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COVID-19 surges in Manitoba, Nov 12th 2020

November 12, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) Philosophy for dealing with the pandemic: How we are going to get through the next 3-6 months while awaiting a vaccine?

2) Ontario’s pandemic is not well controlled with over 10,000 active case in Ontario with 1575 new cases today (click here): We are heading for 2000 cases/day in December.

3) COVID-19 volumes remain stable in KFL&A, although there is another new nursing home outbreak. (click here)

4) Canada’s second wave of COVID-19-rapidly increases, especially in western Canada

Regular reminders and updates:

  • KHSC bed capacity: 
  • Use the Mobile Screening Tool to expedite clinic visits 
  • KHSC visitor policy: 
  • COVID-19 testing at Beechgrove Community Assessment Center: (click here): 
  • Increased outbreaks and deaths in Long Term Care facilities (LTC)
  • COVID-19 in toddlers and young children: (click here). 
  • The COVID-19 global pandemic

1) Philosophy for dealing with the pandemic: As you read today’s report you will see that the COVID-19 pandemic in Canada is not headed in the right direction. Cases are rising rapidly. There are over 1500 new cases of COVID-19/day in Ontario and Toronto’s case prevalence has skyrocketed to 1011.2 cases/100,000 population. As more community spread occurs we are seeing more infections of older people (who tolerate the disease less well), more hospitalizations, and more deaths. This requires additional tightening of public health measures now. While intensified public health measures should be done in a targeted way, and be relaxed once control of spread is clearly established, these interventions are needed. It is likely that the tightening of public health restrictions in Toronto and Peel regions will be expanded as we try and protect a still vulnerable population. Ongoing restrictions and anticipated intensified restrictions, will reach KFL&A. New restrictions in response to the pandemic worsening will require each of us, health workers and lay people, to dig deep into our reserves to find the will to actively support evidence-based public health interventions that slow disease spread and save lives. 

Meanwhile, each of us needs to maintain physical distancing, wear masks in indoor spaces, wash hands frequently, get tested if one has symptoms to suggest COVID-19, get our flu shots!! and stay home if sick. We will need to base our behavior on information from trusted organizations (click here) not from politically or ideologically motivated sources (click here). People are tired of the public health restrictions and the economic and social pain this pandemic inflicts; however, adherence to public health measures is our ONLY defense until a vaccine is rolled out in 2021. 

While we have been fortunate in southeastern Ontario and still have a low case prevalence, we would be wise to learn lessons from other countries that have failed to control community spread, like Switzerland and the USA. Their trajectory shows that once major metropolitan area have high COVID-19 prevalence, the disease inevitably spreads throughout the country to smaller centers and soon hospitalizations and mortality rates rise.

Meanwhile, our vigilance needs to increase. It is likely that our hospitals will soon resume asking screening questions about travel to high prevalence areas, like Toronto etc. We may also see public health agencies further tightening rules on the access to businesses and restaurants. No one wants a complete lockdown but we need to be responsible and accept, with whatever grace we can muster, the inconvenience that increased restrictions (or even temporary lockdowns) will cause. However, there is now realistic hope on the horizon, with several vaccines appearing to be effective and likely available in early 2021 (click here). This exciting development should sustain us during the winter. However, we need to begin the dialog to ensure that the public feels confident in the new vaccines and will widely accepts the importance of being vaccinated once this is offered.

Red Skys Over Water

Hope on the horizon-courtesy of Dr. Kathie Doliszny

2) Ontario’s pandemic is not well controlled with over 10,000 active case in Ontario with 1575 new cases today (click here): We are heading for 2000 cases/day in December.

There have been a of 88,209 cases, up over 600s cases from Monday with 1575 new cases since yesterday, a +1.6% from yesterday (click here). There have been 6365 hospitalizations, and 3275 deaths in Ontario, since the pandemic began (up 7.2% and 3.7% since yesterday, respectively). The rate of positive SARS-CoV-2 tests in Ontario remains high having recently hit 5% and remains 4.3% today. 

Thus the pandemic is not currently well controlled with over 10,000 active case in Ontario today. Ontario’s provincial rate (604/100,000 population) has doubled in the past month and is now 6X higher than in KFL&A (91.2 cases/100,000 population). Toronto remains Ontario’s hotspot for COVID-19 (1011.2 cases/100,000 population, up from 711 cases/100,000 population 2-weeks ago and 10 times higher than Kingston). Ottawa is also a hot spot at 732.4 cases/100,000 population (click here). Despite 3 weeks of increased provincial restrictions, wave 2 has not begun to plateau. Asa result Section 22 measures have been invoked in Peel and Toronto rolling back the opening of business to levels more similar to rules that were in operation in stage 2 of the pandemic reopening.

