About johnageddes

Kingston, Canada based family physician, photographer, grandfather, thespian and philanthropist. Founding Trustee of the CanAssist African Relief Trust. Development work in Bosnia and Herzegovina and East Africa.

COVID-19. A wake-up call.

Today I am thinking about that meme of Jack Nicholson in The Shining with “I’m Back” written on it.

After a few weeks of no new cases of COVID-19 in Kingston, with the exception of two cases that had a link to the GTA, the KFLA Health unit has reported 10 new cases in the past week.  Apparently none of them have known connections outside our district.  One of these is associated with a unit at the hospital, another works at a local restaurant and several associated with a nail salon**.  Public Health officials will be working hard to track down, test, and isolate any known contacts. By the time you read this, there may be more.

In the KFLA district, we’ve been both lucky and responsible so far. This recent little outbreak in Kingston should act as a wake-up call to all of us that we are not done with COVID-19 despite our relatively light exposure over the past few weeks.  Maybe the fact that we have had so little in our community has seduced us to be more negligent about following the advised recommendations.

In recent days, I have seen groups of people clustering, not within 2 metres of each other and not wearing masks outside an ice-cream shop, on the street, and in the barber shop.  I have had friends say “It’s OK to get together as long as it is less than 10 people”, seemingly unaware that this comes with the additional caveat that small groups can gather but only if they are following the distancing guidelines.  I see lots of people in stores, even clerks, not wearing a mask. It is encouraging to see the numbers in Ontario and Canada abating. However, we only need to look at what is happening in parts of the US where the guidelines are being resisted to see how quickly this virus can gain control. 

There has also been a shift in the demographic of COVID-19 cases to include more younger people. Perhaps this is because they are more likely to be mingling with each other and they might feel a bit less vulnerable than their older fellows.  I worry about when students will inevitably return to Kingston for university or college and we have all heard of tourists being spotted in Kingston from other districts.  Protecting ourselves by being cloistered is simply not going to be an option. 

I fear that complacency is asking for trouble.  While we are able to be outdoors, our risks are certainly reduced but because of our luck and success at avoiding a major outbreak so far in Kingston we have become lax with following the guidelines.  

I admit to having relaxed in some respects, too.  But I am going to try to tighten up.

I have a small group of friends that I will continue to walk with (less than 5) and we will do our best to keep our distance as much as possible and only meet outdoors.  I have only been in 3 houses of other people in the past 14 weeks and have only had two others come into mine on limited occasions. I will continue to limit indoor visits anywhere.  I will wear a mask whenever I am inside a store of any kind and often on the street when I see that distancing is going to be tricky because of narrow sidewalks or busier pedestrian traffic. I am aware that this will offer me limited protection but any advantage is better than none. It will also act to protect others from me if I am infected and don’t know it. If more of us wear masks under these circumstances it will become the norm, rather than the exception. This will help our community to limit spread. I will wear a mask in a car if anyone else is in the vehicle and insist that they do as well.  I will continue to wash my hands whenever I return from being out anywhere. If I become sick at all, I will avoid others and will consider getting a COVID-19 test if symptoms are suggestive of that in any way.  Testing is easily available now to anyone  and widespread testing with appropriate contact tracing will help to squash any outbreak we have.

It is discouraging to have to admit that this COVID-19 thing is going to be a challenge for several months to come. Like you, I was hoping it would  just go away. But it is here for a while. We need to continue to be diligent, without being antisocial or paranoid, in order to keep it under control, to protect our community and our Health Care System and to limit the adverse effects of this virus to as much as we can.

Stay calm but stay the course. Protect yourself and your community by continuing to act responsibly.

John A Geddes MSc MD CCFP June 25, 2020.

** In the six hours since I posted this blog i have heard that most of the new cases in Kingston are connected to the nail salon. Amazing how one breach in security can have unfortunate ripple effects through the whole community.

Covid-19. Modifying the “Stay At Home” message.

Kingston has remained fortunate that the COVID-19 virus has not caught hold here as it has in some other Canadian communities.  Canada’s numbers have plateaued but not dropped significantly in the past week.  Ontario’s numbers actually went up a bit last week but today’s count is better. The GTA is the biggest contributor to new Ontario cases. The numbers do bounce around somewhat so looking at the trend (and deaths) gives a better sense of what is happening than daily counts. Canadians have been able to keep the demand on our Health Care facilities manageable and that was the initial aim of all the restrictions requested of us. But there is still risk of clusters of spread and we’ve seen that some folks are being somewhat defiant.

