January 7, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
All patients admitted to KHSC will undergo Covid-19 testing
1) Vaccine rollout to start soon at KHSC (which is a regional vaccine centre)
2) Ontario’s epidemic is not under control with a rate of test positivity of 6.1%, 1472 hospitalized patients (1/4 in ICU) and 3266 new cases/day (click here).
3) Update on outbreak of COVID-19 at Joyceville Institution and Collins Bay
4) COVID-19 rates remain stable in KFL&A (see update from KFL& A Public Health)
5) Canada’s COVID-19 epidemic: 626,796 total cases to date, 82,740 active cases and 16,369 deaths (a cumulative case mortality rate of 1.9%) (click here)
6) The COVID-19 global pandemic: A total of 1,886,921 million deaths and 87,384,218 million cases, 2 million more since Monday (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 21st
1) Vaccine rollout to start soon at KHSC (which is a regional vaccine centre): KHSC is a regional vaccine distribution site. We have not yet received our vaccine allocation. Vaccinations will start within 24 hours of the arrival of the shipment with the prioritization of administration guided by provincial mandates. There has been new guidance received about how to effectively distribute the Pfizer vaccine to off-site vaccination clinics once we have our onsite clinic running. This is important since the Pfizer vaccine has requirements for extreme cold storage. Provincial mandates prioritize vaccination of workers and care providers in long term care facilities, followed by frontline health care workers. 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:
- The clinic will run 7 days/week.
- No doses will be wasted. Any reserve vaccine capacity will be used to vaccinate heath care workers on an on call basis.
- 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.
In terms of managing expectations: information flow re: timing of vaccine distribution is controlled at a governmental level beyond KHSC. I apologize for the lack of detail in my note but will share information once its available and deemed reliable. Also, a reminder that vaccine supply will initially be insufficient to meet the pent up demand and patience will be required as we vaccinate people in accordance with provincially determined prioritization guidance!
- Ontario’s epidemic is not under control with a rate of test positivity of 6.1%, 1472 hospitalized patients (1/4 in ICU) and 3266 new cases/day (click here).Ontario has had 200,626 COVID-19 cases 3,266 new cases since yesterday, a slight reduction in our positive COVID-19 test rate from 9.7% on Monday to 8.5% today/. Ontario’s provincial rate is 1349.7/100,000 population, now 5-times higher than in KFL&A (271.07 cases/100,000 population). In KFL&A our prevalence has increased 5-fold since the summer!
Ontario’s pandemic at a glance Jan 7th 2021 (click here)
COVID-19’s large second wave in Ontario is resulting in rising rates of hospitalizations (1472 in hospital today with 363 in ICU beds). Most patients with COVID-19 are cared for on Medicine wards (gold below) and the balance are in ICU (black line in graph below) (click here). This ~4/1 ratio of ward to ICU admissions has been fairly constant throughout the pandemic. The government need to be mindful of this fact as they distribute resources to support pandemic care. Their rhetoric often to focus on supports for Emergency Departments and Critical Care Units (which are important) and too often fails to mention Medicine Units, such as Connell 3 at KGH, which 75% of COVID-19 care is provided. Fortunately, at KHSC the administration is well aware of our local reality! On this note a huge shout out to our amazing staff of nurses and other health care workers on Connell 3 and to the able leadership of Michelle Matthews (POD Medicine) and her Medicine program management team! In partnership with Dr. Chris Smith and Dr. Kristin Marosi they are ably ensuring we are prepared to manage COVID-19, even if admission numbers surge-KUDOS team Medicine!!!
Peel (on Toronto’s western border) remains the hot spot in Ontario with 2650.2 cases/100,000 population (click here). Toronto’s prevalence remains high at (2024.1 cases/100,000 population, more than double the rate 1 month ago (711 cases/100,000) and ~9 times higher than Kingston. Windsor (2056.4 cases/100,000 population) and Ottawa (1013.8 cases/100,000 population) remain hotspots. Eastern Ontario, around Cornwall, continues to rise rapidly (797 cases/100,000). These hotspots, which include much of Ontario’s population, have rates 4-10 times higher than KFL&A, which is why elective travel to Kingston from these areas should be avoided.
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 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 6168 cases/100,000 residents, ~ 10X the burden of COVID-19 in the Beaches neighbourhood (556 cases of COVID-19/100,000 residents). When one examines recent cases (i.e. those diagnosed in the past month), case prevalence is still concerning-ranging from 60 cases/100,000 residents in Runnymeade-Bloor West Village to 955 cases/100,000 residents, in Westminster-Branson (click here).
We should avoid elective 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 67 active cases at Joyceville. None of the inmates has required hospitalization over the holidays (i.e. all COVID-19 cases are being managed within the CSC facilities). Canadian Correctional Services has announced they will be providing the prison with 1200 vaccine doses for vulnerable imamates (although there is no detail on timing).
