PEG])*
  • Immediate allergic reaction of any severity to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)*

FAQ 4) I’m immunosuppressed, should I get vaccinated? This question has a less clear answer. First, be reassured is no virus (dead or alive) in the Pfizer or Moderna vaccines so it is not possible for a person to get infected from the vaccine. However immunosuppressed people were not included in the initial clinical trials. That said, they probably are safe to be vaccinated but this is more a matter of expert opinion. In Canada the National Advisory Committee on Immunization (NACI) currently advises that the COVID-19 vaccine should not be offered to populations excluded from clinical trials “until further evidence is available.” However, they also say (an immunosuppressed person or those with an autoimmune disorder can still be vaccinated if a risk assessment deems that the benefits of vaccine outweigh the potential risks for the individual.” (click here).

The British Society for Immunology recently issued a statement indicating that vaccination is safe in immunosuppressed people (click here), albeit the resulting immune response may be weaker. They remind us that because there is no virus in the vaccine there is absolutely no risk of acquiring COVID-19 from the vaccine. Our own Dr. Mike Beyak (gastroenterology) nicely summarized evidence from a registry of ~4500 patients who were immunosuppressed for their inflammatory bowel diseases (Crohn’s disease and ulcerative colitis). There was no increased risk of contracting COVID-19 in these 4500 patients. Apart for patients on prednisone, there was also no increased complications from COVID-19 when it occurred. Interestingly, some biologic therapies (antibody treatments for IBD) actually appear to reduce adverse outcomes in IBD patients who contracted COVID-19. This is not surprising since the truly bad outcomes in COVID-19 seem to occur in people who mount a hyper-aggressive immune response. Overall these data are good news for our many patients with rheumatoid arthritis, asthma and IBD who are on immunosuppressive therapies. However, since these people were not included in the vaccine clinical trials, it is advised they consult the physicians/clinic that is managing their care to inform their vaccine decision.

FAQ 5: How long can I wait after my first dose to get a second vaccine dose? It appears a second dose at day 42 is as effective in producing a neutralizing antibody response as when the dose is given at day 21 (the normal interval from dose 1). This more lenient 42-day protocol has been approved by Health Canada.

syringe and needle drawing vaccine from bottle

FAQ 6: Can I get COVID-19 from the vaccines? This answer is simple-NO! None of the approved vaccines in Canada contain the virus itself. They do not contain live virus; they do not contain dead virus. Canada’s approved vaccines (from Pfizer and Moderna) contain only the messenger RNA (genetic code) to allow you cells to make the viral spike protein which then triggers your immune cells to build anti-spike antibodies which protect you. So, while you might get a sore arm or a fever from vaccination this is just your immune system responding as it should; there is no chance of getting COVID-19. Obviously one could contract COVID-19 around the time of vaccination the normal way, before the vaccination’s protection develops (i.e. in the first 2 weeks after vaccination). 

5) Ontario’s epidemic continues to improve with 1058 new cases yesterday and a further 11% decrease in hospital rates); however, all 3 variant viruses (UK, Brazilian and South African) are present in Ontario and these variants have caused R0 to rise slightly above 1.0 (meaning infection will continue to spread)(click here).

The COVID-19 epidemic is markedly improved in Ontario (see below) with new case rates below 1100/day. The rates of new and active cases have declined 6% and 14% respectively over the past week and the provincial death rate is down 11% (likely due to the effective LTC resident vaccination program). Ontario’s test positivity rate is plateaued at 3.3%.

salmon coloured bar graph peaking in the middle then dropping off

COVID-19 second wave continues to improve-Feb 22nd, 2021 (click here)

The slide below (from Dr. Gerald Evans) shows a rise in the viral reproduction number. It is believed that this is occurring because of the emergence of new, more infectious variant viruses in Ontario. This is a reminder of the absolute necessity of ongoing adherence to public health practices while vaccines roll out.

grey bar graph with red line graph

Rising R0-role of variant viruses

The graph below, also from Dr. Evans shows that there remains high rates of infection in Toronto, Peel, and York (in blue bars).

