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July 20, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Local COVID-19 Update KFL&A: 

There was 1 new COVID-19 case in the past week (last Friday). This case was related to the nail salon outbreak and the person is recovering at home. The running total for the epidemic is now 106 cases in the KFL&A region (see update from KFL&A Public Health). KFL&A now has 3 active cases and they are recovering in the community. The latest case does not show up on the KFL&A site because the site is under revision. Our stable local epidemiology is consistent with the ongoing improvement in the epidemic we are seeing across Canada and in Ontario, with the exception of Toronto-Hamilton-Windsor, where the disease is still quite prevalent. There are no inpatients with COVID-19 in KHSC. 

SARS-CoV-2 Testing: Over the past 3 days we have performed 1295 SARS-CoV-2 tests. There was only 1 positive test (from the Kawartha area). Of tests performed, 1.1% of the tests were of technically inadequate quality. Our test positivity rate in KFL&A continues to fall and is currently <0.4% (vs 2.0 % provincially). 

Where to get a COVID-19 test?

  1. A) The public: Leon’s Centre testing facility is 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) KHSC staff:Should KHSC staff develop symptoms consistent with COVID-19, please do not come to work! Instead, 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. Results are usually available next day.

KHSC capacity: We continue our surgical ramp-up and resume our ambulatory care ramp up 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. 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. 

Universal Masking Policy: Another 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). 

                                                        blue disposable medical masksman wearing face mask with Canadian Flag on it

All people entering the hospital are required to wear a mask (unless an exemption has been prospectively obtained). MASKS WILL BE PROVIDED AT ALL KHSC ENTRY POINTS.

In a policy to begin tomorrow, you will be allowed to wear a cloth mask when entering the building (this includes both staff and visitors). 

  1. a)Fabric masks cannot have an exhalation valve. 
  2. b)Fabric masks cannot be used in patient care. 

If you use a hospital provided medical mask:

  1. a)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. 
  2. b)these masks can be used in patient care as well, with the sole exception of caring for a patient on droplet precautions, such as a patient with COVID-19. In these cases you will need to get a different mask which is available at the nursing station. 

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.

Ontario’s COVID-19 outbreak (click here) Ontario’s prevalence rate is 253/100,000, much higher than in KFL&A, at 49.8 cases/100,000 population. Toronto still has a rate >8 times higher (444.7 cases/100,000 population). The region with the highest prevalence of COVID-19 is Windsor (458/100,000), likely because of its border proximity with Detroit. Provincially the epidemic is in decline. There were again 164 new cases yesterday (up 0.4% from yesterday). Ontario has had a total of 37,604 total cases and 2751 deaths to date. The 0.7% rate of positive SARS-CoV-2 tests yesterday continues a trend of low positivity rates, consistent with the epidemic being controlled.

map of Ontario colour coded areas of COVID-19 numbers

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).

Toronto skyline with CN tower and Rogers Centre

These neighbourhoods include: 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, it remains in the yellow zone due to its local outbreaks and rate of test positivity, as you can see from their dashboard (click here) and graphic below. Toronto remains in Stage 2 of recovery.

graph showing summary of COVID-19 stats in Toronto

The first wave of Canada’s epidemic is resolving (some much needed good news) We have had 110,331 cases of COVID-19 in Canada and 8852 deaths (see below). Most cases are resolved. Most reassuring one can see in the past few days an increase in resolved cases, green line below, and a proportional fall in active cases (orange line below). Whether this reflects a true sudden improvement in the epidemic and/or a change in case reporting from Quebec is uncertain…but in any case it is good news. This puts the active case load back where it was before the epidemic took off in March-YAY!!!

graph of cases vs recovered vs deaths in Ontario

Canadian aggregate data 

The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below). Canada has ~ 7% of seniors in LTC facilities, so this is a big problem (click here).

graph showing percentage of seniors in LTC by province

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 1841 deaths to date. There was 1 death over the weekend in Ontario LTC centres. Canada had the highest rates of mortality in LTCs of any surveyed country (click here)! This is sad indictment of Canada’s LTC facilities and attests to a lack of government oversight and lack of a comprehensive plan for senior care. 

photo of nasal swab in nostril  to test for COVID-19

Testing for SARS-CoV-2 (click here): We have tested 9.96% of all Canadians (3,811,621 people) (see below). The rate of test positivity is declining and nationally is 2.89% (vs 2.01% in Ontario). Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average, with 12.89% of Ontarians having been tested. A very promising sign is that with more testing we are finding a lower rate of positive test results. 

graph of tests performed vs positives in Ontario

COVID-19 testing in Ontario July 20th 2020

For Canadians who worry we don’t test enough or that our rate of positive test results is not an encouraging sign, let’s take a road trip to our southern neighbour. The USA has an average rate of positive tests of 9%. Indeed, in states where the govenor shares the Trump government’s “hands off/ masks off” mindset, rates of COVID-19 test positivity are “spectacular”. For example in Arizona 25% of all nasal swabs are positive, see blue line below (click here)!

graph showing testing vs positives in Arizona

The COVID-19 pandemic has grown by 3 million cases in 2 weeks! There are now 14,530,525 cases globally and 606,741 deaths. On July 6th there were “only” 11.5 million cases and now, 2 weeks later, there are 3 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 3.77 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 data sheet below shows daily cases world wide-this is evidence that the pandemic is not resolving.

world map with stats on cases confirmed, deaths and recovered by countrycartoon of a globe with an ice pack on it's head and a thermometer in it's mouth

One cannot help but reflect on the roots of this crisis: COVID-19 has spread because of global warming with destruction of animal habitat, overcrowding of cities which accelerates the spread of the virus, lack of access to basic health care for large swathes of the world’s 7 billion people, lack of public funded education to ensure an informed populace, and populist governments and dictatorships which do not deal in truth or science and therefore cannot manage a humanitarian crisis. Ultimately, it is our mistreatment of our fellow humans and our planet that has allowed a 1918 level pandemic to occur despite 21st century medicine and science. Prevention of future pandemics and resolution of the current pandemic will require us to address these non-medical determinants of public health.

Stay Well!

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