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July 8, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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KHSC COVID-19 Outbreak: We have a COVID-19 outbreak on Davies 5, one of our medical wards, with ~ 14 new cases. To date there have been 7 staff members infected and 7 patients/visitors infected. The variant causing the outbreak is the alpha variant (the UK variant). Eight of the infected people were unvaccinated and 3 only partially vaccinated; however, 3 were fully 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. Because of the outbreak we have had to close Connell 3 ward (our medical COVID-19 unit) to visitors until the outbreak is resolved. There will be an update on the outbreak as a community hall for all staff via an open forum at noon tomorrow.

The graph below shows this new rise in COVID-19 cases in KHSC (yellow bars on right). The difference this time is that the cases are not people transferred from Toronto or the Porcupine region (the first 3 peaks) …they are local cases. 

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A new COVID-19 outbreak at KHSC

Question of the Day: “Why are we having a local outbreak while the province as a whole is improving? And What are we doing about it?”

1) First, the outbreak was largely driven by infection of people who were unvaccinated or not completely vaccinated. A reminder: if you are not vaccinated (meaning 2 weeks out from the second of 2 vaccine shots) you are not immune! 

2) Second, while high rates of community vaccination provide herd immunity we are not yet at these levels of vaccination (~80% of people must be fully vaccinated to achieve herd immunity)-locally we are at 48%. Moreover, even when we get to 80%+ rates of full vaccination, people who are not vaccinated and who get exposed to the virus will still become infected in most cases. The Globe & Mail reports that “ As of Monday, 78 per cent of those eligible to be vaccinated in Canada have received at least one dose, and 41 per cent were fully vaccinated, making the country one of the most immunized in the world. Among the Group of Seven nations, Canada ranks second next to Britain with the highest number of doses administered per 100 people. Thus, Canada (and KFL&A) have not yet reached herd immunity levels of vaccination and even herd immunity does not confer INDIVIDUAL immunity. So we have an outbreak because we have virus in the community, a reservoir of susceptible patients and perhaps we have (collectively) slightly reduced our vigilance when it comes to the use of PPE and physical distancing (understandable after > 1 year of COVID-19).

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Canada is only half-way to achieving vaccinations levels that would likely confer herd immunity

3) Third, an initial negative COVID-19 test doesn’t mean a second test can’t become positive (and indeed this was the case in several of the patients involved in this outbreak). We screen all patients with COVID-19 tests upon admission to KHSC. We also often perform repeat COVID-19 testing after an initial negative result. This is usually precipitated by patient risk profile (their likelihood of being infected) or by a patient developing new symptoms. Fortunately, we did this repeat testing in this situation and detected several cases where the first test was negative (because the patient was too early in their disease to register on the first test).

4) Fourth, we use universal precautions so even when cases arise in hospital the risk to staff who adhere to proper protection (including masks and eye shields) is low. It is likely (but not proven) that diligence in adhering to these rules has been slightly less in recent weeks as wave 3 resolves. We also perform extensive contact tracing to ensure people exposed to a person with COVID-19 in KHSC are tested until we know they are negative for the disease. 

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. If you want 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. 

A big thank you to our IPAC team (Infection prevention and Control) (click here). This amazing team is keeping us safe and leading the charge to quash the KHSC outbreak.

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) Is it too early to ditch masks? (click here)

2) KFL&A update: 3rd wave resolving locally (despite outbreak in KGH), 17 local active cases (up from 4 cases 1 week ago) and 78% of eligible residents (12-years and older) vaccinated at least once and 48% fully vaccinated (see update from KFL& A Public Health)

3) Wave 3 subsides as Ontario exceeds vaccine targets and infection rates fall (210 new cases yesterday and a 0.8% positive COVID-19 test rate) (click here(click here): 

4) Canada’s COVID-19 epidemic rapidly resolving with > 40.6 million doses of vaccines administered (up 4 million from last week): New and active cases (down -23%), hospitalizations falling (-22%) and deaths down to 6 people yesterday (click here) (click here)

5) World vaccine roll-out tops 3.32 billion people (click here)

6) The global pandemic: ~185.3 million cases (up 4 million from last week) and deaths top 4 million 3 to date click here

 

1) Is it too early to ditch masks? (click hereThe simple answer is no one really knows. The closer we get to full vaccination the safer being mask free will become. The amount of risk an individual will accept is quite variable and the circumstances (personal and professional) matter. In crowded indoor spaces masks remain (and will remain) important for some time. In outdoor spaces or indoor spaces with good ventilation and physical distancing, masking makes less sense for vaccinated people. For the vaccine hesitant 20% of Canadians however, masks will likely be a good idea for a substantial period of time. They are not themselves protected and are perfect vectors to spread variant coronaviruses to friends and family. 

