October 13, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
1) COVID volumes continue to increase in KFL&A and there has been a nursing home outbreak (click here)
2) The second wave of COVID-19 in Ontario now matches the 1st wave, with 746 new cases yesterday (click here)
3) Use the Mobile Screening Tool Complete the COVID-19 pre-screening tool here
4) Air travel is “relatively” low risk (click here)
1) COVID volumes continue to increase in KFL&A and there has been a nursing home outbreak (click here): There have been 19 new COVID-19 cases in our region since my note last Thursday. The total number of cases since the pandemic began is now 167 (up from 148 last week). Currently there are 14 active cases locally (down from 27 last week) and they are recovering in the community (see update from KFL&A Public Health). There are 27 active cases in south eastern Ontario. Our KHSC lab completed 3183 tests over the weekend with 11 positive tests (1 from Belleville, 4 from KFL&A and others from Kawartha and other parts of Ontario).
There was an outbreak at Fairmont nursing home last week with 1 infected staff member (click here). The definition of an “outbreak” in a nursing home is quite strict and only requires 1 case to qualify as an outbreak. Unfortunately, contact tracing revealed extensive socialization amongst workers and so the single case affected almost half of the staff (in terms of need to self-quarantine). It is remarkable the impact a single case can have. One positive case can have major adverse effects for a medical facility or LTC. This is a reminder to health care workers to mask when interacting outside your small bubble when physical distancing cannot be maintained.
We have started to see a people 40-50 year old people infected in our region. These case are clearly not part of the Queen’s University cluster, discussed in prior notes. Nonetheless, 50-60% of cases since September have been Queen’s University students.
COVID-19 in KFL&A Oct 13th 2020
2) The second wave of COVID-19 in Ontario now exceeds the 1st wave in case numbers, with 746 new cases yesterday (click here). COVID-19 cases numbers have doubled in Ontario ~ every 2 weeks. Modeling suggests that there may be 1000 cases/day by mid-October (click here). The graph below shows that the majority of infections in Ontario are in young adults age 20-29 years (blue and green below). In contrast virtually all deaths are in people over the age of 60 years (gray on graph below) (click here).
Ages of people infected with COVID-19 Oct 13th 2020
Also note the concerning, recent, rise in hospitalizations in Ontario (shown by the black line in the graph below).
Compared to last week we are starting to see more active cases in the Halton and Hamilton health regions (see blue part of graphs below).
New cases of COVID-19 by region Ontario Oct 13th 2020 (click here)
There have been a total of 60,692 cases with 5466 hospitalizations and 3017 deaths in Ontario, since the pandemic began. The ICU admission rate is also beginning to rise. Hospitalizations are up 9% and ICU admission up 1.9% versus last week. This reflects the expected evolution of the pandemic with an increase in cases being followed several weeks later by more hospitalizations. The rate of positive SARS-CoV-2 tests is up sharply from 1.3% last week to 2.6% yesterday.
Ontario’s COVID-19 prevalence rate is up from 356.4/100,000 last week to 408.3/100,000 yesterday. A month ago, between wave 1 and 2, it was 263.8/100,000! This provincial rate is ~54X higher than in KFL&A, which has a prevalence of 78 cases/100,000 population. Toronto has a rate 9 times higher than Kingston (688.7 cases/100,000 population). Windsor no longer has the highest prevalence of COVID-19 (642.4/100,000), having been surpassed by Toronto.
Map of COVID-19 prevalence in Ontario October 13th 2020
Our strategy for the second wave must include ongoing resilience, calmness and adherence to public health policies. With careful attention to public health measures we can flatten the second wave without shutting down schools, business and society. To address wave 2 we should:
- prioritize who we test and ensure rapid availability of test results.
- limit indoor assembly to the permitted group size (<10)
- focus on key demographics who tend to get infected (young adults, migrant workers, low income neighbourhoods)
- continue to respect our social bubbles and avoid socializing in broad groups
- protect our essential workers including health care workers
- Continue practicing simple and effective public health measures (physical distancing, mask use indoors, frequent hand washing).