In Kingston, our only new COVID case in the past four weeks has been someone who reportedly went to the Greater Toronto Area and brought it back.   I don’t know the exact details but this does point out that Kingston’s greatest risk at the moment is introduction of the virus from people outside our district that we invite in (tourists, relatives) or Kingstonians who travel, don’t adequately physically distance themselves, and then bring COVID-19 home with them.   Initially we were asked to STAY HOME, meaning indoors and not going outside for anything other than groceries or something deemed urgent.  Most of us complied.  It worked.   Now the message is still STAY HOME but the definition of “HOME” could be expanded to be within our district.  The stats from the KFLA Health Unit for the past month would suggest that picking up COVID-19 in our district from people who have stayed inside our community is negligible.

Reported cases of COVID-19 in the KFLA Health Unit as of May 26. The last reported case was introduced from outside our district.

That is great news. Let’s not get complacent, however.  You don’t know who the interloper might be.

We have adjusted to a new social normal already.  In general, people are seeming to keep their distance in public places. No one is offended if you veer away from them on the sidewalk.   Most people walking together are courteous enough to move to single file to let others pass within a safe distance when the pathway is narrow.   I thought today how, in the past few weeks, I have said hello to many more strangers than I did in the past and I’ve been greeted with smiles and responses.

We will adjust to the changes required to keep us safe.  I remember, as a child, bouncing around in the back seat of my parents’ car without a seatbelt and how much of an unwelcome restriction it was to have to wear one. Do you recall how restauranteurs and bar owners thought that a no-smoking policy would ruin their business? Think about the changes in airport security that we accept now as normal when virtually none existed only a few years ago. 

If you can adjust to standing by your German Shepherd as it takes a dump by the fire hydrant, then bend over to scoop up the poop in a plastic bag that you carry nonchalantly on the rest of your walk, you can certainly adjust to putting on a mask when you go into a grocery store. 

There will be other societal changes to which we will acclimatize.  Cash will disappear.  That trend has already started in many countries but these events will accelerate that movement.  For some time, indoor gatherings like theatre or conferences or church will be discouraged.  And people will be reluctant to participate, even if they were to occur.   Limits to the number of people in a store will be common place.  Take out meals will be more comfortable than indoor dining for a while.  There will be sanitation changes required to public washrooms.  Travel will be cumbersome and awkward.  

We will adjust. We have done so to many other societal changes in the past.

Eventually this virus will run its course or become manageable with medical treatment and immunization. In the meantime, we must remain cautious but not scared, compliant with the recommendations made by our Public Health Unit, friendly from a distance and courteous and respectful of others.  As a community we can support each other and protect each other.  We already have, in fact.   Let’s keep that up, Kingston.

COVID-19 We’re just beginning

Let’s start with the good news first.

Kingstonians can continue to breathe a collective sigh of relief as we enter this holiday weekend, knowing that there has been no new COVID-19 case identified in our Health Unit cohort for over two weeks.  All 61 of the previously identified cases have been declared “resolved”.    This is reason for appropriate celebration and considerable relief that we have passed a first wave of COVID-19 without experiencing the feared, overwhelming situations like those we have seen in some other centres around the world.

In addition the KFLA Health Unit figures indicate that only 18% of the cases in our district were “Community Acquired”, the rest being found in returning travellers or direct contacts of known cases.  Our Health Unit serves about 215,000 people. That means that of the 61 diagnosed cases – I say “diagnosed” because we don’t know if there are others out there that we have missed because they were not tested – 11 of them arose from sources unknown or random community transmission. That is one such case in 20,000 people.  Those are not bad odds.

Does this mean we can let down our guard?  NO, indeed!

It means that the measures that have been put in place in our community have minimized the spread of the virus and it has had nowhere to go so it has temporarily petered out.  But it is still there.  And it is still there with a vengeance in Montreal, only 250 kilometres away.  The reality is that our community remains highly vulnerable because we are still quite COVID-naive. So far, we Kingstonians are living in a bit of a bubble.

I wonder what will happen when we open up a bit or when people go to their cottage near Ottawa or when they visit their family in Toronto and return to Kingston.  What will happen if we start to get people from Montreal coming for a summer weekend vacation?  Or when some college or university students return to Kingston in September?  If we become overly confident and let our guard down too much will we start to see more community spread of this virus that is still out there, waiting to find  an entry point?