4) COVID-19 rates remain stable in KFL&A (see update from KFL& A Public Health)
The total number of cases in KFL&A since the pandemic began is 597. This is not counting the prison outbreak. There are currently 50 active cases in KFL&A, decreased from 115 active cases just before Christmas. There are 2 COVID-19 patients hospitalized at KGH. There was one new staff case at KHSC over the holidays and contact tracing is being done (with no evidence of transmission to date). In the last 3 days we have done 2705 tests for SARS-CoV-2 and 49 tests were positive. Most positives are from the Kawartha area. There are 128 active cases in all of South Eastern Ontario. There are 9 regional outbreaks (all in KFL&A). The Beechgrove assessment centre remains very busy, particularly as students return to Kingston. The team at Beechgrove is doing 300-350 tests/day. Starting Monday we will restart our Queen’s satellite testing centre at Mitchell Hall (stay tuned for details).
Table showing the outbreaks in KFL&A (which appear to be reducing in number)
Graphic showing the outbreaks in KFL&A (which appear to be reducing in number)
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.
5) Canada’s COVID-19 epidemic: 626,796 total cases to date, 82,740 active cases and 16,369 deaths (a cumulative national case mortality rate of 1.93%) (click here) We have had 626,796 cases of COVID-19 in Canada since the pandemic began, up ~100,000 cases from Dec 23rd (when the total was 526,371) (see below). Our second wave of active cases (orange line) has yet to reach a clear plateau (and certainly has not begun to decline). 85%% of all cases have already recovered. There has been a ~1.9% national 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 (top left below). Ontario remains the province with the most testing (~8.23 million tests) and has a 2.44% cumulative positive rate). On the bottom left note that the age of most infected people is < 60years. This age paradox has been true throughout the pandemic-you people are more often infected; old people more often die. The new strain of COVID-19 in the United Kingdom seems to be infecting younger children, less than age 10, more than the predominant strain that is present in Canada. The excess mortality in people over age 70 years is a reality that has been factored in to the guidance on who gets vaccinated early versus late in most countries.
COVID-19 in Canada: a marked rise in hospitalizations-Jan 7th, 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 26thOntario lockdown). Thus far rates in Ontario and Quebec (home to almost 63% of all Canadians) have not hit a plateau (see orange lines below). This relates (in part) to these two provinces being slow to ratchet up public health measures, several weeks later than western provinces. 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.
Quebec-late lockdown; rising active cases (orange)
Ontario-late lockdown; rising active cases (orange)
Manitoba-earlier lockdown; plateau in active cases (orange)
Saskatchewan-earlier lockdown; plateau in active cases (orange)
Graphics showing that two provinces which locked down or intensified public health measures earlier in Wave Two have achieved plateau in new case rates; Ontario and Quebec lagged behind in their response and we await a clear impact of the Dec 26th lockdown.
6) The COVID-19 global pandemic: A total of 1,886,921 million deaths and 87,384,218 million cases, 2 million more since Monday (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).
Rising global COVID-19 burden and death rate: Jan 7th 2021
The USA with 21,342,187 cases and 361,900 deaths tops the COVID-19 list and accounts for ~24.2% of the global pandemic (up from 21% pre-Christmas). The USA only accounts for ~4% of the world’s population (see below). There are as many case in America as in India, Brazil and Russia combined! 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 salmon-colored dot the higher the active cases/100,000 population). Note the graph at bottom right (white) shows rising deaths/day. The ONLY solutions 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 ~6.1% rate of positive tests remains lower than the USA, which has an average positive test rate of 13.4% (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!). California has a positive test rate of 13.7% whilst South Dakota remains at a staggering 39.1% rate of test positivity today (back up from 36% pre-Christmas). For snowbirds- rates in Florida are rapidly climbing (reaching 14.1% today)-see below.
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).
KHSC bed capacity and preservation of elective care despite lock down: Bed capacity has reduced since Monday when it was 110. The number of available beds now is 84 but we have 49 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.
KHSC visitor policy: If a family member is coming in from a high prevalence area they cannot enter KHSC (i.e. they will fail the screening question). There are exceptions made for exceptional circumstances and this family presence policy will be updated by the end of the week (to make it clear who grants final decisions on exceptions that allow access). 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 on line 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).
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 2909 deaths in nursing homes (up 114 deaths since Monday) account for ~60% of all deaths in Ontario, click here. There are also ~ 1258 active cases in LTC residents and 1230 of active cases in LTC staff! In the last month the rate of death amongst LTC residents continues to increase daily and is now >100/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 21st since on-site schooling does not resume until later in January.
Happy New Year and Stay well!