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Doug Ford with PSW

July 16, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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KHSC COVID-19 Outbreak: We continue to deal with the COVID-19 outbreak on Davies 5, one of our medical wards. There have been 16 total cases. To date there have been 7 staff members infected and 9 patients/visitors infected. Eight of the infected people were unvaccinated and 3 were partially vaccinated. Currently we have 8 patients with COVID-19 admitted at KHSC, 7 on the Medicine COVID-19 ward and 1 in ICU. The variant causing the outbreak is the alpha variant (the UK variant). Eight of the infected people were unvaccinated and 3 only partially vaccinated. Contact tracing is underway on all exposed visitors and staff and testing for COVID-19 is being performed on all people at risk of exposure. 

This is a reminder of the critical importance of: a) health care workers being vaccinated and putting the safety of patients first b) testing of all admitted patients and retesting despite an initial negative test if symptoms develop c) recognizing that fully vaccinated people can get COVID-19, although the symptoms are almost always mild or absent.

KHSC Covid-19 Admissions Graph

The graph above (9 right-most bars) shows this rise in COVID-19 cases in KHSC related to our outbreak (yellow bars on right). They are largely local cases as the status of COVID-19 elsewhere in Ontario continues to rapidly improve, including resolution of the outbreaks in the Porcupine Health region and Toronto. 

So in summary, our outbreak is disappointing; but not surprising. This virus is persistent and many Canadians are not yet fully vaccinated. The ONLY long-term way to keep KHSC (and our community) safe is full vaccination of all eligible people. To help us get the hospital “back to normal”, so we can provide care for the 99.9% of people who don’t have COVID-19, PLEASE get vaccinated. It will keep you and your family safe and allow us to safely provide health care! In the meantime we each need to redouble our attention to proper use of PPE. 

What needs to be done to ensure all Ontario hospitals remain safe places to receive care? I am pleased to report that the body governing doctors at KHSC, the MAC, has unanimously approved a motion requesting that KHSC require all new employees, credentialed staff and learners to show proof of vaccination against COVID 19 before commencing work or study at KHSC, unless there is a bona fide medical contraindication with supporting documentation. This MAC request is intended to protect our patients, staff and physicians while Covid 19 infection remains a threat to the Ontario community. Stay tuned as consideration of policies evolves. 

Similar considerations are being managed provincially with the Ford government considering whether those health care workers who decline vaccines should be subject to ongoing, regular COVID-19 testing as well as mandatory PPE use (which I would personally think is fair and reasonable). (click here for more on this debate).

News Photo of Doug Ford with PSW

A highlight from the CBC article isdraft provincial document obtained by CBC News reveals the government is wading through the legal and ethical issues involved in developing vaccination policies for certain employment sectors. Although the document frequently refers to "mandatory vaccination," the policy it ultimately recommends would not actually require any workers to be vaccinated against COVID-19. Rather, it would allow unvaccinated health-care workers to have contact with patients, provided that they wear full protective equipment (PPE) and undergo frequent screening for the coronavirus.”

  1. B) Reminder to KHSC staff-Please send your vaccination notice to occupation health:

Kingston Health Sciences Centre (KHSC) has implemented the COVID-19 Staff Vaccination Policy # 02-199 for all staff who work at KHSC including employees, physicians and credentialed staff, students, volunteers, and contracted staff who regularly work on site. 

Although COVID-19 vaccination is currently not mandatory, it is strongly recommended as a key strategy to protect our patients, staff, and their families, and is a key factor in KHSC’s re-opening framework.

The policy requires all individuals working at KHSC to undertake one of the following:

1) Provide proof of their COVID-19 vaccination to Occupational Health, Safety & Wellness (OHSW).

  • Note: Even though you were vaccinated at KHSC, proof of vaccination is still required as OHSW has no access to those vaccination records.

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1) KFL&A update: 3rd wave resolving locally (despite outbreak in KGH), 11 local active cases and 79.4% of eligible residents (12-years and older) are vaccinated at least once and 56.9% are fully vaccinated (see update from KFL& A Public Health)

2) Wave 3 subsides in Ontario with 6.1 million people fully vaccinated and 10 million partially vaccinated (153 new cases yesterday and a 0.6% positive COVID-19 test rate) (click here(click here): 

3) Canada’s COVID-19 epidemic rapidly resolving with > 44.1 million doses of vaccines administered (up ~4 million from last week): New and active cases (down -4% and -11% respectively), hospitalizations falling (-13%) and 8 deaths yesterday (click here) (click here)

4) World vaccine roll-out tops 3.5 billion people and safety record remains excellent (click here): 

5) The global pandemic: ~188.5 million cases with 4,061,263 deaths to date click here with most deaths in the USA, India and Brazil

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1) KFL&A update: 3rd wave resolving locally (despite outbreak in KGH), 11 local active cases and 79.4% of eligible residents (12-years and older) vaccinated at least once and 56.9% fully vaccinated (see update from KFL& A Public Health)

Apart from the hospital outbreak of COVID-19 at KHSC the resolution of the 3rd wave continues. One major reason for this is high rates of vaccination (essentially 80% of eligible people in our region have had at least one vaccine) (see below).

KFL&A Vaccine Dashboard

Vaccination rates in KFL&A, July 15th 2021

Another reason for the decline in cases is the season-coronaviruses seem less prone to spread in warm weather with lots of outdoor activity. A third reason may be the relative lack of local delta variant viruses (see below-we mostly have the British alpha variant in green), which are more infectious. In general all good news.