The World Health Organization this week has suggested that we are in for a long haul with COVID-19. Like HIV, it may be a pathogen that we will have to accept is here to stay.   We will eventually develop some “herd immunity” that lowers its prevalence but it may always be there, lurking and threatening to surge if given the chance.  There are also studies this week from both Spain and France suggesting that in these countries, where there has been a significant burden from disease this spring, only about 5% of the general population has antibodies. A similar study done in Boston and reported today discovered about 10% of the population had antibodies.  This suggests that the prevalence of undiagnosed infection or sub-clinical infection is less than we had hoped for and that significant proportions of the population are still vulnerable to infection.

This week, the Canadian government approved an antibody test that will be very helpful in identifying what is happening in our various communities to track this infection and aid in management. It is not ready for widespread clinical use yet but this is a start.

Just like what has happened with malaria, and TB and influenza and HIV, I am confident that we will eventually come to learn much more about this novel coronavirus and develop strategies and medical managements that will lessen the impact or be able to treat it.    We will develop better/quicker screening and testing for COVID-19 and be able to earlier identify and quarantine those with an active infection and their contacts. Maybe there will be a drug that can be taken by contacts that will suppress the infection proactively.  Hopefully, we will come up with immunization that will help to improve the herd immunity.  It will take a while to provide immunization to 7 billion people. Unfortunately, there will likely be a backlash and resistance from those who oppose vaccinations of any kind that will slow the process for the rest of us.

In the meantime we need to stick to what we have found is actually protecting us so far. Wash those hands often. Limit your close exposure to others.  Don’t gather in groups where distancing is not practical and particularly in indoor closed areas. Work from home when you can. Consider wearing a mask when you are shopping or in a situation where physical distancing is impractical.  When you are sick, stay home. Better yet, get medical advice and possibly a COVID test if it is advised so your recent contacts can be warned if you are infected and so you don’t spread it unwittingly to others.  We will need to take particular care of those in Long Term Care facilities and, as a community, protect individuals whose co-morbidities put them at increased risk of serious consequences of the infection.

Although the last 9 weeks have felt like a lifetime, we are only just starting. The COVID-19 virus is new to the world. We are guessing to a certain extent, using scientific reasoning, how best to mitigate its effects at the moment but how this unfolds over the next couple of  years is taking us down an unknown path. International cooperation and learning from the experience in other parts of the world has been helpful.

Some folks are eager and others might be understandably anxious about re-opening the economy. The bottom line is that we can’t remain in total isolation forever. My opinion is that if we proceed gradually in a responsible way and remain ready and responsive to deal with any emerging infection clusters that develop, we can go ahead with caution. It will be slower than we want and there will be challenges to working around new restrictions that will be in place for some time. We will adjust.

Life will change. Our societal habits will change.  But humans are pretty resilient and flexible and we have science and technology that was not there for past pandemics on our side.  Our short-term success shows that we can do it.  It’s a long course ahead, however, and we will have to buckle down and accept that sobering reality.

John A Geddes MSc MD CCFP

Here is a message from our Local Medical Officer of Health posted today on the KFLA website.

COVID-19 Now what?

If epidemiologists and Public Health specialists are right, Canada has just about reached the peak – or at least a plateau – on the COVID-19 curve.  How long we stay at the peak before coasting down the other side is uncertain. New cases are still being reported in large numbers but they have tended to level out rather than increase exponentially.   A significant number of deaths are also still occurring, especially associated with Long Term Care facilities, but these, too, are anticipated to start to decline in the next couple of weeks.  

When I wrote about this in mid-March, the fear was that we would be overwhelmed with a surge in COVID-19 infections that would inundate our Health Care Facilities and hospitals with patients requiring intensive care. We were cautioned that we must “flatten the curve” and with Public Health guidance, we significantly changed our social interaction with others and washed our hands until they are raw. This strategy seems to have worked as hoped.

We must bear in mind, however, that we are flattening the curve, not eliminating it all together. Yet. The downward curve will be very gradual and prolonged.  COVID will linger for quite some time and there will always be the threat that if we lighten up our precautions too quickly the curve will bump up where we don’t want it to be.

In Kingston, Ontario, where I live, we have been especially fortunate to have avoided the anticipated huge peaks and potential overwhelming surge on our Health Care facilities. The KFLA Health Unit, serving a population of about 215,000, reports today that there have been a total of 59 confirmed cases with 56 of them already declared “resolved”. Our health unit has recorded no COVID-19 deaths. No COVID-19 patients are currently in our ICU or on a ventilator.  In the last three weeks there have been only four newly-confirmed cases. Thanks to both good luck and preemptive precautions taken by our local Public Health Unit, our Long Term Care facilities have, so far, remained safe with no outbreaks. This is indeed a great relief for our community. You can see for yourself in the image at the end of this post, how our local curve has remained flat for several days.

