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back to school cartoon with masks, gloves, hand sanitizer along with notebooks for sale

September 3, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Today’s Headlines

  1. Influenza vaccination
  2. Update on local COVID-19 status (good) and global pandemic (not good) after summer hiatus

Influenza vaccination: As we have talked about in prior notes, SARS-CoV-2 is far from the only respiratory virus afoot in the world. Currently there are several outbreaks of the rhinovirus (common cold) in Kingston. This virus is not dangerous but can create upper respiratory and nasal symptoms in infected children and adults. More importantly, influenza season is coming soon. Usually we begin vaccination ~October 1st. It is critical to get vaccinated this year in particular, not only because influenza is a major cause of disability and death but also because it mimics COVID-19. The less influenza we have to deal with the less congested the hospital will be and the less anxiety and stress the public systems (businesses, schools and daycares) will suffer. KHSC has a very efficient vaccination program for its staff and in patients. My advice to both health care professionals and the public regarding influenza is to get vaccinated as soon as the vaccine becomes available! We are soon going to be deploying a test that can from a single nasal swab distinguish COVID-19 from influenza. Beginning later in the fall (date to be determined) KHSC hopes to offer a multiplex test that can simultaneously detect influenza A, influenza B and respiratory syncytial virus (RSV), as well as SARS-CoV2. Stay tuned for news on when this test will be available.

The COVID-19 pandemic has grown by almost 15 million cases in 2 months! There are now 26,074,609 cases globally and there have been 864,153 deaths. The pandemic hot spots are in the Americas (Brazil, Mexico, Peru, Chile and USA), Russia, and India (click here). The USA with 6,115,276 cases alone accounts for 23.5% of the global pandemic.

global map highlighting large areas of COVID-19

COVID-19 Sept 3rd 2020 -The Johns Hopkins Dashboard. A global look at COVID-19 

The table below shows countries that have had a cumulative case total of more than 100,000 cases to date. Note the length of this list has doubled in the past month! 

ranking of countries with COVID-19 cases and deaths

Local COVID-19 Update KFL&A: 

There have been 112 COVID-19 case in our region since the pandemic began in early 2020. Currently there is only 1 active case locally and they are recovering in the community (see update from KFL&A Public Health) (see graph). 

Graph showing COVID-19 cases in KFL&A

COVID-19 in KFLA since the beginning of the pandemic

There are no inpatients with COVID-19 in KHSC. Our stable local epidemiology is consistent with the ongoing improvement in the epidemic across Canada and in Ontario. We did 1574 COVID-19 tests over the last several days. None were positive. There is consideration of creating a satellite testing centre to focus on students returning to Queen’s University. 

At KHSC operations are stable, our PPE supply is good and we are making progress in increasing our capacity for elective care for the 99%. However, our outpatient clinic volume remains at ~50% of what it was pre-COVID-19. We recognize the urgency of increasing our ambulatory patient capacity and are striving to get to ~70% of pre-pandemic capacity, the balance being provided by virtual care (telehealth and video visits). While KHSC bed capacity remains adequate, there are 50 alternate level of care (ALC) people in hospital (a significant increase in the past month), which limits our flexibility in managing people who are sick and need to be in hospital.

Ontario’s COVID-19 epidemic: (click here) (see map below) Ontario’s COVID-19 prevalence rate is 287.2/100,000 up slightly from a month ago when it was 263.8/100,000, much higher than in KFL&A, which has a prevalence of 30.3 cases/100,000 population. Toronto has a rate 16 times higher than Kingston (476 cases/100,000 population). The region with the highest prevalence of COVID-19 remains Windsor (596/100,000), largely because of a poorly regulated agricultural sector and suboptimal housing of farm workers.Ontario’s positive test rate is down to 1.4%. There is a 25% increase in the volume of local testing because of the return of students to Kingston.

map of Ontario showing high COVID-19 prevalence areas

There were 132 new cases yesterday (up 0.3% from yesterday). Ontario has had a total of 42,686 total cases and 2812 deaths to date. The 0.6% rate of positive SARS-CoV-2 tests yesterday continues at a stable low rate over the past month, consistent with the first wave of the epidemic being controlled (see graph below). 

graph showing COVID-19 cases since January in Ontario

SARS-CoV-2 is a litmus test for social inequities: consider the epidemic in Toronto (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 83 cases of COVID-19/100,000 residents. In contrast, Weston has 1884 cases/100,000! Thus, there is no single “Toronto”, as seen through a COVID-19 lens; it’s a diverse patchwork with a >23-fold variation in disease prevalence.

