June 1, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Dr. Archer's Updates on COVID-19

General DOM News & Events

| 1 June 2020

COVID-19 Update: There is 1 new case of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region (see update from KFL&A Public Health). This related to contact with a person form Toronto. We did 1000 SARS-CoV2 tests this weekend. There were 18 positive tests. There were 14 positive tests from Kawartha, 2 from Belleville and 2 from our area (1 of which was a repeat on a known positive patient). The positive test rate in KFL&A remains at 0.5% (vs 3.9% in Ontario), see below. There were 2% of our samples which were unanalyzable due to “poor specimen quality”, as previously discussed. 3 patients in KFL&A to are being investigated but there are no cases in KHSC. The running total for the epidemic remains at 63 COVID-19 cases in the KFL&A region.

Our lab is receiving limited numbers of extraction kits for PCR testing but they have been able to adapt and maintain high volume testing. A gentle reminder to MDs: Please don’t call the lab requesting test results as this takes workers away from performing the test. They are going as fast as they can and lab results will be placed in PCS as soon as the test results are available!

Our PPE supply is stable with 3 weeks reserve, at the current level of activity.

Chart showing COVID-19 in the KFL&A region

Pandemic pay: The government has now specified which health care professionals, at which sites, will receive pandemic pay. It remains unclear when the pay will actually flow to these frontline, non-physician, healthcare workers. Employers will receive funding for pandemic pay starting in early June, though exact timing will vary. Eligible employees will receive pandemic pay through their existing payroll systems. The government has declined to consider further expansion of the scope of this program and have also determined there could be no appeal to this ruling from labour unions. For more details click here.

COVID-19 screening of asymptomatic health care workers (policy in evolution). Currently testing of asymptomatic health care workers is voluntary and staff will be referred to the Memorial centre if they wish to be tested when they are asymptomatic. This testing is to be done on personal time, rather than during working hours.

Universal masking policy (policy in evolution): The Ontario government has suggested universal masking should occur in hospitals. However, this is currently not policy (just a recommendation). Such a recommendation may make sense in Toronto hospitals but is unlikely to be needed (at present) in a low incidence region like Kingston. Stay tuned for more!

Starting June 8^th hourly parking rates will be reinstituted by the City of Kingston-The precise boundaries will be in KHSC’s daily briefing. The approximate borders affected are within the boundaries of Earl, Albert, King and Ontario streets. (i.e. anything close to KHSC). This is just a friendly reminder; please check and ensure whether you need to pay!

How’s the epidemic going? To date there have been 90,947 cases of COVID-19 and 7295 deaths in Canada (see below). Nationally, the COVID-19 curve has flattened, with a decline in the number of new cases (see bar graph below, right). However, the disease remains most prevalent in Quebec (below left), with 51,059 cases and 4641 deaths. Quebec accounts for 56% of the cases and 64% of all deaths from COVID-19 in all of Canada.

map and graphs showing cases by province and date

Are we about to treat domestic travel the same way we treated international travel a few months ago? In my Friday piece, “To Travel or not to travel?” I cited the importance of knowing the local epidemiology before making travel decisions. This requirement is getting more and more granular. It’s not enough to know what’s going on in a province in general. You need to know what’s transpiring in the specific place you wish to visit (and the places you may have to pass through enroute). Kudos to the government of Quebec and the globe and Mail for the following data, published this weekend. The graphic below shows Quebec data. Note the extremely high prevalence in Montreal and Laval, 4- times the incidence seen in Toronto and 43 times the incidence in KFL&A!

chart showing Quebec regions and COVID-19 cases

Montréal alone accounts for 28% of all cases in Canada to date. So this is not the time to be visiting Montréal or Laval for tourist purposes (see below)!

Contrast this to Ontario. Kingston remains in a bubble with a low incidence of COVID-19 (29.1 cases/100,000 population), positioning us to carefully reopen the city and ramp up activity at KHSC and Queen’s University (read the blog if you’re interested in hearing more re: Queen’s). In contrast Toronto has a rate 11 times higher (329.8 cases/100,000 population) and this rate continues to increase daily (see below).

Map of Ontario showing COVID-19 cases by region

What does this all mean? It means that domestic travel between provinces, and perhaps within a province, may need to be monitored the way we were monitoring international travel a few months ago. It is likely health care workers at KHSC may soon see screening questions that require disclosure of travel to higher incidence areas within the province, outside KFL&A. Whether this will trigger 14-day quarantine remains to be seen. Currently in the Maritime provinces, travel outside a health care worker’s home province triggers an automatic 14-day self-quarantine.

COVID-19 continues to disproportionately affect the elderly and particularly the frail residents of 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 account for ~72% of all deaths from COVID-19! There were 6 deaths since yesterday in Ontario LTCs.

Chart showing COVID-19 cases in LTC Jan - June

Testing for SARS-CoV-2: We have tested 4.66 % of all Canadians (1,740,742 people) and are at approximately the same rate of testing in Ontario. The rate of testing has once again rebounded, reflecting increased testing of asymptomatic people, per government mandate.

graph showing COVID-19 test performed vs positives in Ontario

To see where Canada stands amongst nations in the COVID-19 pandemic, click here. The global case total has exceeded 6 million cases (6,217,949) and the number of death is up to 373,032. Here is a list of the most affected countries. I dipped down to show countries with more than 80,000 cases, which includes Canada. The data remind us we have nothing to feel smug about. We have exceeded the deaths reported in China’s outbreak.

Ranking list of confirmed Cases by Country/Region

A revised reminder for people in the community (last updated May 27^th)

1) People in the community can self-refer for assessment and possible testing. We are now on testing people for much broader indications (we are no longer requiring fever or travel as preconditions for testing). We are testing people who have only 1 COVID-19-type symptom or who are concerned they have been exposed to the disease. KFL&A has also suggested that health care workers should be routinely and repeatedly surveyed by nasal swabs (discussed above). You can seek out testing at Memorial Centre in Kingston, (see instructions below). Here is a link to the self-assessment tool used to see if you should be tested (although I suspect it will be updated soon): click here.

The Community COVID-19 Assessment Centre is located at:
Kingston Memorial Centre (please use the well-marked main entrance)
303 York Street, Kingston, Ontario
Monday to Friday: 10:00 a.m. - 6:00 p.m.
Saturday and Sunday: 9:00 a.m. - 12:30 p.m.

2) Our hospitals and clinics are safe places to receive care (in part because everyone including staff is screened prior to entry and in part because the local incidence of COVID-19 remains low). Upon entry to the hospital there is now a new screening question related to the discussion above about the high local prevalence of COVID-19 in Quebec: Have you traveled outside the province? You should not delay accessing care that you or your doctor deem to be urgent.

Your moment of Zen: This nesting loon, photographed by Ted Dyke, is a reminder of impending summer. A reminder we live in one of Canada’s most beautiful regions.