Coronavirus in Kingston, Canada. My take on what we might expect.

There has been a lot written and published about COVID-19 and I don’t want to add to the barrage of information out there.  But I thought I could give my friends some indication of what I have learned and what to expect with regard to current status about COVID-19 as it pertains to our Kingston, Canada community.

In some ways, we are lucky that we are farther down the chain.  Our Public Health authorities have had the advantage of seeing how this is playing out in other parts of the world and how the virus is behaving so appropriate measures can be taken to limit its effect here.

The numbers around the world change by the hour.  For up to date numbers you can see how many people have been diagnosed  worldwide and in every country (and their outcome) on this website.  https://www.worldometers.info/coronavirus/

This novel coronavirus was unknown only a few weeks ago and currently there are over 100,000 cases and there have been 3600 deaths. Using these figures, gives a death rate of over 3%. The death rate from influenza which causes thousands of deaths a year is 0.1%.  In other words, according to current worldwide figures, COVID-19 has about 30 times the death rate of influenza. This figure may be a bit high as there are likely undetected cases in the community which would skew the denominator but even conservative estimates indicate that COVID-19 is at least 10 times as deadly as influenza which causes about 3,500 deaths in Canada and over 50,000 deaths in the USA annually.

Of those who contract the virus, 80% will have relatively mild symptoms – cough, fever and shortness of breath – that will resolve in a few days with symptomatic treatment.  Another 10% may develop pneumonia (viral or a superimposed bacterial pneumonia) and require additional support.  Another 10% may require hospitalization and 3% will die of complications of the infection.

Currently the highest death rate occurs in people over the age of 70 and particularly those with other chronic diseases like diabetes, COPD, cardiovascular disease and high blood pressure.  If you are under 50 and in good health your risk of dying from this virus is minimal but you might have a couple of weeks when you are sick. You will, no doubt, know people who become seriously ill and who die from this virus.

As for your kids and grandkids, for some reason, not yet understood, children either tend not to get this virus or are not significantly affected by it.  It may be, however, that children can present a minimally ill or asymptomatic reservoir that can spread the virus to others who are more vulnerable.

The virus attacks and replicates in the lungs primarily and as lung cells are compromised, breathing becomes more difficult.  Any illness associated with significant fever also causes malaise, muscle aches, headaches and fatigue. 

The virus spreads by droplets from sneeze or cough. Droplets containing virus can also be on hands, phones, desks, coins or any other surface. If you are within a metre or so of people who sneeze or cough without covering their face, or if you handle some object that has been contaminated by infected hands or droplets from sneezes and then touch your face, you may become infected,

The incubation period from exposure until when symptoms appear is about 5-7 days.  Most people who have been exposed and will get ill, should show signs of the illness by 14 days.

The test for the virus is a Nasopharyngeal swab.  This is done by advancing a swab through your nostril to the back of your throat for a sample. It is uncomfortable but not painful. Currently there there are an adequate number of swabs to test and identify patients who are most likely to be infected and the turnaround time for a test, done in Kingston, is 24 hours. If you require a test, you will be asked to self-isolate until the results are back.

The 95% of people who acquire this virus and recover from it will likely develop immunity, at least for a few years. Only time will determine with certainty how we respond with acquired immunity to this virus but one hopes that it will be like how we react to similar viruses.

There is no immunization yet for this virus and it will take at least a year to get one. longer to have it widely distributed.  Having an influenza shot is a good idea if you have not yet done it BUT the FLU shot does not protect from COVID-19 (just as it is not effective for the common cold).

There is no current treatment, other than symptomatic management for the disease in the 80% who are mildly affected.  These folks should NOT go to the Emergency Department or even to their doctor’s office.  They should self-isolate at home for 14 days, use fluids, and acetaminophen or ibuprofen.  Cover their mouth when sneezing or coughing.  Avoid  close contact with others in the household.  Do not go to the store or out to places where you are in contact with others.  You might wear a mask to avoid droplet spread to others but masks are now in short supply so you may not be able to get them.  Masks in public to prevent getting the disease are not effective and not necessary.

People who are more significantly ill with an Acute Respiratory Illness (ARI) of cough, fever and shortness of breath should call their doctor’s office for information as to where to be evaluated.  In all likelihood, there will be Regional Assessment Centres set up in our community where all people with ARI will be evaluated and tested if deemed necessary.  This will avoid anyone with COVID-19 passing the virus on to other people who are seeing their doctor for other reasons and may be more at risk for serious complications.   Currently the testing in Kingston will likely be for anyone presenting with an ARI and who have been outside Canada in the previous 14 days since person to person spread in our community has not been happening – yet. Yes, this means if you were in Florida for Spring Break and within 14 days develop a cough or fever, you will be sent to the Regional Assessment Centre and be tested.  Drive-through testing might also occur. You wind down the window of your car and are swabbed through the open window, thus avoiding contamination of others in an office or waiting room.