Toronto skyline

The epidemic is gradually improving in Toronto (overall), but will persist until we are able to deal with these local hotspots (click here) (see graphic below). The best way to stop the epidemic in Toronto is to address housing conditions in its poorest neighbourhoods.

graph showing cases spike

The first wave of Canada’s epidemic is resolving (although there is an increase in cases in Alberta, BC and Saskatchewan in the past week) We have had 129,923 cases of COVID-19 in Canada and 9136 deaths (see below). Most cases (88%) are resolved. The situation in Canada remains good, with low levels of hospitalization (top left below), low rates of new cases (top right below) and most cases resolved (bar graph bottom left). The rate of new cases remains low nationally (bottom right panel).

graphs and charts showing data for Canada

Canadian aggregate data Sep 3rd 2020

There are however concerns about focal outbreaks on farms in Ontario and increases in disease incidence in the Western provinces, related to people associating without respect for masking and physical distancing and to the previously mentioned hotspots within large cities like Toronto. A reminder: we remain as susceptible to this virus as we were last year! This reinforces the need to continue to practice physical distancing, hand washing and use of masks when in doors. It does also remind us of the importance of targeted public health interventions. Nonetheless, these data support the wisdom and safety of carefully reopening Canadian schools. 

Despite this good news, we will continue to see COVID-19 outbreaks across Canada, like the one recently reported at a Karaoke bar in Quebec city (click here). This outbreak is very reminiscent of Kingston’s recent nail salon outbreak. 

News article re covid-19 outbreak at karaoke bar in Quebec City

To manage outbreaks contacts (exposed people) need to be rapidly targeted for follow-up contact tracing. It is incumbent on business to keep good client records. Because the bar could did not set up a contact registry, public health could not confidentially trace all clients, and so they had to go public and reveal information to the public that would have otherwise been kept private. This also happened with our nail salon outbreak. This is a good reminder for our Universities schools and businesses to keep good records of people coming and going in their facilities. In the Quebec city outbreak there are already 40 new cases (singing when infected is a great way to spread COVID-19). The infections contracted at the bar ended up leading to new cases at three Quebec City schools.

The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below) (click here). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they still account for ~67% of all deaths from COVID-19! There have been 1848 deaths to date. There have only been 3 deaths in Ontario’s LTCs in the past month (which is finally some good news). 

COVID-19 data in LTC since January 15

Testing for SARS-CoV-2 (click here): We have tested 16% of all Canadians (6,073,470 people) for COVID-19. The rate of test positivity is declining and nationally is 2.14% (vs 1.41% in Ontario). Ontario SARS-CoV-2 testing continues at a rate that exceeds the national average, with 20.8% of Ontarians having been tested.

graph showing COID-19 tests performed in Canada since March

COVID-19 testing in Canada Sept 3rd 2020

In contrast with Canada’s 2.14% rate of positive tests, the USA today has an average rate of positive COVID-19 tests of 5.5%. Even Arizona and Texas have improved and are under 10% positive rates. This is an encouraging decrease in the rate of positive tests in the US, down ~ 2-3% over the past month (click here). Nonetheless, the US-Canadian border remains closed for routine travel at least until the end of the month. 

graph showing positive COVID-19 tests in USA Apr-Sept

Rates of positive tests for SARS-CoV2 in America

To Parents: Today is the first day of back to school for elementary students. I am sure it’s an anxious period for parents with young children. The data support return to school and suggest it should be safe. My thoughts are with you!

cartoon showing back to school items include masks, hand sanitizer and gloves

Back from Vacation!

Here is a vestigial reminder of my recent PEI vacation. The lobster are glad I am back in Ontario!

photo of dinner plate with 2 cobs of corn and a whole lobster

Stay well!

 

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