various bar graphs showing high rates of covid in toronto area

The figure below maps Ontario case rates in the past week (green good; blue and red bad). Note, more green and gold than we have seen in many weeks, which is great news! KFL&A is in Gold zone and our neighboring counties are in the Green zone.

map of Ontario colour coding areas. based on the amount of covid and the zoning

5) KFL&A COVID-19 rates remain amongst the lowest in the province with 21 active cases in our region (see update from KFL& A Public Health)The total number of cases in KFL&A since the pandemic began is 709, not counting the prison outbreak. This is up 4 cases from Thursday. The prison outbreak has been resolved with no new positive tests in the past week (after a total of 160 cases amongst inmates). There has only been one death of a KFL&A resident since the pandemic began. There are 21 active cases in KFL&A, 10 in Leeds-Grenville, and 12 in Hasting- Prince Edward county for a total of 43 active cases in South Eastern Ontario, up 13 from last week. We have run 4545 tests run in our lab in the past 7 days, 45 positive. Our test (+) rate is <0.5% (0.7% for south eastern Ontario). None of these positive tests were from KFL&A. There remain 4 COVID-19 patients hospitalized at KGH, all in ICU. 

table summarizing current covid data for KFL&A

COVID-19 in KFL&A Feb 22tnd 2021

Late breaking notice: The Limestone school board has just communicated that staff and students with any new or worsening symptom of COVID-19, even those with only one symptom, must stay home until they have a negative test result, have an alternative diagnosis, or it has been 10 days since their symptom onset and they are feeling better. This may also require the household to quarantine when a child has only one COVID-19 symptom. This will likely create challenges for our parents with kids in Limestone schools.

5) Canada’s COVID-19 epidemic continues to improve: There have been 846,714 total cases with 2,351 new cases yesterday There are decreases in new cases (-12%), active cases (-15%) and hospitalizations (-11%) and deaths (-32%) (click here) (click here). 

There have been 21,685 COVID-19 deaths thus far (a cumulative national case mortality rate of ~2.05%). Canada has performed 24,310,638 million COVID-19 tests with a cumulative test positivity rate of 3.48%. There is a gratifying decline in both ward and ICU hospitalizations (see below). We are now seeing a large reduction in deaths. 

salmon coloured bar graph showing decline in Canada's covid cases

Improvement in wave 2 continues: Feb 22nd 2021 (click here).

Rates of infection remain plateaued in all Western provinces (BC to Manitoba) as a result of introduction of more aggressive public health measures. Saskatchewan too has now seen a decline in rates and assumed a new lower plateau trajectory. Rates in Ontario and Quebec (home to almost 63% of all Canadians) are experiencing a lockdown-induced decline. Infection rates remain low in the other Maritime provinces and in the North. However, the sudden rise in COVID-19 in Newfoundland persists, a reminder that with <2% of Canadians vaccinated, the vast majority of the population remain as susceptible to COVID-19 as they were a year ago.

colourful line graph showing increase in covid cases in Newfoundland

COVID-19 outbreak continues in Newfoundland, although new case numbers (orange) not up from yesterday (see rise in active cases-orange line-click here), Feb 22nd 2021

6) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines working: Most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and LTC facilities. As of today, the 3,734 deaths in nursing homes (up 4 deaths in the past week) account for ~57% of all deaths. In contrast, LTC residents account for only 5.3% of all cases in Ontario, click here. There are ~ 126 active COVID-19 cases in LTC residents and 242 active cases in LTC staff. These numbers are rapidly and massively declining each week for the past 4 weeks, which is very encouraging!  These statistics (see below) show the beneficial impact of the province’s decision to prioritize vaccination of health care workers and residents of Ontario’s LTCs. In KFL&A we will finish the vaccination of LTC residents by next week.

table of current covid data in LTC

Ontario LTC’s are improving rapidly because of vaccinations

three senior citizens sitting at a table all wearing masks

Regular reminders

KHSC bed capacityBed capacity is adequate with 81 beds available (up 14 from last Thursday) and good ventilator capacity (48 units). Critical care beds are never plentiful but there is better reserve than we have seen in the past month (see below). Medicine remains busy with our doctors caring for people in 184 beds, not including ICU beds on Davies 4 staffed by the Medicine program. 