Even those who are not ill or are minimally affected should be prepared to be significantly inconvenienced by an outbreak which will inevitably arrive in our community.  There may be school closures and cancellations of sporting events or conferences or meetings.  Certain travel might be curtailed.  Theatres or any place where people may be congregating within a metre of each other may be closed.  You may be required to self isolate (stay home) if you have been in close contact with a known COVID-19 case or if you have returned from traveling to a high risk area – and these are increasing all the time. 

So, if most people have mild illness, what’s the big deal?

This is a totally new virus and none of the 7.7 billion people in the world will have acquired immunity to it. (Except the 60,000 who have had it in the past month and have recovered.) We are all susceptible.

This virus is readily transmitted by droplet spread. 

We have no treatment to cure it.

It will be at least a year before immunization is available. 

It has a high death rate for vulnerable people. 

It will put a huge strain our health care resources if it comes in a big wave.

We can not prevent this virus from hitting our community but we can dampen the spread by diagnosing and isolating positive cases, avoiding close contact with others in group events, avoiding shaking hands or hugging friends or co-workers, washing hands regularly with soap and water or using a 60% alcohol hand sanitizer (currently not available as it has been sold out), and avoiding touching your face. 

If you have symptoms or if you have been diagnosed by swab, you MUST self isolate.  This may seem like a bother if you are only mildly ill but you need to avoid spreading this into the community and to others who may be at much higher risk.

If we can flatten the curve of infection in the community using the above measures, we will be able to deal with those who are more seriously ill with the virus.  If there is a huge spike in cases all at once, the health care system will be overwhelmed, there will not be enough beds to support those who are seriously ill and health care workers will also be affected and need to self isolate which will cut the number of health care providers who can look after the acutely ill. 

If you want to see the restrictions ITALY has put in place today, March 8, 2020, to try to curb spread of this virus for the above reasons, check here : https://johnageddes.com/2020/03/08/restrictions-applied-in-italy-on-march-8-to-curb-spread-of-covid-19/

All this is changing day to day. I have tried to give a current status of how we are or might be affected in Kingston.   We have to hope that there will be  a slow infection rate so our system is not overwhelmed.  If we are lucky, there may be some abatement over the summer (we don’t know if that will happen yet but it does with influenza) but, even if that happens, it will definitely be back with a vengeance next fall as immunization will still not be available at that time and there may be more asymptomatic or mild cases throughout the community.

I hope this information is helpful to you. We will be OK in the long run but there may be some bumps along the way. Be glad that you live in Canada where we have a capable, publicly-funded health care system.

John A Geddes MSc MD CCFP

March 8, 2020

I have published and updated to this information HERE on March 12, 2020.

32 thoughts on “Coronavirus in Kingston, Canada. My take on what we might expect.

  1. One of your points I’m questioning.. An infectious disease specialist said today on CBC Radio that it is unknown if a person who survives COVID19 is immune.

    • Thanks, Hannah, for this comment. There are a lot of things that aren’t known with certainty yet about this virus. I will add the word “likely” to this sentence since there is a bit of an assumption here that our bodies will respond in a similar way to other viruses that are like this one and it will only be with time that we will be able to confirm this. I agree with you that perhaps I should not have stated this so definitely.

  2. Thank you Dr. Geddes. This is the best, most rational article I have read. I wish everyone in Canada could read it.

  3. Thank you. As a soon to be octogenarian I would be interested in knowing of any tips to strengthen senior lungs, such as exercises, and if you think that strengthening lungs would be helpful.

    • Hi Taneda

      I am in my early 70’s myself so am part of your cohort. I think it is a good time for smokers to quit and for people who have other chronic ailments to get them tuned up with their family doctor so they are in the best balance they can be. Other than that, I don’t think there is anything specific you could do, other than minimizing your vulnerability with the now widely-published advice to wash your hands, not touch your face (hard to do) and avoiding gatherings where people are packed together (a crowded subway car at rush hour might be an example). After that we have to rely on a little luck to not be counted in the 3% for whom this is fatal. But if you look on the bright side that means you might be sick but have a 97% chance of recovery.

      Thanks for your question.

      John

    • Hi Frank. Thanks for your question.
      Statistics are sometimes hard to sort out and they often vary a bit. I am not sure where you get the number 13%, however. Could it be that this is the number of cases per 100,000 population since that is often the way the numbers are expressed. The consensus is that influenza causes an overall death rate of around 0.1% with the same vulnerable people as would be affected by COVID-19 having the highest proportion.