Deaths and hospitalizations have begun to increase in wave 2 -on right (See graph above). There are 431 (black line) hospitalized people out of 11,271 active cases (red bars), a hospitalization rate of 3.8% (see graph below).

Graph - Deaths & Hospitalizations in ON

The majority of infections in Ontario are in young adults age 20-29; but, as can be seen from the pink bars on the graph below, we are now seeing more active infections in older people. However, most deaths are still in people over the age 60, see graph below (click here).

Graph - Cases by age & gender in ON

Neighborhood variation in COVID-19 in Toronto: Half of Toronto’s neighbourhoods are COVID-19 hotspots with prevalence of over 1000 cases/100,000 population and Weston exceeds 3000 cases/100,000 (click here).

Toronto Skyline

Toronto remains a collection of neighbourhoods with vastly different COVID-19 realities due to differences in social/economic, racial and health circumstances. Case load is very high in some Toronto neighbourhoods. For example, whilst Weston has had 3546 cases/100,000 residents. In contrast, the Beaches has a cumulative prevalence of 287 cases of COVID-19/100,000 residents. When one examines new cases (i.e. what those diagnosed since Oct 16th) case prevalence is of course lower-although still concerning-ranging from 14 cases/100,000 residents, in Palmerston-Little Italy versus 860 cases/100,000 residents, in Maple Leaf. 

3) COVID-19 volumes remain stable in KFL&A but there has been an outbreak (3 cases in a family cluster at a local school) (click here): There have been 14 new COVID-19 cases in our region since my note on Monday. The total number of cases since the pandemic began is now 199. Currently there are 15 active cases locally, up from 6 on Monday. All local COVID-19 patients are recovering in the community (see update from KFL& A Public Health). 

COVID-19 in KFL&A Nov 12th 2020

COVID-19 in KFL&A Nov 12th 2020

The KHSC lab has performed 1453 COVID-19 tests in the past 4 days with 4 positive tests. Three positive tests were from Kingston and 1 from the Kawartha area. There are no hospitalized patients at KGH.

4) Canada’s second wave of COVID-19-rapid increases in new cases in western Canada: We have had 277,960 cases of COVID-19 in Canada and 10,696 deaths (see below) since the pandemic began. There are 43,019 active cases in Canada today. 15.2% of all cases are now active cases, which has increased 2% from Monday. Canada has done over 11.2 million tests and has a cumulative test rate positivity (since the pandemic began) of 2.45%. Ontario remains the province with the highest amount of testing and has a cumulative positive test rate of 1.61%, although it is much higher lately (4.3%). Note the increasing % of new cases in the bar graph on top below and increasing number of active cases (in orange in the lower graphs). Rates of infection are rapidly rising in all Western provinces (BC to Manitoba) whereas they are rising (but more slowly) in Quebec and Ontario). Rates of new infection are stable and low in all Maritime provinces.

Infographic: Manitoba Overview

Below is a graph showing the situation in Manitoba which clearly indicates the effects of rapid community spread of the virus. Note the alarming rise in hospitalizations with almost 15% of hospitalized people requiring ICU admission. 

COVID-19 surges in Manitoba, Nov 12th 2020

COVID-19 surges in Manitoba, Nov 12th 2020

Regular reminders

KHSC bed capacity: Resuming elective admissions but beds remain in short supply

Kingston General Hospital (KGH) has 73 beds available, up slightly from Monday. Not all of these beds are in locations that can accommodate an adult COVID-19 patient, however. Elective inpatient care has resumed but with the rising wave of COVID-19 in Ontario it is uncertain how long this can be sustained. I urge colleagues to see patients in person that require face to face visits (it remains safe to do so). When in person visits are not possible, we offer video visits (using REACTS and OTN), telephone visits and e-consults (using our asynchronous, online consultation for family doctors). While both elective admissions and elective clinic visits are available to us, let’s make hay while the sun shines! 

Cartoon hay field with sunshine

Use the Mobile Screening Tool to expedite clinic visits: Complete the COVID-19 pre-screening tool here and you will be able to “skip the line”: One way to safely expedite entry of patients into our facilities is to have all patients complete our pre-screening questionnaire before their clinic visit. This will screen out people who are sick and expedite entry to the facility for everyone. Reducing lines waiting to enter the clinics will be particularly important as colder weather arrives. The mobile screening tool only takes a few minutes to complete and you will receive an email with confirmation to bring with you, along with your appointment slip, in printed form or on your mobile device. To complete the mobile-screening in English, click here and in French, click here.