Around the world leaders are struggling to decide when countries are “safe enough” (allowing masks to be optional). The struggle is similar to the one we had in deciding to require universal masking in public spaces in the early stages of the pandemic. A recurring challenge in this pandemic is balancing convenience and freedom with public safety and the timing of demasking is no exception. Clearly, we are getting closer to a point where most people will accept not wearing a mask as safe in most conditions (while recognizing masks may still be required in some circumstances and for some people). 

woman putting on a face mask beside a stronger bc for everyone sign

The masks are largely off in the USA for fully vaccinated people. The UK is considering adopting this as well. Alberta and British Columbia relaxed their masking/public health rules on Canada Day. Saskatchewan plans to drop all public health orders, including mandatory mask use on July 11th. 

My advice: We need to accept that there is uncertainty. The decision to unmask will be graded and variable by region. Follow the advice of your local public health unit and be patient. We will learn from our unmasked neighbours to the south and elsewhere how delta variants and unmasking mix and whether this will be (as we hope) safe (or not). The next few months are looking positive for losing our masks but in Ontario we are not quite there yet for indoor spaces. Stage 3 reopening may get us there (or close) shortly-stay tuned!

2) KFL&A update: 3rd wave resolving locally (despite outbreak in KGH), 17 local active cases (up from 4 cases 1 week ago) and 78% of eligible residents (12-years and older) vaccinated at least once and 48% fully vaccinated (see update from KFL& A Public Health)

table showing current data re cases in stage 2 in KFLA

The 3rd wave of COVID-19 is resolving in SE Ontario; but this week reminds us it’s not over! Since the pandemic began we have had 1574, cases in KFL&A, not counting the resolved prison outbreak or people from other regions (see below). This represents 17 new cases since last week. There has been a significant increase in active local cases (from 4 to 17). Regionally, we have increased from 14 to 28 active cases. There have been 4 deaths of KFL&A residents since the pandemic began (one this week).

table showing current data for phase 3 of vaccinations in kfla

Vaccination rates in KFL&A, July 8th, 2021

Our rate of positive COVID-19 tests is for the first time ever higher than the provincial average for test positivity (see green line below)!

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The Medicine program remains extremely busy with non-COVID-19 care. We are looking after >174 patients at KHSC and run an additional ward at HDH. 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).

3) Wave 3 subsides as Ontario exceeds vaccine targets and infection rates fall (210 new cases yesterday and a 0.8% positive COVID-19 test rate) (click here(click here): 

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Wave 3 resolving in Ontario, June 30th , 2021

Ontario has made amazing progress toward quashing wave 3. 41.1 % of all eligible Ontarians are fully vaccinated (6.1 million people). The rates of new and active cases are down 19 and 18% respectively in the past week. Deaths and hospitalizations are also significantly decreased compared to last week (see above). The graph below (courtesy of Dr. Gerald Evans) shows the decline in cases week to week continues in Ontario.

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4) Canada’s COVID-19 epidemic rapidly resolving with > 40.6 million doses of vaccines administered (up 4 million from last week): New and active cases (down -23%), hospitalizations falling (-22%) and deaths down to 6 people yesterday (click here) (click here)

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Resolution of Wave 3 in Canada June 30th, 2021

New and active case rates are falling rapidly and hospitalizations are declining across Canada (see above). We have had 1.418 million cases of COVID-19 since the pandemic began. The case mortality rate remains at 1.45% with 26,387 deaths. We have done 37.7 million COVID-19 tests (with a cumulative positive rate of 3.76%). We have administered a cumulative 40,666,338 million COVID-19 vaccinations. Hospitalizations are also declining (661 people in hospital today). 

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COVID-19 infections and hospitalizations falling across Canada July 8th, 2021

The one exception to the COVID-19 good news is the Yukon, where cases are on the rise (see below):

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Cases on the rise in the Yukon (orange line)

Canada’s vaccine success story: 68% of Canadians have had at least one shot and 39.1% are fully vaccinated! 40.9 million doses have been administered (click here): To date, 49.7 million doses of COVID-19 vaccines have been delivered but only 82.3% 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 7th, 2021 (see below).

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

5) World vaccine roll-out tops 3.32 billion people (click here): If you have a vaccine hesitant friend you might want to show them this graph. After the clinical trials were completed we began vaccination in Dec 2020. Seven months later we have vaccinated >3.3 BILLION people and the complication rates remain very low. It is safe (click here for Canada’s safety data) to get vaccination and vaccination is very effective against all forms of the coronavirus, particularly as judged by preventing hospitalization or death. 

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

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3.32 billion vaccines administered globally as of July 7th, 2021!

Vaccines are the key to ending COVID-19; however, low-income countries remain vaccine deserts. The entire continent of Africa remains a vaccine desert.

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COVID-19 Vaccines remain rare in Africa (click here), July 7th, 2021 

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 are 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. 

6) The global pandemic: ~185.3 million cases (up 4 million from last week) and deaths top 4 million 3 to date click here.

satellite photo of earth taken from space

Here is today’s map of the global pandemic. Daily cases have plateaued (i.e. not continued to fall) which is not good (red graph). Deaths remain in decline (white graph). 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).

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Global COVID-19, June 30th, 2021

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

A big thank you to our IPAC team (Infection prevention and Control) (click here). This amazing team is keeping us safe and leading the charge to quash the KHSC outbreak.

list of IPAC members and brief bios

Stay Well! …. Get Vaccinated!!!

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