This good news does come with a bit of a snag, however. Because our community has been so spared of a significant outbreak, it means that most of us are COVID-19-susceptible.  The challenge becomes how we can start to relax our restrictions but not find ourselves at square one again because very little has actually changed about our community in terms of COVID-19 vulnerability.  As long as we remain somewhat cloistered as a community, our risks of infection are lower than many other areas that have been more heavily infected.  But how long can we remain isolated as people start to travel a bit more widely to visit family or students return to Kingston or folks take a bit of a vacation in the summer outside our area?

The Ontario government has published a scheme whereby things might gradually open up but the timing of reducing restrictions will be entirely dependent on what is happening in terms of infection rates, hospitalizations and deaths.  Realistically, it will take a long, long, time to return to any semblance of normal.  And the normal that we return to will inevitably be different from our past. The physical distancing thing will certainly remain a standard for some time.  It will affect the way we shop, interact with friends, travel and celebrate together.  Group activities will be curtailed for months to come. 

There is still a lot that we don’t know about this virus.  We will need more widespread NP swab testing to identify the presence of virus.  When we test more broadly, we will be able to identify earlier the people who might be infected and thereby infectious to others. If we quarantine those people and actively contact trace to find anyone who might have had interaction with them and then test and isolate those people, we will reduce exposure to others within the community.  We know that there is a significant number of people who exhibit no symptoms and yet are infected and able to spread the virus.  We need to be more aggressive with testing to identify as many as we can so the transmission to others is reduced. 

Eventually antibody testing to determine the presence of both recently and more remotely acquired antibodies that hopefully will result in immunity will give us a better sense of how widespread asymptomatic or mildly symptomatic infections have been.

I anticipate that some medical management will soon be determined to be available to those who are more acutely ill.  This would really help to manage the severely ill and reduce the strain on hospital resources.  We have not found this treatment yet but I am certain that eventually we will discover an effective management strategy.

The ultimate fix that will allow us to return to “normal” will be if and when an effective, safe vaccine is developed and made widely available to people throughout the world. We know that vaccination works. Consider, for example, what immunization has done to squash Smallpox, Polio, Tetanus, Measles. Getting it right is important, however, so that we know that it is safe and effective.  Combined with antibody testing, this might be the ultimate “Get out of jail free” card we await.

I have spoken to a lot of people who are wondering if the cough and fever that they had  in January was actually COVID-19.  Although we know that this COVID-19 virus was probably circulating, undetected, weeks before it was first identified in labs, it is probably more likely that most of those folks with “flu” early in the year were suffering from another viral illness. Acute Respiratory Infections caused by a number of agents  give similar clinical pictures.  The only way to find out how many of those January coughs were COVID-19 will be when the antibody test is available for widespread use. 

In the mid 1980’s when HIV was ravaging various segments of our society and decimating African communities, we talked about ‘safe’ sex. Eventually we realized that no sex was 100% safe so we changed the terminology to ‘safer’ sex.   I think we will need to think similarly about COVID-19.  Until a large percentage of the entire world has developed  immunity, this virus will be present and we will have to do what we can to minimize our own risks and limit spread in our community. It won’t be perfect, but with careful hand washing, limited close contacts, changes to the way that we gather in groups,  physical distancing where practical, testing, contact tracing and eventual immunization, we will be able to cautiously inch forward to arrive at a new normal.  The world has encountered plagues and epidemics and pandemics before and survived.  We will too.  But it will take a long time to get there and many things will have changed irrevocably in the meantime. 

John A. Geddes MSc MD CCFP

COVID-19 update. Kingston has dodged the bullet for now. But are we dealing with a revolver or a machine gun?

When I first wrote about COVID-19 a couple of weeks ago it was on the horizon but had not arrived with any intensity. The major concern at that time was that the virus would surge in and overwhelm our Health Care System.  Canada has had an advantage over countries that had been bombed by this infection already in that we could see it coming and take action to avoid it.   Social distancing was advised early.  Public Health measures  and planning were put in place.

In Kingston, Ontario, where I live, we have been fortunate to have been able to keep the “curve” pretty flat.  Our community of about 215,000 people has only had 53 documented cases of COVID-19 with 36 of those people having recovered.  As of April 10 we have not had any COVID-related deaths and only two people are currently in hospital being treated for COVID-19 specifically.   Some of this is just good luck.  But the community has certainly embraced the principles of social distancing responsibly.  Other factors that may have helped are that the local university and college has closed up and many students have gone home.  We have no tourists. Clinics are treating their patients “virtually” rather than in face-to-face visits.  We have passed the 14 day risk period from returning spring break or winter snowbird travellers who have isolated themselves to protect the rest of us.  Congratulations Kingston, it’s working for you right now.

There has been a partial flattening in other parts of Canada, too, but we are yet to reach the predicted peak later this week.  Deaths from COVID will rise across Canada for the next couple of weeks. There is a 2-3 week lag between the number of new cases and the number of deaths because deaths don’t occur immediately when the diagnosis is made.  

Is there a story behind these numbers that we have to consider?   How reliable are these statistics?   How do they compare to other countries or communities?

We have to bear in mind that the numbers are only for confirmed cases of the infection.   People who have had milder symptoms or even no symptoms at all are not included in these figures.  This means that the rate of infection in the community is certainly much greater than the numbers presented and that we must continue our social distancing practices  both to protect ourselves and to protect others.  

How can we actually compare how we are doing?  Hospitalizations and deaths are figures that are more reliable and a reflection of what is happening in the community in general.  About 10% of those who are infected will require additional medical care and are more apt to be tested and identified. We can look at those cases to determine the overall prevalence in the community.   Death rates attributed to COVID-19 are also an indicator of how widespread the illness is. The consensus is now that COVID had about a 1% death rate.  This does vary from one demographic or population to another but the affect of the virus on the community can be ascertained by looking at the death rate figures.  Because population numbers from one country to another vary,  I have been watching the deaths per million population number to get a sense of how comparisons can be made.    

According to the Worldometer statistics up to April 10, Canada currently has had an attributed  COVID death per million of our population of 15.  For the USA this is 57 deaths per million.  For Italy it is a terrible 312.  Italy’s high rate is in part because they were taken by surprise when the infection arrived and their health care system was submerged quickly.  This means that many people who might have benefited from more intensive care were unable to get it and subsequently died. There may be other factors like population density, a higher older population and more families with multiple generations living in the same household that influenced this as well. This disastrous result is particularly what we have been trying to avoid by “flattening the curve” and Canada has had the advantage of a bit of time to prepare and take precautions earlier than Italy.

We also have to be aware that this pandemic, although global, tends to be presenting unevenly in scattered epidemic areas, like New York City or Milan or even Toronto for example.  So numbers might be drastically different from one locale to another. 

The down side of being in the lower numbers right now is that this curve has not been erased but is only being flattened – stretched out so to speak.  Because we have a lower prevalence in Kingston, we remain more vulnerable as we don’t have a significant proportion of people with naturally acquired immunity and immunization is yet a year away at least.   The question is how will this unfold over the upcoming months?  If we let up on our social distancing will it lead to a surge later that is hard to deal with?  How can we gradually return to a more normal society and when will that happen? Will children be back in school in June? In September?  When will people who have been  laid off get back to work? How long will we be asked not to go for coffee or dinner with friends or family?  When will I be able to go to a movie or a theatre event?  When will travel restrictions be loosened up?  

No one has answers to any of these questions yet.  For the time being those of us who live in Kingston need to be glad that we have dodged this bullet and that we are currently able to sustain a reliably functioning health care system and not be overwhelmed with unmanageable numbers of seriously ill COVID patients or COVID deaths.  But we are stuck in this holding pattern for the near future and maybe several more weeks or even months.

 Before it is all over we will, unfortunately, lose many lives to this infection.  But with time, it will subside. More people will acquire natural immunity from infections that don’t present severely.  We will get more intensive testing to identify and aggressively trace and isolate specific people with symptoms and their close contacts. We could even identify those who have no symptoms but are infectious in order to limit contagion.  We will get a quick test to identify people who are immune.  I hope that we will also get some medical management to help manage the more severely ill patients, possibly reducing the need for intensive care and ventilation.   And the final success will come when we eventually have immunization.  

In the meantime, we must stay the course because for now, it is working, Kingston.

If  you want more numbers, here are some figures from Worldometer and the KLFA Public Health Unit as of the end of yesterday, April 10, 2020. These figures change by the hour.

John A Geddes MSc MD CCFP

Kingston, Canada

COVID-19 Numbers, numbers, numbers

The COVID-19 numbers out there can be scary.  We have cocooned ourselves for the past several days and the stats are still going up.  Most of us have nothing much else on our minds but anxiety about where this is headed, particularly when we look at the devastation that has happened in Italy, Spain and New York City.   We wonder “Is Ontario next?”

Today the Ontario government released projection figures that are both disturbing and motivating.  We know how this virus tracks from how it has exploded in other parts of the world.  With those models as a predictor, Ontario, without any restrictive measures in place, would have anticipated 300,000 cases and 6000 deaths by the end of April.   If we follow the current recommendations to limit physical contact and stay at home most of the time, however, that number can be reduced to 80,000 cases and 1600 deaths by April 30.  Still an incredible burden but it means we will effect a significant reduction of over 4400 deaths in Ontario this month alone if we just stay the course.  If we restrict further (and further restrictions may ensue) that number could be reduced even more.

It may be frustrating to see that we are trying to stay in and stay apart and the number of cases and deaths in Canada keep going up.  But that was anticipated. For a while we were slow to get testing results so the statistics lagged by a few days.  We also had the influx of travellers returning to Canada and some bringing their virus with them.  Some of those didn’t self isolate as diligently as requested. Although they thought they were not infected or had minimal symptoms, they could have spread the virus to others. There is also a 7-14 day incubation period before the symptoms become evident and some people have minimal symptoms of infection. This means that people who were exposed two weeks ago might just now be showing symptoms and becoming ill enough to test. And others are simply unaware that they are infectious.

Don’t get too frustrated by the current increasing numbers.  From the charts of the various possible trajectories, it is evident that our current social isolation is actually working to reduce the otherwise catastrophic infection and death rate that would have happened if left unabated.


Another graph that was released today was also encouraging. (see below) It shows the possible numbers (in red) if no measures were in place and the anticipated numbers if we are compliant with the current stay at home  and physical distancing recommendations (in blue)   The two dotted lines represent the Ontario capacity for ICU management in the province both in place prior to the pandemic starting (the lower line) and now planned (the upper line).  We are fortunate that we have had time to anticipate this imminent glut of infection cases and our hospitals are putting additional capacity in place.  If we follow the blue curve we will be able to sneak under the expansion capacity line.  That is good news.  

Our COVID-19-associated death rate per million in Canada right now stands at 5 per million population as compared to 21 per million for the USA and 243 per million for Italy.  Remember that deaths occur later in the process so they will continue to rise for the next while. As long as we can stay under that dotted line and have adequate access to ICU beds, we will be better able to manage the seriously ill and more lives will be saved.  Many of the deaths in countries with very high rates were partly as a result of ICU capacity being suddenly overwhelmed and medical management simply not being available.

So, the message is that the potential for seriously devastating numbers is there but we are already going to have some effect on the curve with what we are doing now. With more dedication to these restrictions we can do even better over the next month. This will be a marathon, not a 100 metre dash.  Take some big breaths.  Settle in to our new temporary reality and know that it is making a difference, saving lives, and in the long run things will get better.

Through various medical connections and meetings, I have been impressed that our Public Health officers, Ministry of Health and local and provincial physician groups and clinics have been very actively anticipating and planning for the surge that we anticipate that we will experience in the next couple of weeks. I feel confident that in Kingston, Ontario, and across Canada, we will receive excellent care and support during this unprecedented challenging time.

For my neighbours in Kingston, as of this morning we have 48 confirmed cases and no COVID deaths in the KLF&A district with likely many more out there who are not ill enough to have been tested. General testing has been a bit restricted initially because of the need to ration available tests but this will likely loosen up a bit soon so more cases might be confirmed. This increased testing may lead to more confirmed cases being reported.

COVID-19. Is there any good news?

We are all traumatized by the incredible changes in our lives that have happened in the past couple of weeks. We also worry about what is to come. Canada could be swamped in the next few weeks with cases of COVID-19.  Just how swamped will depend on how much we pay attention to the physical distance warnings we have been receiving from all directions.

We are being deluged by the worst case scenarios that are being presented to us in order to make us sit up and take notice and do something now to try to reduce the inevitable increase in numbers of sick people and the extraordinary strain on our Health Care System and other resources in general.  We know, from our experience in the past couple of weeks, that it is impossible to predict how this will have unfolded a month from now.

Rather than dwell on only an apocalyptic view of the future, I think we need to be aware that there are glimmers of hope out there.  What I will present here is entirely my own opinion but it is these thoughts that give me some hope that we can eventually get past this challenge.  

At the moment, the number of cases in Canada is rising.  This is certainly discouraging but is entirely expected.  They will continue to rise in the next couple of weeks as people who have been infected prior to our physical distancing efforts, people returning from international destinations and cases that have not been counted yet rise.  We can not expect this curve to flatten until we get over this initial phase.  I continue to watch the cases per million number on the Worldometer site and Canada is sneaking up but not near with the slope that we see in the USA for example.   I am hoping that this slope will flatten after a couple of weeks to keep our total number of cases per million at a manageable number.

How “flat” we can make that curve is yet to be seen.  At the moment, we are buying time to make the current escalating situation more manageable and until some more definitive management can be in place. It may not be working quickly or as much as we would like but we are having some influence by our combined efforts to reduce spread. Keep working on this, Canada.

We are still not able to determine with certainty just how many cases are really out there in the community because testing has been limited and mainly used to test those who are either at significant risk or seriously ill.  If this virus infects some people who develop few symptoms or even with symptoms that have been diagnosed as “flu”, there may be a cohort out there who have already had it or even have it now.  This is both encouraging and discouraging because it would mean that there are folks who have some immunity in the community, lowering the number of people at risk, but it also means that there are people who have been spreading this virus unknowingly. 

Availability of testing has been limited although we are doing better than many countries at testing high risk people. Testing resources are becoming more available and will ramp up in the next while. There will be a lot of folks who may have, or have had, this virus who are under the radar in terms of confirmation.  We don’t know how many who have had an Acute Respiratory Illness and have been told to isolate themselves and treat it symptomatically might have had COVID-19. But that, in some creepy way, is good news in that they are recovering without needing special medical care and they will be developing, we hope, antibodies to this virus.  The more people who have antibodies, the fewer in the population who can be infected or spread it.  Herd immunity is something that will help down the road. But it may be a while before that herd is big enough to affect the numbers.

Current tests for COVID-10 consist of a swab from the back of your nasopharynx that identifies specific COVID-19 RNA. It takes time to process and is not comfortable to obtain. Researchers have developed a rapid blood test that will show whether someone is infected or even has immunity from prior infection.  It is done with a finger prick of blood and results are available in 15 minutes.  The results would read as negative (not infected and not immune), having IgM antibodies (the first antibodies that are produced in response to an infection and suggest active infection) and IgG antibodies (the later immunological response we get when we develop some sort of longer lasting immunity to a particular infection).  Imagine if we could immediately test everyone presenting to a hospital, for example, like this.  It would allow us to isolate those who are infected immediately. We could also know what health care workers, store clerks, and other front line workers were already protected somewhat by their past exposure and antibody titres.  We could identify the silent asymptomatic carriers so they could isolate until they have recovered and not spread the virus to other vulnerable people.  Having this available will make a huge difference to understanding the prevalence of the virus in our communities. It will also help with management and control. It is on the horizon. Not sure when but it is something that provides me some hope. It might be the first significant tool to help manage this pandemic.  

I also think that we will likely come up with some sort of antiviral or medical management that can be safe and effective for helping to treat those with severe disease.  I don’t want to sound like “you know who” on this because it is a bit down the road, but I think it will eventually happen.  Medical researchers in the entire world are working ( I was going to say feverishly, but that might be a poor choice of words right now) to find effective medical management.

There will eventually be immunization for this virus.  It may take a year to get it on  the market and we will have to produce millions/billions of doses but, if combined with the antibody test, those who are not yet immune and vulnerable service workers could get the immunization first if supplies are limited. The caution is that, like influenza, this virus might change over time so keeping up with the specific viral mutations could be a challenge.  With any luck, the combination of acquired immunity and immunization will be able to bring some element of control. Widespread immunization is still months away but it will happen.   

Don’t take from this that I am underestimating the serious consequences that we might face soon as a result of the impending viral surge. However, in addition to heeding the warnings and scary projections, we should keep in mind that there will be advances that help us to get out from under this oppressive threat to our community health and our economy.

Prime Minister Trudeau, this morning, put it this way. “The best way we can work together is by staying apart.”

Stay the course, Canada. We can do this.

COVID-19 Update. How this extrovert deals with Social Distancing

We are social beings.  We all need connection. Some of us more than others. This Social Distancing thing is urgently important so we can minimize the anticipated surge in cases of COVID-19 in our communities in the next few weeks.  Unfortunately, the need to socially distance ourselves is not going to go away soon. 

Social distancing is not the same as quarantine or self isolation.  Those measures apply to people who are returning to Canada from international destinations, people who are  symptomatic and awaiting COVID-19 test results, those who have had a COVID-19 diagnosis confirmed and people who have had direct contact with COVID-19 positive cases.  These folks should not mingle at all with others for 14 days or until they are deemed cured.

Of course, if you are sick you should stay home, even if it is not COVID but is another Acute Respiratory Infection. This will minimize spread but also not lead to so many others getting a cold and then worrying it is COVID-19

All the rest of us need to practice Social Distancing. This means we minimize as much as possible close contact with others as well as follow all the other the routine advice for hand washing, elbow-sneezing, avoiding hugging or handshaking and not collecting in clusters of people.

I will share with you some practical strategies that I am adopting so I can comply with the need for social distancing over the next several weeks.

First of all, I will, at this point, go for walks outside.   I need to get outdoors and have some exercise. We are lucky that spring is around the corner so we can actually get some fresh air.  BUT that comes with the caveat that we must keep our distance from others.  The advised two metres is best.  I have a couple of friends who are also following the rules with whom I will meet periodically so we can smile at each other, have a bit of a laugh together and share some conversation.   But we will work to maintain the required physical distance as best we can. 

When I am out I don’t touch anything that I don’t need to touch.  I don’t sit on a public bench, for example.  I carry a small microfibre cloth in my pocket so if I have to open doors or carry a basket in the grocery store, I can use the cloth to make the contact.  When I get home I throw it in the wash. (I have a pack of 5 that I got at Dollarama).   If I can open a door using my elbow or hip or a push button or Key fob I do that rather than touch the handle.  I am also putting my clothes in the laundry basket if I have been out somewhere during the day so I can start with fresh clean clothes every morning. Although the virus has been shown to live on plastic and metal for up to 72 hours, it can also remain viable on clothing or cardboard for a day or so. Better safe than sorry.

When I pass someone on the street I am attempting to say Hello or Good Morning even if they are strangers.  It is always pleasant to be greeted and a brief verbal hello might just make someone’s day.

I will try to go to stock up on groceries at off-peak hours.  I live only 10 minutes from my usual grocery outlet so I will walk there early in the morning or go in the last hour before closing to avoid the busiest times.  We are being assured that generally the food supply will not be affected.  The empty shelves that you may have experienced last week are the result of exceptional panicked buying and hoarding. It will take a while for those folks to use all that toilet paper they have in their garage so that will leave some for the rest of us when we need to buy it.  Same with meat and pasta and rice and flour and…    There will be food.  Don’t panic.  And while I am at it, I will extend our thanks to the people who are working to keep us supplied  – clerks, shelf stockers, truck drivers, all of you.  We need you and appreciate this service.

I will still see my family who don’t live with me from time to time.  We will avoid hugging or touching and we will be careful to wash our hands or anything that we might have touched.  We will keep our distance as much as practical.  If any of us are sick at all we will self-isolate and not expose the others. 

For example, I spent a couple of hours this morning with my 8-year-old granddaughter. Kids are scared. They know what is going on and they also know that their family and friends are scared too.  We were able to have a great visit, taking extra care to avoid close contact, washing our hands after handling anything and playing interactive games that we streamed to the TV.   We talked about COVID, how to look after ourselves and our worries. When she went home, we both felt infinitely better.  She was happy and so was I.

I have been making a point of connecting with others both locally and internationally by using FaceTime or Messenger or Skype for audio/video chats.  We need to stay connected.  Text messaging is fine when we are busy and have the opportunity to interact face to face easily but a smile or the sound of someone’s voice does a lot to sooth that need for connection.

The economy is also taking a hit right now and where that leads is uncertain for all of us.  We have enough to worry about now without being fussed about things we can not control.  None of us know what the next month or six months or year will bring.  It is futile to try to plan that far ahead right now so I am refusing to spend my energy trying to plan that far in advance or think about what situation I or, for that matter, the world, might be in by then.  It is best to set priorities about what we need to do now.  Currently my priority is to be responsible to my community, my friends and family and to myself so as to dodge as much as possible the immediate effects of COVID-19. Catastrophizing (is that a word?) is counter-productive and I will try to avoid going that route in my head.

There have been an absolutely phenomenal number of individuals, entertainers and groups that have reached out online to help us stay upbeat and mentally busy in our distancing mode. I have looked for those and will definitely join in to pass the added alone time.  I will also break out a jig-saw puzzle soon.

This will pass.  Unfortunately, the need to socially distance ourselves and the drastic disruption to our normal routine is going to last for weeks or even months. It will definitely get tiresome and I am afraid that it will be too easy to put these thoughts aside and let our guard down when the sun is shining and the weather is encouraging.  In order for it to work, however, we will need to stay the course. Remember that it will take some time before we reap the benefits of this challenging change in our social interactions.  

Hang in. Help others. Support each other. 

John A Geddes MSc MD CCFP

Kingston, Canada

March 20, 2020

My favourite coffee haunt looks more like a bowling alley these days. Up to be a pin-boy instead of a barista, Nick?

Addendum: Six hours after I loaded this post, Balzac’s closed (along with other coffee shops like Starbucks.