Pre-screening tool

KHSC visitor policy: One of the hardest aspects of COVID-19 care in the hospital is the need to restrict visitors to ensure we don’t import COVID-19 into the hospital. A very few cases of COVID-19 can paralyze the hospital, particularly if they are brought in by visitors and then spread undetected. All details on the policy can be found using this link (click here). 

COVID-19 testing at Beechgrove Community Assessment Center: (click here): All COVID-19 test must be scheduled appointments (versus walk in). Appointments can be scheduled by telephone or by our new Eventbrite on line scheduling system. Before booking a test, individuals should complete the online tool to determine whether they qualify for testing (click here). The Beechgrove Complex is south of the King St. West/Portsmouth Avenue intersection. Signage will direct people through the Complex to the Recreation Centre building at 51 Heakes Lane for walk-in testing. Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily. To be tested you will require: A valid Ontario health card or a piece of photo identification. You must also wear a mask and maintain physical distancing at all times while in the walk-in line.

nasal swab diagramKids dressed as doctors

We began testing staff at Beechgrove instead of Hotel Dieu 2 weeks ago. Because health care workers (doctors and staff) are increasingly having to miss work because their children have been sent home from school or daycare with symptoms of a upper respiratory tract infection, we have arranged that their children can access expedited testing at Beechgrove . The goal of this service is simply to allow the healthcare worker to return to work as quickly as possible for the public good. The children of staff will be tested between 1230 -1300 by appointment, 7 days/week. The new program for families applies to children up to age 18, an includes children of staff and physicians who provide clinical care and service. Staff and physicians themselves should contact occupational health to book their testing appointment. To book an appointment for a child, KHSC staff should call 613-548-2376. Testing of clinical staff and faculty and their children is processed at the KHSC lab with an average turnaround time of less than 24 hours.

Increased outbreaks and deaths in Long Term Care facilities (LTC): We have 4060 LTC beds in KFL&A. As discussed in many prior notes, most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and long term care facilities (LTC). As of today, the 2048 deaths in nursing homes (up from 1996 on Monday) account for 61% of all deaths in Ontario, click here. In the last 3 weeks the rate of death amongst LTC residents continues to increase, with 52 deaths since Monday! There is one new outbreak in a regional seniors residence, the Trillium Care Community Centre, where 1 infected staff member was recently identified on screening testing (click here).

Outbreaks in nursing homes usually start with a person in the community (health worker or family) acquiring the infection and importing it into the facility. Thus, protecting LTCs is best done with a combination of reducing community spread of COVID-19 and ensuring single occupancy rooms in LTCs (as well as appropriate pay for PWS workers, provision of PPE and rapid testing capacity).

COVID-19 in toddlers and young children: (click here). 

Fortunately kids remain much less likely to be infected by SARS-CoV2 and when they are infected they usually become much less ill (click here). The vast majority of upper respiratory tract infections in kids in Ontario are caused by other viruses, like rhinovirus and RSV. Thus, health policy makers and parents of young children should recognize that while children are not immune from COVID-19 infection, infections are relatively uncommon and outcomes are usually excellent for those who are infected. Nonetheless, we are about to prioritize children of healthcare workers for testing at KHSC so we can return the parents to work when children with symptoms (which will rarely prove to be COVID-19) are sent home from school or daycare.

boy with backpack

Children are usually infected by an adult, usually in their home, rather than by other children. The number of cases in school age children (which includes teenagers) has increased to 1794 up from 1523 on Monday and 985 cases 2 weeks ago. 

little girl

Amongst younger children and toddlers COVID-19 remains relatively rare. In Ontario’s 5,500 licensed child care centres and over 120 licensed home child care agencies there is a very low COVID-19 burden (see table ). The rise in cases has been modest in these young children. 303 children have now been infected to date, up from 279 children on Monday and 209 cases 2 weeks ago.

The COVID-19 global pandemic exceeds 1.2 million deaths and over 52 million cases: There are now 52,538,595 cases globally and there have been 1,290,095 deaths. The number of cases has increased over 3-fold the beginning of August, 2020 when there were 16,296,790 cases globally. The pandemic hot spots are in the USA, India, Brazil, and Russia (click here). The USA with 10,500,259 cases and 242,436 deaths tops the COVID-19 list and accounts for ~20% of the global pandemic, while only accounting for ~4% of the world’s population. India has the second largest number of cases (see global map of COVID-19 Nov 5th-below).

Global COVID-19 Nov 12th 2020

Global COVID-19 Nov 12th 2020


Stay well!

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