graph showing bed capacity on KHSC covid areas

ICU capacity (light blue) is adequate

We are committed to providing care to the 99.9% of patients in SE Ontario who do not have COVID-19. In addition to acute care for heart attacks, strokes and trauma etc., we are continuing to provide elective care. We recognize that the term “elective care” is really a misnomer. Many “elective” patients have chronic pain and disability or suffer from cancer and other serious diseases and will not tolerate delay in care. We continue to encourage physicians to optimize the use of e-health visits. We are also reminding patients who are coming to clinics in person that unless it is essential (and approved) they need to come alone, to minimize crowding in our clinic waiting areas. That said, it remains VERY safe to attend appointments at our clinics or to come to hospital for needed care!

Use the Mobile Screening Tool to expedite clinic visits: Complete the COVID-19 pre-screening tool here and you will be able to “skip the line”: All patients should complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility. The mobile screening tool only takes a few minutes to complete and you will receive an email with confirmation to bring with you, along with your appointment slip, in printed form or on your mobile device. To complete the mobile-screening in English, click here and in French, click here.

prescreening app on iPhone with finger scrolling

KHSC visitor policy: We continue to strongly discourage visits from people coming from Red Zones, like Toronto. Details on our visitor policy can be found using this link (click here). This is one of the hardest aspects of COVID-19 care in the hospital. Nurses in particular bear the burden of fielding numerous requests for visitation and while many requests tug on the heart strings we need to keep our hospital safe so it can function for the good of all residents. There are exceptions made to allow visitors under exceptional circumstances, particularly for palliative or dying patients. These exceptions are usually for a single visit. Our policy is necessary to prevent importation of infection to the hospital which would impair our ability to care for all patients. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected. 

COVID-19 testing at Beechgrove Community Assessment Center: (click here): All COVID-19 test must be scheduled appointments (versus walk in). Appointments can be scheduled using our on line scheduling system. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily. To be tested you will require: A valid Ontario health card or a piece of photo identification. You must also wear a mask and maintain physical distancing at all times while in the walk-in line (click here).

animated photo of female getting nasal covid swab testthree young boys all dressed as doctors

Because health care workers (doctors and staff) are increasingly having to miss work because their children have been sent home from school or daycare with symptoms of a upper respiratory tract infection, we have arranged that their children can access expedited testing at Beechgrove . The goal of this service is simply to allow the healthcare worker to return to work as quickly as possible for the public good. The children of staff will be tested between 1230 -1300 by appointment, 7 days/week. The new program for families applies to children up to age 18, an includes children of staff and physicians who provide clinical care and service. Staff and physicians themselves should contact occupational health to book their testing appointment. To book an appointment for a child, KHSC staff should call 613-548-2376. Testing of clinical staff and faculty and their children is processed at the KHSC lab with an average turnaround time of less than 24 hours.

COVID-19 in toddlers and young children: (click here). It has remained true throughout the pandemic that children in general are less severely affect by the virus and young children are somewhat less infectious (perhaps because they are less sick). Rates of infection are very low in preschool children. 

The situation in Ontario schools remains stable. The good news is the reopening in the 7 areas where it was permitted has not resulted in major increases in new cases. Below is the new baseline report for school age children in publicly funded Ontario schools. School boards report every weekday from Monday to Friday. There have been 5560 students with COVID-19 since the pandemic began; 340 new cases in the past 2 weeks.

4 teenagers sitting on a bench with iPhones, iPads and books

Here are the parallel data from licensed childcare facilities in Ontario-where there have been 1282 children infected since the pandemic began, 166 new cases in the past 2 weeks.

young children all sitting on a classroom floor

 

After the email of my covid note went out I received information that we recently received the transfer of three Covid-19 positive patients from Moose Factory.  Two of these patients are on Internal Medicine floors while the third is in the ICU.

Stay well! 

 

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