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outline of when to start next stages in fighting the pandemic

July 17, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

 Local COVID-19 Update KFL&A: 

The local outbreak of COVID-19, largely related to infections acquired in nail salons, is under control (note our “green status-Figure below). There have been no new cases in over 1 week. Our local epidemiology is consistent with the ongoing improvement in the epidemic we are seeing across Canada and in Ontario, with Ontario reporting the lowest number of new cases yesterday that has occurred in months (111). The running total for the epidemic remains at 105 cases in the KFL&A region (see update from KFL&A Public Health) (Table below). There are now only 2 active cases and these COVID-19 patients are recovering in the community. There are no longer any inpatients with COVID-19 in KHSC. 

SARS-CoV-2 Testing: Over the past 3 days we have performed 1181 SARS-CoV-2 tests. There were only 3 positive tests, all from the Kawartha area. Our test positivity rate in KFL&A continues to fall and is currently <0.4% (vs 2.1% provincially). 

This is good news and will allow us to continue our surgical ramp-up and resume our ambulatory care ramp up, as we continue efforts to provide better care for the 99.9% (click here for more on this). KHSC has capacity for our elective procedure ramp up; but things are busier, with the hospital inpatient census now exceeding 400 patients for the first time in months. One risk to our capacity is the resurgence in the numbers of Alternate Level of Care (ALC) inpatient people. We had reached a low of 20 ALC people and are now back up to a census of 40 ALC people . These are people waiting LTC and retirement home placement and by definition should not be in hospital. They are “stranded” here as they await a return to home or an LTC. This puts our capacity to provide care for the 99.9% in jeopardy. This positions us well for Phase 3 reopening of the province today. On the KFL&A scale below we are solidly in the green!

chart showing the criteria for red, orange, yellow and green levels

Stage 3 reopening of Ontario begins (click here): This is the next phase of recovery from the 1st wave of COVID-19 and expands permitted activities. It is being done by region, and higher prevalence areas like Toronto will be delayed in entering Stage 3. Here is the info hot off the press from the Ontario government (in italics below): 

criteria for moving to the next stage in reopening Ontario

Timelines in the reopening of Ontario

Stage 3 is another significant step towards fully restarting our economy. In Stage 2, over 90 per cent of economic activity was enabled to resume, which resulted in employment increasing by 377,900 net new jobs in June, including 66,200 jobs in the manufacturing sector. 

In Stage 3, more restrictions will be loosened and nearly all businesses and public spaces will reopen, as long as they follow the public health advice and workplace safety guidance necessary to keep everyone safe. 

The Chief Medical Officer of Health, public health experts and other officials have advised the following high-risk places and activities are not yet safe to open, due to the likelihood of large crowds congregating, difficulties with physical distancing, or challenges maintaining the proper cleaning and sanitation required to prevent the spread of COVID-19: 

  • _Amusement parks and water parks 
  • _Buffet-style food services 
  • _Dancing at restaurants and bars, other than by performers hired by the establishment following specific requirements 
  • _Overnight stays at camps for children 
  • _Private karaoke rooms 
  • _Prolonged or deliberate contact while playing sports 
  • _Saunas, steam rooms, bath houses and oxygen bars 
  • _Table games at casinos and gaming establishments. 

All other businesses and public spaces will be permitted to be open, subject to ensuring the appropriate health and safety measures are in place, as well as limits on gathering sizes. 

Here are some examples of what is permitted in Stage 3:

list of permitted openings in stage 3

The following regions will remain in Stage 2, as additional time is required to assess and monitor any impacts and readiness to move into Stage 3: 

  • _Durham Region Health Department 
  • _Haldimand-Norfolk Health Unit 
  • _Halton Region Public Health 
  • _Hamilton Public Health Services 
  • _Lambton Public Health 
  • _Niagara Region Public Health 
  • _Peel Public Health 
  • _Toronto Public Health 
  • _Windsor-Essex County Health Unit 
  • _York Region Public Health 

Universal Masking Policy: Revision of our entry mask policy is starting next Tuesday-it will allow cloth masks for entry/exit

The one constant in the pandemic is change! Change in KHSC policy is based on evolving scientific evidence, local epidemiology, resource availability and provincial/KFL&A rules and regulations. Your patience and understanding of change is appreciated (and we do understand change can be upsetting/confusing). 

picture of blue medical masks

picture of a man wearing a mask with a canadian flag on it

 

All people entering the hospital will continue to be required to wear a mask. MASKS WILL BE PROVIDED AT ALL KHSC ENTRY POINTS and they must be used (unless an exemption has been prospectively obtained). 

In a policy to begin on Tuesday, you will be allowed to wear a cloth mask when entering the building (this includes both staff and visitors). Fabric masks cannot have an exhalation valve. Please note that once KHSC staff reach a patient care area they must use a medical mask (replacing their cloth mask). 

If you use a hospital provided mask they should be reused for a week, storing it in a paper bag when not in use (bag provided). These are not single use masks. For staff in non-clinical areas this is the only mask you need. The new policy (still being perfected) allows cloth masks for building entry/exit. It does not require one to use a cloth mask and KHSC will continue to provide a medical entry/exit mask.

Occupational health will be reviewing requests for exemption. When there is an exemption, it will usually mean that a face shield will be worn as an alternative (i.e. some form of facial PPE will still be required). An important reminder however; face shields are not as effective as masks and personal exemptions will likely be rare.

Where to get a COVID-19 test?