However, we should not shut down schools and businesses. Indeed this is not being proposed by public health officials. The unintended consequences of shutting down society for the 99.9% are huge and not readily reversible.
3) Use the Mobile Screening Tool Complete the COVID-19 pre-screening tool here : We are working hard to get as many patients as possible into our outpatient clinics to ensure care for the 99.9% of patients (i.e. those who do not have COVID-19 but who have a multitude of other pressing health needs). One way we physicians can help safely expedite entry of patients into our facilities is to ask them to complete the pre-screening questionnaire. This will screen out people who are sick and expedite entry to the facility for everyone else.
To all patients: You can help too! Please complete your COVID-19 screening for your upcoming outpatient appointment online with the mobile screening tool. The mobile screening tool, available in English and French, 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.
Screening staff will validate the confirmation at entry and you will be able to go directly to your appointment. This mobile screening must be completed a maximum of four hours before your appointment. If the screening confirmation expires, you will need to re-do the mobile screening or be screened in person (by a screener) when you arrive.
With the exception of caregivers for children, this mobile screening tool is for patients only and does not give family members or caregivers an option to pre-screen because we must continue to restrict family presence for outpatients at KHSC in order to maintain physical distancing. To complete the mobile-screening in English, click here and in French, click here.
3) Air travel is low risk for COVID-19 if done properly (click here) With wave 2 of COVID-19 upon us you may consider any mention of air travel superfluous. However, people still need to move around the country and air travel is safer than you might think. The JAMA (Journal of the American Medical Association) has a nice article for patients on this which offers sound advice. Few COVID-19 cases have been linked to air travel, likely because the passengers are screened for COVID-19 prior to boarding (so few people traveling are sick). In addition, the air on the airplane (at least on modern airplanes) is frequently exchanged and highly filtered. These onboard HEPA filters remove the particles and droplets that spread COVID-19. To date there have been only ~ 42 cases of COVID-19 globally that have been linked to air travel. So what can you do to be safe if you need to fly? Wear your mask, wash your hands and don’t travel if you’re sick or have been exposed to someone with COVID-19. That said, air travel is relatively safe.
Beechgrove: Kingston’s community assessment center (click here): All COVID-19 tests 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). We are still working on our on-line system (it will be available shortly).
A reminder: The ministry announced that we do not test asymptomatic people unless they have a confirmed COVID-19 contact and we do not recommend testing children with runny noses as their sole symptom (click here).
The Beechgrove Complex lies just 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. We do not have drive through testing yet but are considering this possibility.
Operating hours: Testing hours will return to 9 a.m. to 4 p.m. daily.
- People are required to bring a valid Ontario health card or a piece of photo identification.
- People must wear a mask and maintain physical distancing at all times while in the walk-in line.
KHSC capacity-preparing for an anticipated need for hospital admission: KGH has adequate bed capacity for a COVID-19 surge (with 86 available beds-up from 62 last week) and good ventilator capacity. In the event of a COVID-19 hospitalization surge and/or quarantine of wards we will need to expeditiously transfer ALC people from the institution to more appropriate sites.
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. Children are typically infected by an adult, usually in their home, rather than by other children. Here are some data supporting this assertion, first for school age children and then for daycare age children. That said the number of cases in school age children (which includes teenagers) has doubled since last week.
There have been 531 COVID-19 cases in Ontario school students to date (up from 262 last Thursday).
Amongst younger children and toddlers in Ontario’s 5,500 licensed child care centres and over 120 licensed home child care agencies there is also a very low COVID-19 burden (see table below). The rise in cases has been modest in these young children. 140 children in Ontario’s licensed childcare facilities have been infected to date (up from 87 cases last Thursday).
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. Further reassurance for parents of young children comes from Ontario wide data which show rare hospitalizations and only 1 death to date in the pandemic (click here).
