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syringe with needle getting vaccine out of bottle

January 4, 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) Vaccine rollout to start next week at KHSC (our regional vaccine centre)

2) Ontario’s epidemic is not under control with a rate of test positivity of ~10% and over 3000 new cases/day (click here).

3) Update on outbreak of COVID-19 at Joyceville Institution and Collins Bay

4) COVID-19 in KFL&A (see update from KFL& A Public Health)

5) Canada’s COVID-19 epidemic: 607,475 total cases to date, 82,449 active cases and 15,926 deaths (a cumulative case mortality rate of 2.6%) (click here)

6) The COVID-19 global pandemic: 7 million new cases since Christmas with a total of 1,847,186 million deaths and 85,362, 013 million cases (click here):

Regular reminders and updates:

  • KHSC bed capacity (not updated at time of note) 
  • Use the Mobile Screening Tool to expedite clinic visits 
  • KHSC visitor policy
  • COVID-19 testing at Beechgrove Community Assessment Center: (click here): 
  • Increased outbreaks and deaths in Long Term Care facilities (LTC)
  • COVID-19 in toddlers and young children: (click here). No new data since Dec 22nd
  1. Vaccine rollout to start next week:KHSC is a regional vaccine distribution site. We have been notified that we will get our first shipment of Pfizer vaccine from Belgium next week. Vaccinations will start within 24 hours of the arrival of the shipment with the prioritization of administration guided by provincial mandates. Provincial mandates prioritize vaccination of workers and care providers in long term care facilities, followed by frontline health care workers. However, with vaccine supply inadequate to meet demand initially patience will be required as we vaccinate people asap! Vaccination will run from Burr gym at KGH and we will perform a dry run today to ensure all goes well. KHSC will be notify staff of the day they will be vaccinated. Important factors that guide the vaccine team are that:
    1. the clinic will run 7 days/week. 
    2. No doses will be wasted. Any reserve vaccine capacity will be used to vaccinate heath care workers on an on call basis.
    3. KHSC is a regional centre for vaccine distribution so equitable access will be ensured for LTC workers and health care workers at other hospitals and clinics.

Thanks to VP Brenda Carter and Lori Van Manen and their extensive team for leadership over the holidays to prepare for this crucial program.

needle and syringe taking vaccine from bottle
  1. Ontario’s epidemic is not under control with a rate of test positivity of ~10% and over 3000 new cases/day (click here).Ontario has had 194,232 COVID-19 cases 3,270 new cases since yesterday, a record high 9.7% positivity test rate and 192 new hospitalizations since yesterday (click here). Ontario’s provincial rate is 1306.7/100,000 population, now 5-times higher than in KFL&A (260.0 cases/100,000 population). In KFL&A our prevalence has increased 5-fold since the summer! 
table with current overview of Ontario pandemic data

Ontario’s pandemic at a glance Jan 4th 2021 (click here)

The most concerning sign that the lockdown will be needed for some time is the rising rate of positive COVID-19 tests (see graph below, provided by Dr. Gerald Evans, Chair IPAC, KHSC). Note that while rates of positive tests are increasing in Southeastern Ontario (Blue line) the situation in the rest of the province, driven by rates in the greater Toronto area, has skyrocketed (Orange line).

graph showing major increase in positive covid cases in Toronto vs southeastern Ontario

Rates of positive testing have skyrocketed in Ontario

Consistent with the high rate of tests positivity, our 7-day average rate for new cases is now ~3000, triple what it was in early November 2020 (see graph below).

graph showing daily positive covid cases in Ontario

COVID-19’s large second wave in Ontario is resulting in rising rates of hospitalizations (1190 in hospital today), most on Medicine wards (gold below) and the balance, 333, in ICU (black line in graph below) (click here). This ~3/1 ratio of ward to ICU admissions has been fairly constant throughout the pandemic.

graph showing hospitalized and ICU covid cases

Peel (on Toronto’s western border) remains the hot spot in Ontario with 2579.4cases/100,000 population (click here). Toronto’s prevalence remains high at (1973.4 cases/100,000 population, more than double the rate 1 month ago (711 cases/100,000) and ~9 times higher than Kingston) (see map below). Windsor (1974 cases/100,000 population) and Ottawa (992.0 cases/100,000 population) remain hotspots. Eastern Ontario, around Cornwall, continues to rise rapidly (753.2 cases/100,000).

map of Ontario highlighting areas with various covid #'s

Southern Ontario is gradually turning red, as most areas in the south have >500 cases/100,000 population. This is why the lockdown in Ontario will likely be necessary for the foreseeable future,

Neighborhood variation in COVID-19 in Toronto: Most of Toronto’s neighbourhoods are COVID-19 hotspots and have a cumulative prevalence of over 1000 cases/100,000 population (click here).

Toronto waterfront and skyline with CN Tower

Toronto remains a collection of neighbourhoods with vastly different COVID-19 realities due to differences in social/economic, racial and health circumstances. Although COVID-19 is increasing in the city as a whole, case load is widely variable amongst Toronto neighbourhoods. Since the pandemic began the Thistletown-Beaumond neighbourhood has had 5801 cases/100,000 residents, ~ 12X the burden of COVID-19 in the Runnymeade-Bloor West Village neighbourhood (536 cases of COVID-19/100,000 residents). When one examines recent cases (i.e. those diagnosed since Dec 9th), case prevalence is still concerning-ranging from 50 cases/100,000 residents in Runnymeade-Bloor West Village to 980 cases/100,000 residents, in Englemount-Lawrence (highlighted in map below-click here).

map of GTA area highlighting specific areas with high covid

We should avoid travel to and from these hot spots from lower prevalence areas, like Kingston.

3) Update on outbreak of COVID-19 at the Joyceville Institution and Collins Bay: The COVID-19 outbreak at the prison is not resolved but is heading in the right direction. There are currently 54 active cases (8 new cases over the weekend) with 90 recovered people. None of the inmates has required hospitalization over the holidays (i.e. all COVID-19 cases are being managed within the CSC facilities).

4) KFL&A remains a lower prevalence region (see update from KFL& A Public Health)The regional data has not been updated since Jan 3rd.The total number of cases in KFL&A since the pandemic began (as of Jan 3rd 2021) was 549. This is not counting the prison outbreak. As of Jan 3rd there were 47 active cases in KFL&A, decreased from 115 active cases just before Christmas. There are 2 COVID-19 patients hospitalized at KGH. In the last 4 days we have done 2876 tests for SARS-CoV-2 and 70 tests were positive, only 6 of which were from KFL&A. Most positive tests were from the Kwartha area.

table of KFL&A covid-19 data

KFL&A (Jan 3rd data-2 recent KHSCCOVID-19 admissions not shown)

Bottom line: The vaccine will ultimately protect us; however, it will take months to get a critical mass of Canadians vaccinated. Meanwhile we have to rely on good public health practices (as outlined by provincial lockdown). This is the final leg of a marathon and the next 3-4 months will challenge us all to remain patient and follow policies that have harsh financial and social consequences. However, there is light at the end of the tunnel in the form of the vaccines.

3d picture of a tunnel showing depth

5) Canada’s COVID-19 epidemic: 607,475 total cases to date, 82,449 active cases and 15,926 deaths (a cumulative case mortality rate of 2.6%) (click here) We have had 607,475 cases of COVID-19 in Canada since the pandemic began, up ~80,000 cases from Dec 23rd (when the total was 526,371) (see below). 85%% of all cases have already recovered. There has been a ~2.6% mortality rate amongst people diagnosed with COVID-19. Most cases of COVID-19 in Canada have been (in descending order), in Quebec, Ontario, Alberta and BC. Canada has done ~16.4 million COVID-19 tests and has a cumulative test rate positivity (since the pandemic began) of 3.66%. Ontario remains the province with the most testing (~8 million tests) and has a 2.39% cumulative positive rate).

map graph and data of current Covid-19 data in Canada

COVID-19 in Canada: a marked rise in hospitalizations-Jan 3rd 2021 

Rates of infection are high in all Western provinces (BC to Manitoba) but with introduction of more aggressive public health measures rates in these provinces have plateaued (which is the intended outcome of the Dec 26th Ontario lockdown). Thus far Ontario’s rates have not hit a plateau! Rates of new infection remain low in all Maritime provinces. The outbreaks in the North have been controlled with few new cases in the NWT, Yukon, and Nunavut. 