  1. A) Leon’s Centre testing facilityis open for COVID-19 testing of community members (click here for details of hours). The wait time at Leon Centre is short (10 minutes).
  1. B) Symptomatic KHSC staff:Should KHSC staff develop symptoms consistent with COVID-19, please contact occupational health and safety and they will tell you how to proceed (ext 4389 at KGH site, or email COVIDrtwadjudication@kingstonhsc.ca). You will likely be tested at the Hotel Dieu testing centre. Do not come to work!

Ontario’s COVID-19 outbreak (click here) Ontario’s prevalence rate is 248.6/100,000, much higher than in KFL&A, at 49.4 cases/100,000 population. Toronto still has a rate >8 times higher (442.4 cases/100,000 population). Provincially the epidemic is in decline. There were again 111 new cases yesterday (up 0.3% from yesterday). Ontario has had a total of 37,274 total cases and 2746 deaths to date. The 0.9% rate of positive SARS-CoV-2 tests yesterday continues a trend of low positivity rates.

animated picture of a flame

The prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, defined as rates over 1000 case/100,000 (click here), including: Moss Park, Newton Brook West, Yorkdale Glen-Park, Downsview Roding CFB, Maple Leaf, Rexdale-Kipling, Black Creek, Mount Olive, Beechborough, York University Heights, Mount Dennis, Glenfield Jane Heights, and Weston. Humber Heights Westmount with 1763 cases/100,000 once again has the highest prevalence in Toronto. The ministry has deployed public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”. While things are gradually improving in Toronto, as you can see from their dashboard (click here) they are not yet entering Stage 3 of recovery.

How’s Canada’s epidemic going? We have had 109,264 cases of COVID-19 in Canada and 8827 deaths (see below). Most cases are resolved (89%, green, top left below). The number of hospitalize people continues to decline and few people are n ICUs (top left). The number of active cases per day has plateaued (orange bar graph, below right and orange line graph, bottom right). Quebec remains the hot spot with more active cases than the rest of the country combined (bottom left graph). 

aggregate data for Canada's covid-19 cases

Canadian aggregate data 

The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they still account for 67% of all deaths from COVID-19! There have been 1840 deaths to date. There were two deaths since yesterday in Ontario LTC centres. Canada had the highest rates of mortality in LTCs of any surveyed country. 81% of all Canada’s COVID-19 deaths occurred in residents of LTCs (click here)! This is sad indictment of Canada’s LTC facilities and attests to a lack of government oversight.

Stats for ltc facilities since January

Testing for SARS-CoV-2 (click here): We have tested 9.6% of all Canadians (3,677,864 people) (see below). The rate of test positivity is declining and nationally is 2.97% (vs 2.09% in Ontario). Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average, with a rate of 12.29%. A very promising sign is that more testing is being associated with a lower rate of positive test results. 

graph showing covid-19 testing performed vs positives in Ontario

The COVID-19 pandemic has grown by more 2 million cases in less than 2 weeks! There are now 13,832,242 cases globally and 590,608 deaths. On July 6th there were “only” 11,495,412 cases and now less than 2 weeks later there are almost 2 million more cases. The pandemic hot spots are in the Americas (Brazil and USA), Russia, and India (click here). These 4 countries account for over half the world’s cases. America has 3.58 million cases and accounts for over ¼ of all cases in the world. The pandemic is also increasing rapidly in Peru, Chile, Mexico and South Africa. The graph below shows daily cases world wide-this is evidence that the pandemic is not resolving. Rather, hot spots continue to build creating repositories of the virus which can spread when travel resumes.

graph showing global growth of pandemic jan - July

Worldwide Growth of pandemic from Jan 27th-July 13th 2020

map of world showing deaths from pandemic

World COVID-19 cases July 17th-red dots proportionate to confirmed case load

Global trends: Globally the pandemic is increasing (click here). This is due in large part to failed leadership and the related growth of the epidemic in Brazil and the USA. Here is a snapshot of today’s prevalence (confirmed cases per 100,000 people). America, Brazil and Peru have the highest disease incidence.

graph showing increase of global cases by country since the 50th case was confirmed

COVID-19 on July 17th-a global perspective

In America there is a disturbing second part of wave one which is still increasing in intensity (see below). The map below shows that the state by state prevalence of COVID-19) (click here). The red states have the highest incidence of COVID-19. Interestingly the red states are largely RED STATES (in the political sense). It is evident that things are not going well south of the Mason-Dixon line (a reference for you civil war buffs-this is the line that dived the North and South during the American Civil war). The Mason-Dixon line remains symbolically important today, as seen by the diversity if responses to the pandemic in southern states like Florida, Arizona and Texas versus northern states.

map of USA showing prevalence of COVID19

Trouble in the south: COVID-19 in America

As I mentioned on Wednesday, the USA leads the world in testing (see below, click here). America’s testing rate is double that of Canada’s; however their rate of infection is 10-fold higher. 

graph showing testing in the USA

COVID-19 testing in the USA

When testing positivity rates are high it means either a country is only testing the sickest people or there is a lot of COVID-19 in the community (or both). With broader testing of less symptomatic people, the rates of positive tests should decline. The WHO has said that in countries that have conducted extensive testing for COVID-19, the rates of positive tests should remain at 5% or lower for at least 14 days for the epidemic to be deemed to be under control.

                           photo of man holding a kitten on his shoulderCharlie Brown and Snoopy dancing with the caption ready for the weekend

TGIF!

 

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