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photo of finger nails painted with a COVID-19 related design

June 25, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Important update (new outpatient cases)

Communication and civility in the era of COVID-19: This topic came to mind because of two recent events. First, yesterday we had a false positive test of a patient on Kidd 7. This caused a lot of planning for quarantine and thus created anxiety only to learn that the “Kidd 7” individual’s COVID-19 test result is now clearly confirmed to be a FALSE positive. A near miss! The good news is that we did not ultimately continue the brief quarantine of the ward! The bad news is of course the news made patients and staff anxious. 

Then, late last night I got a text from a friend asking if they should be tested because they had been at a local restaurant where a case of COVID-19 was recently diagnosed. My first response was that I had heard nothing of this “new case” and had checked on our local epidemiology just hours before. “Did they have details?”, I asked. I was sent a Facebook posting about a worker who tested positive at The Rustic Spud and then a Whig Standard article (click here)….and this is how I got my information, which led to advice…”Yes, go to Memorial Centre and get tested in the am”.

news article with photo of COVID-19 cells

I offer these as examples of the need to revise information and to accept information that arrives by non-traditional routes with good grace. Communication does not always flow through a single route and sometimes results need to be revised or policies need to be reversed. It reminded me, to be patient and understanding with this fact; rather than being surprised or miffed that I learned of a case from a layperson in the community. Most of us do best with constancy and stability; however, the pandemic offers neither and so it is incumbent on all of us to dig a little deeper into our stores of kindness, patience and understanding. 

Variations in the timing and source of announcements of new COVID-19 cases, or changes in policy related to masking, access to testing or domestic travel leave each of us with a choice. We can be offended or upset or we can be accepting and calm. Change is the constant in the COVID-19 pandemic. The new practices in our hospital and in broader society are being modified daily as new facts emerge-it’s like building an airplane in flight! 

When it comes to information for this note, I use reliable sources (IPAC, KFL&A Public Health, the CDC, etc.) but wobble can still occur. It is important to me to ensure that the information I relay is valid, not necessarily that it is first. There is no “I” in TEAM, and while there is an “I” in COVID-19, I suggest we focus on the team! The purpose of my daily note is to convey, to the best of my ability, timely and accurate information to inform, educate and reassure…and I will continue to do that. For a throwback to the importance of being part of the team and dealing with the challenges of pandemic in a calm, collegial manner this may be a timely read: (click here).

On the theme of communication led me add a big thank you to Dr. Evans and Heather Candon, our IPAC team, and the KHSC Incident Command team. Their openness and diligence has served our patients and our organization well.

photo of Team Canada Hockey players celebrating after a goal

Speaking of dynamic changing environments: As I was writing today’s note, for example, the following news arrived from KHSC:

photo of painted nails reflecting COVID-19 design

“Today, KFL&A Public Health declared an outbreak of COVID-19 associated with a personal service setting, Binh’s Nail and Spa at 500 Gardiners Road in Kingston. A number of cases in our community are linked back to visits there, including a KHSC staff member who tested positive last week. Salon staff have also tested positive. Public Health has issued an order to close the premises. 

How does this affect KHSC?

We are asking any staff who have attended Binh’s Nail and Spa since Friday, June 12, 2020, to take the following steps:

  • Identify yourself immediatelyto Occupational Health, Safety and Wellness (OHSW) at KGH ext. 4389 and provide the date when you attended the salon.
  • Exclude yourself from work for 14 days from the date of your salon visit.
  • Be tested for COVID-19. During your phone consultation with OHSW you will be directed to the location you can attend for swabbing (either HDH-site or Memorial Centre Assessment Centre).
  • Be prepared to stay off work regardless of your swab results. Exemptions in the case of critically-needed staff will be determined by OHSW.”

If you are not KHSC staff you should let your supervisor know, get tested and self-quarantine. This testing can be done at Memorial centre (see further down in this note).

We are relieved to know that the source of infection for the KHSC staff member was not the workplace. This is a point Dr. Evan’s IPAC has made repeatedly-most cases of health care workers being infected relate to community infections (not to acquisition of the infection in the hospital).