      This paragraph is from a WHO article published two days ago.
      “Mortality for COVID-19 appears higher than for influenza, especially seasonal influenza. While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower. For seasonal influenza, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of health care.” https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2

      I hope this clarifies things for you. Take a look at whether the figures you are looking at are a percentage of the population or number per 100,000.

      Thanks for reading my post and for reflecting on it. Stay well.

      • Thank you for the response.

        In the link mentioned, below the section titles “Signs and Symptoms” it states:

        Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths.

        650,000 of 5,000,000 is 13%

        It’s too bad WHO seems to have contradictory info as well.

        If you google how many deaths related to influenza the numbers are all over the place.

        Great article regardless.

      • But the respiratory deaths there are compared to the 5,000,000 “severe” cases, not the total number of cases, many of which are not severe. The death rate for ALL cases of influenza is more like 0.1% and that is quite consistent. The death rate for those who end up with “severe illness”, of course, will be a higher percentage than for the total number of cases of all degrees. Glad to have this conversation, Frank.

  4. Well written and informative. As usual, we are our own worst enemies. If we think practically and perform our daily tasks with thoughtful avoidance, it is just another flu.

    • I think this will be more disruptive than influenza but we will have to learn to deal with it over time. For the next few months it may be more difficult as it is totally new and we are all vulnerable to catching it. Wash hands!

  5. Very informative article. Thank you so much for all your advice. I’m nervous because there has been so much news about this new virus. I’m 73 and my husband is 80. We will just keep washing our hands and keep our fingers crossed and minimize our going out and about to small numbers and keep our distance from others.

    • I think that is the right course to take. One needs to.be sensible and cautious but not panic. FYI, I am 73 too and will be doing just what you are doing to minimize my risks. My biggest risk might be from my exposure to patients but that goes with the job. Be well.

    • People over 65 or others with conditions like Asthma, COPD, Diabetes or Heart disease should get the pneumococcal vaccine regardless. The pneumonia caused by COVID 19 is mainly viral BUT there is the possibility of a superimposed bacterial pneumonia as a complication. So, yes, a pneumococcal vaccination is a good idea for higher risk patients although it is specific to bacterial pneumonia and won’t alter the effects of the coronavirus. Good question.

  6. Thank you. I do wonder why the wearing of masks by all, even a cloth one that is homemade, is not recommended. If the spread can be prevented by not coughing or spitting it out it seems to be a given that less people would be affected than if everyone is spreading it randomly.

    • Good comment. You are right. If you have the virus and are being exposed to others, wearing a mask or otherwise covering your mouth and nose with something (even a tissue) when you cough or sneeze, will reduce the droplet spread. If you attend your family doctor’s clinic and have a cough, fever or shortness of breath, you will be asked to don a mask and sanitize your hands immediately and be put in a room rather than the waiting room.

      Where a mask is not thought to be effective is people wearing them in the street to avoid infection. That is not required or recommended. Health Care Providers will wear a full mask and googles and gloves and gown to do any close inspection or sampling from at-risk patients but that is a more intimate contact than passing people on the street or in the grocery store. Keep your distance from others, avoid touching them, wash your hands and try not to touch your face.

  7. Thank you for the excellent article. I’m not quite 65 and don’t otherwise fall into “at risk for pneumonia” except that I have had pneumonia three times, most recently about ten years ago. Are there downsides to getting that vaccination?

  8. If you get over back to health can you infect people..should be able to you carry this for rest of your life..mild case of childhood messils..

    • Hi Ron. I appreciate your question. Once you have had this virus and recovered, you will NOT be infectious to other people. It’s not like HIV or Herpes. Once you get over it you will not be able to infect others and hopefully will have acquired natural immunity so you don’t get it again, either.

  9. Thank you for the excellent info! I have a friend who is doing a self isolation after travelling in part of Italy which has now become a high risk area. She has no symptoms. My question is: If you get a nasal swabs test done before you exhibit signs and symptoms, would the test be negative even if you have acquire the Covid-19 but are in an incubation period? Thank you!

    • Hi Louise. From what I have gleaned from the medical literature, it would appear that if you get swabbed too early, ie if you are in the incubation period and not yet full-blown, whatever that turns out to be for you, then the swab might be negative, even if you are incubating the virus. So we can’t really depend on negative swabs in the pre-clinical phase to rule out the virus. Self incubation if you have come from a high risk area (Italy, Iran, South Korea) for 14 days is a responsible thing to do and, if you develop symptoms, you could be tested. Thanks for your question. And thank your friend for taking pro-active measures to protect her community.

  10. Pingback: My Covid-19 update. 'Social Distancing' is imperative at this point. | johnageddes

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