6) The COVID-19 global pandemic: 7 million cases since Christmas with a total of 1,847,186 million deaths and 85,362, 013 million cases (click here): There are now 85,362,013 million cases globally. There have been 1,847,186 deaths. The number of cases has increased over 5-fold since the beginning of August, 2020, when there were 16,296,790 cases globally. The pandemic hot spots are in the USA, India, Brazil, and Russia, with the UK, France and Turkey in hot pursuit! (click here). A bit of a bright note is that the graph showing daily cases (bottom right in orange) is beginning to plateau.

map of the world highlighting high prevalence covid-19 countries and list ranking of countries

Global COVID-19 burden: Jan 4th 2021

The USA with 20,667,587 cases and 351,872 deaths tops the COVID-19 list and accounts for ~24.2% of the global pandemic (up from 21% pre-Christmas), while the USA only accounts for ~4% of the world’s population (see below). The COVID-19 active case map (above) shows the high incidence of infection in the US and South America, as well as in Europe (the bigger the red-colored dot the higher the cumulative incidence-cases/100,000 population). The ONLYsolutions to this are adherence to public health measures and rapid, mass vaccination.

USA positive test rates and extension of border closure (click here): Ontario’s ~9.7% rate of positive tests remains lower than the USA, which has an average positive test rate of 13.5% (click here); however both countries are doing much worse than prior to Christmas (when Ontario’s rate was <5%). Ontario’s rising rate of positive tests is similar to rates in a number of states. However, rates of positive testing in the USA are extremely variable by state (as are public health policies!). South Dakota remains at a staggering 43.8% rate of test positivity today (back up from 36% pre-Christmas). For snowbirds-rates in Florida are rapidly climbing (reaching 13.1% in the past week. 

US and Canada flags with title border restrictions extended until Jan 21

The US-Canadian border closure has been extended until at least Jan 21st, 2021 (click here). That said, Canadians can still fly to America (although certain rules apply) and as discussed in my note in early December, Canadian citizens can return to Canada from America, with a number of requirements, including quarantine) (click here).

Regular reminders

KHSC bed capacity and preservation of elective care despite lock downBed capacity at KHSC has remained stable over the holidays with 110 beds and 47 ventilators available. Our ICU capacity remains extremely limited (by non-COVID-19 cases). We are only reducing elective care to the smallest extent required, ensuring we provide care to the 99% of patients who do not have COVID-19. We recognize that the term “elective care” is really a misnomer-many of these “elective” patients have cancer and other serious disease which will not tolerate delay in care. We are not reducing cardiac work, as just one example, as much of this work is urgent and delay would be life threatening. We are encouraging 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”: One way to safely expedite entry of patients into our facilities is to have all patients complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility for everyone. Reducing lines waiting to enter the clinics will be particularly important as colder weather arrives. 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.

screen shot of KHSC covid-19 prescreening app finger scrolling on smartphone

KHSC visitor policy: One of the hardest aspects of COVID-19 care in the hospital is the need to restrict visitors to ensure we don’t import COVID-19 into the hospital. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected. All details on the policy can be found using this link (click here). 

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 online scheduling system. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). The Beechgrove Complex is 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. 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).

female getting covid nasal swab three young boys dressed up 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.

Increased outbreaks and deaths in Long Term Care facilities (LTC): We have 4060 LTC beds in KFL&A. 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, the 2795 deaths in nursing homes (up 240 deaths since Christmas) account for 59.7% of all deaths in Ontario, click here. There are also ~ 1160 active cases in LTC residents and a similar number of active cases in LTC staff! In the last month the rate of death amongst LTC residents continues to increase daily and is now >50/week! Outbreaks in nursing homes usually start with a person in the community (health worker or family) acquiring the infection and importing it into the facility. Thus, protecting LTCs is best done with a combination of reducing community spread of COVID-19 and ensuring single occupancy rooms in LTCs (as well as appropriate pay for PWS workers, provision of PPE and rapid testing capacity). It is because of these grim statistics that the province has prioritized vaccination of health care workers and residents of Ontario’s LTCs. 

COVID-19 in toddlers and young children: (click here). No updates since Dec 22nd

Stay well! 

 

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