COVID-19 Update: There are 5 active cases of COVID-19 in the Frontenac Lennox and Addington (KFL&A) region in the past week (see update from KFL&A Public Health). 

KFL&A metrics (see figure below): The running total for the epidemic is now 68 cases in the KFL&A region. There are 5 people recovering with COVID-19 in the community, which includes the KHSC staff member who was diagnosed last week. These new cases, occurred despite the continued low local COVID-19 prevalence. This reminds us of the importance of our universal masking policy and the need for ongoing handwashing and physical distancing. It also supports the increasing COVID-19 surveillance testing we are doing in staff and faculty at KHSC. The positive test rate in KFL&A remains at 0.4% versus a 2.8% positive test rate for the province as a whole. 

chart showing cases in KFL&A regionalarm clock with smiley face

1) People in the community can self-refer for assessment and possible testing. Memorial centre remains the site of community COVID-19 testing centre (see instructions below). The physical plant there is not air conditioned and is thus becoming uncomfortable with the summer heat. Test results are available within 24-48 hours from this site. Here is a link to the self-assessment tool used to see if you should be tested: click here

The Community COVID-19 Assessment Centre is located at:
Kingston Memorial Centre (use the 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. 

Starting Monday, testing will move from Memorial Centre to the Leon Centre.

Symptomatic KHSC staff: Should KHSC staff develop symptoms 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!

Despite the 3 new cases, Kingston remains in a bubble with a low incidence of COVID-19 (32 cases/100,000 population). Toronto has a rate ~13 times higher (412.4 cases/100,000 population). The prevalence in Toronto has increased every day for the past month, reflecting neighbourhood hot spots. Provincially the epidemic is in modest decline. There were 189 new cases yesterday and 34,205 total cases and 2641 deaths to date. The 1.3% rate of positive SARS-CoV-2 tests is down -0.5% compared with yesterday. 

animated photo of a flame

The prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, 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 WestonHumber Heights Westmount, a neighbourhood in Etobicoke , with 1699 cases/100,000, has the highest prevalence in Toronto. Humber Heights and others like it need customised intervention for their good and for the broader good of society. The ministry has deployed public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”.

map of GTA showing COVID-19 cases by neighbourhoods

How’s Canada’s epidemic going? We have had 102,431 cases of COVID-19 in Canada and 8494 deaths (see below). The number of active cases per day is declining (orange line below right). Quebec remains the hot spot, both for total cases and active cases (below left).

graph showing cases in Canada by province over time

Canadian aggregate data 

The epicentre for COVID-19 mortality remains within 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 69% of all deaths from COVID-19! There were 5 deaths since yesterday in Ontario LTCs. 

cases in Ontario LTC since January

Testing for SARS-CoV-2 (click here): We have tested 7.16% of all Canadians (2,701,573 people)-a downward revision in testing rate. Ontario SARS-CoV-2 testing is exceeding the national average for testing, with a rate of 8.73%.

graph showing tests performed vs positives in Ontario

The COVID-19 pandemic is increasing and case count exceeds 9 million. The pandemic hot spots are in the Americas (Brazil and USA), Russia, Iran and India (click here). The global case total is 9,490,435 and the number of death was revised down to 484,085. The COVID-19 hot spot countries are in red below (click here): Brazil, USA, India, Russia, Iran. The graph below show (in the baby blue) the predominant impact of cases in the Americas on the global pandemic.

graph showing the predominate impact of cases in the Americasthank you written in red cursive

KHSC Medicine staff rock! Today, I want to acknowledge both the nurses and staff on Davies 5 and Kidd 7. Your calm professionalism amidst the swirl of COVID-19 information and quarantines (both sustained and brief) is amazing. Thanks for all each of you do to care for our patients! Thanks to Dr. Chris Smith and Dr. Kristen Marosi for their leadership of the in-patient Medicine services in partnership with Michelle Matthews and her excellent team of managers.

Stay well!

 

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