Graph of VOC in KFLA

Since the pandemic began we have had 1579, cases in KFL&A, not counting the resolved prison outbreak or people from other regions (see below). This represents 5 new cases since last week. There has been no further increase in active local cases (11). There have been 6 deaths of KFL&A residents since the pandemic began (2 in the past week).

KFL&A Cases Dashboard

The Medicine program remains extremely busy with non-COVID-19 care. We are looking after >185 patients at KHSC and run an additional ward at HDH (see below). We have ramped up clinics toward pre-pandemic levels (although volumes are still be limited by the size of waiting rooms and ongoing masking/physical distancing requirements). All physicians are being asked to see patients in person whenever possible and appropriate.

KHSC Dashboard Bed Management

2) Wave 3 subsides in Ontario with 6.1 million people fully vaccinated and 10 million partially vaccinated (153 new cases yesterday and a 0.6% positive COVID-19 test rate) (click here(click here): 

Ontario Cases Graph

Wave 3 resolving in Ontario, June 30th 2021 (active cases back to rates seen last summer)

Ontario has made amazing progress toward quashing wave 3. The rates of new and active cases are down 24 and 1820 respectively in the past week. Deaths and hospitalizations are also significantly decreased compared to last week (-27% and -12%, respectively). 

The graph below shows that death from COVID-19 remains a risk primarily for people over age 80 years. 

Rates of Death Graph Ontario

3) Canada’s COVID-19 epidemic rapidly resolving with > 44.1 million doses of vaccines administered (up ~4 million from last week): New and active cases (down -4% and -11% respectively), hospitalizations falling (-13%) and 8 deaths yesterday (click here) (click here)

Canada MapCanada Wave 3 Resolution Graph

Resolution of Wave 3 in Canada July 15th, 2021

New and active case rates are falling rapidly and hospitalizations are declining across Canada (see graph below-center, orange line). We have had 1.42 million cases of COVID-19 since the pandemic began. The case mortality rate remains at 1.45% with 26,469 deaths. We have done 38.1 million COVID-19 tests (with a cumulative positive rate of 3.73%). We have administered a cumulative 44.1 million COVID-19 vaccinations. Hospitalizations are also declining (661 people in hospital today). The graph below shows that apart from Yukon there are no areas with large numbers of new cases (top left). It also shows that most infected people are under age 60 years (although almost all death are in people over this age). Finally the bottom panel shows hospitalizations are rapidly declining, although 536 people are still in hospital and half of them are in the ICU.

COVID-19 infections and hospitalizations falling across Canada July 15th 2021

COVID-19 infections and hospitalizations falling across Canada July 15th 2021

In the Yukon, new case numbers have been falling for the past week, after their recent outbreak 

Canada’s vaccine story: 69.1% of Canadians have had at least one shot and 46.5% are fully vaccinated! 44.1 million doses have been administered (click here): 53 million doses of COVID-19 vaccines have been delivered but only 83.3% of delivered doses have been administered. Canada is near the top of the pack in vaccines administered per day now! The graph below shows the rate of vaccination per 100 people yesterday, July 14th, 2021 (see below).

Daily COVID-19 vaccine doses per 100

Canada is now a top vaccinator country (vaccines/100 people yesterday)

4) World vaccine roll-out tops 3.5 billion people and safety record remains excellent (click here): If you have a vaccine hesitant friend you might want to show them the graph below. 

COVID-19 Vaccines doses administered July 14

In addition to many clinical trials the safety record of vaccines has been established in the real world, where we have administered 3.5 billion jabs! The complication rates remain very low. Vaccines are safe (click here for Canada’s safety data) against all forms of the coronavirus. They are particularly good at preventing hospitalization or death. 

What you need to know vaccines

The serious complication rate in Canada remains low (5 serious adverse events/100,000 vaccines administered). 

Vaccines are the key to ending COVID-19; however, low-income countries remain vaccine deserts

COVID-19 vaccines doses administered by country and income

The graph above shows how much slower the roll-out has been in lower income countries (red) vs high income countries (green).

Progress in vaccine administration largely applies to wealthy countries. This is not only unjust; it also allows for the creation and spread of new viral mutants, like the delta variant, which is more infectious and may lead to immune evasion, thereby keeping the pandemic going. Both the USA (click here) and Canada (click here) have committed to sharing vaccines abroad by the end of 2021. 

5) The global pandemic: ~188.5 million cases with 4,061,263 deaths to date click here with most deaths in the USA, India and Brazil (left column below)

World

Here is today’s map of the global pandemic. Daily cases are rising again (red graph). Deaths have plateaued (white graph). This shows that globally the pandemic is not yet under control. Vaccine use is on the rise (green graph). There are several caveats, including underreporting of death rates and heterogeneity in vaccine rates amongst countries (worst in Africa).

Global COVID July 15

Global COVID-19, July 15th 2021

COVID-19 Vaccine FAQs and report on Long Term Care Facilities are on hiatus (no updates of significance)

Good news: Ontario enters Stage 3 reopening on Friday-outdoor gatherings of 100; indoor gatherings of 25, indoor dining, and indoor gyms …and more! (click here)

Mayor John Tory interviewed on Stage 3 opening in Toronto today

Mayor John Tory interviewed on Stage 3 opening in Toronto today

Stay Well! …. Get Vaccinated!!!

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