The reforms required to make our Long Term Care facilities (LTC) safe are simple (but expensive): 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 LTCs. As of today, deaths in nursing homes account for ~66% of all deaths in Ontario, click here.
The rate of death amongst LTC residents has once again begun to increase with 12 deaths since my Thursday note in our LTCs. Moreover, one of our local LTCs has also reported an outbreak (which is defined as a single case of COVID-19 in the case of LTCs). The lesson from this infection of a single worker, which took half the facilities workforce off-line, as they isolated because of contact with the infected person, is how a small number of infections can deplete such a facility of staff . The impact is exaggerated if workers are not attentive to the use of physical distancing and masks when socializing outside the workplace (click here).
The reforms required to make our LTCs safe are simple to understand but expensive to implement: single rooms for all residents, proper funding of PSWs so they only work at a single site, availability of COVID-19 testing for residents and staff and adequate supplies of proper PPE. We want to protect residents of LTC facilities but we can’t do this by locking them up and denying them access to family members and loved ones. The emotional trauma, despair and grief caused to people in LTCs in wave 1 is a story that is not yet fully told. In wave 2 we need to do better. LTC residents must be allowed to have ongoing access to their families in friends, with proper screening, PPE and in reasonable numbers. If we fail in this the consequences are as bad as failing to control COVID-19 infections in these facilities.
The rate of deaths from COVID-19 in Ontario has once again begun to increase in residents of Ontario LTCs with 12 deaths since last Thursday
17 or more neighbourhoods in Toronto have a COVID-19 prevalence of over 1000 cases/100,000 population (click here). Toronto remains a collection of neighbourhoods with vastly different COVID-19 realities due to differences in social/economic, racial and health circumstances. For example, the Beaches has 199 cases of COVID-19/100,000 residents whilst Weston has 2490 cases/100,000. These rates, both in low and high prevalence neighbourhoods, have increased each day for the past month. Half of Toronto’s neighbourhoods have a very high disease prevalence of over 1000 cases/100,000 population (each dot is a neighbourhood on the map below and all dots to the right of the one highlighted have >1000 cases/100,000 population).
In Toronto (and around the world), people of low income are disproportionately infected, as shown below (compare the infection rate in low income people-on left- and high income people-on right).
Canada’s second wave: Canada is well into a second wave (which exceeds the first wave of COVID-19 in case number, although not yet in mortality). We have had 182,837 cases of COVID-19 in Canada with 975 new cases compared to yesterday. We have had 9627 deaths (see below) since the pandemic began. Most cases (~86%) are resolved. However, it is clear there are hot spots, like Ontario, Quebec, Winnipeg, Manitoba and Edmonton, Alberta (see bottom left below).
COVID-19 in Canada as of Oct 13th 2020.
COVID-19 testing: Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average of 24%, with 30.3 % of Ontarians tested to date ( click here). Our overall positive test rate in Ontario still remains low. However, there is an important caveat! In some areas, such as certain neighbourhoods in Toronto, positive test rates exceed 10%: A reminder COVID-19 is global but its impact varies greatly from one neighbourhood to the next.
American data of COVID-19 testing: In contrast with Canada’s 2.0% rate of positive tests, the USA has an average rate of positive COVID-19 tests of 5.1% (increasing) (click here). However, some states, like Wisconsin, have unprecedented outbreaks, with a positive test rate of 20%!
The US-Canadian border will remain closed for routine travel at least until the end of October.
The COVID-19 global pandemic is accelerating (a jump of almost 2.5 million cases since last week): There are now 37,974,575 cases globally and there have been 1,083,131 deaths. By comparison there were less than half this number of cases at the end of July (July 27th 2020 = 16,296,635 cases globally). The pandemic hot spots are in the USA, India, Brazil, and Russia (click here). There are approximately 40 countries that have had a total of more than 100,000 cases. The USA with 7,829,575 cases and 215,476 deaths tops the COVID-19 list and accounts for ~20% of the global pandemic. India has the second largest number of cases (see list of countries with the most cases below left). Here is a map of the pandemic as seen today: