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 – The home stretch

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This week, I am feeling like a butterfly emerging from a cocoon. I probably look more like one of those cicadas that has spent 17 years underground.

I am two weeks past my second COVID shot so I am about as protected as I can get at the moment.  I am also encouraged by Kingston COVID numbers dropping to barely countable and a steady drop happening across Ontario and Canada.  We ended last week in Kingston with a case positivity rate in the past 7 days near zero and only 2 unresolved cases in the whole KFLA Health unit area of over 225,000 people. Across Canada over 75% of our adult population are reported as having had one vaccine dose and 20% have completed their regimen with two. This is all great news and something to celebrate.

Hopefully we will continue our upward climb of getting people vaccinated because in addition to following sensible Public Health measures, that is the key to breaking the hold COVID-19 has had on us for months. Canadians are stepping up in droves to be immunized, thereby responsibly protecting themselves and their friends and colleagues. After a very slow start, Canada now leads the world in proportion of the population with at least one dose of a COVID vaccine.  We need the enthusiasm for first dose vaccinations to persist into acquiring second shots since complete two-dose immunization is more than twice as effective in protecting against the Delta variant which is catching hold now. Single dose vaccination only provides about 33% coverage for this variant.   Regardless of which vaccine you have started with, it is imperative that you complete your full vaccination programme. People who had the A-Z vaccine for a first dose may now be complete their course with one of the m-RNA (Pfizer or Moderna) vaccines.   In all likelihood we will all need a booster dose in a few months and this will likely be with an m-RNA vaccine that can be adjusted every once in a while to cover new variant mutations. 

Unfortunately, there will still be some folks who decline to participate in the vaccination programme. They will get a free ride because the relative herd immunity that occurs when the rest of us get vaccinated will protect them as well. But their resistance will also put a limit on how far we can get to squash this virus. Ultimately they will likely pay a price for their reticence in that they may not not be able to travel on some public transport, go to some concerts or events or attend at some educational facilities as freely as vaccinated people.

I predict that the summer will be good – with more outdoor activities, a gradual reopening toward indoor options, continued care with regard to masking and hand washing and social distancing where necessary. My guess is that, even if we get a few local surges in virus activity across Canada, the worst is behind us.  New variants may arise (it is normal for mutations to occur) but with time, vaccines can be altered to accommodate these changes. Until the whole world gets adequate vaccination coverage there is still a global threat that will continue to disrupt lives and economies worldwide. I have talked with my friends in Kenya where they are having more older or vulnerable people dying without much explanation. They do not have access to COVID testing in rural areas so they have no confirmation that it is COVID. And vaccines are a distant dream for them at the moment.

We are not out of the woods yet but the outlook is much more promising and encouraging that it has been for quite a while.  For the next few weeks we must be patient and stay the course to gradual reopening. We are all eager to open up but the mistake Ontario made earlier this year that augmented the third wave numbers was to be too quick to try to resume normalcy and too slow to shut down. We all need to get fully immunized as soon as it is available to us and encourage those around us to do the same.  We may need to stay masked for a while when we are in close contact with others indoors or even outdoors if we sense that we are not able to adequately distance particularly with folks who have not yet been able to get their full immunization in order to protect them from infection. Please respect the boundaries that others set regarding interaction. We all have different comfort with potential COVID exposure and some friends may want to remain more cautious than others for a bit longer.

Fully vaccinated people can safely enjoy connecting with others who also have completed their immunization schedule. Let’s enjoy the great Canadian outdoors and safely reconnect with friends and family. If we follow the Public Health guidelines we will soon get back to what might be close to “normal”.  I am starting to remember what that felt like. And if feels good!

The next thing on my wish list is to get a much-needed haircut!

I started writing articles about COVID-19 over a year ago when we were not swamped with COVID information. But we are inundated now so I will put my COVID pen down. This will be the last of my COVID articles but I will continue to post about topics that interest me (and hopefully interest you as well.)

COVID-19. We’re still in the tunnel!

The COVID-19 news, both globally and in Ontario, has been discouraging in the past few weeks. In Kingston, we have done remarkably well throughout the pandemic but new cases are currently occurring at greater daily counts than our usual and today we have the highest active case count that we have had since all this began. A recent B117 outbreak involving a local construction site where there were “workers from multiple jurisdictions” will probably impact our community for some time as it  can spread to close contact family members.   

Is there any light at the end of this seemingly endless tunnel? 

Unfortunately,  Canadians were a bit smug about our case numbers when comparing them to other parts of the world, including the U.S.A. and U.K.  We became complacent about continuing the recommended Public Health measures that have been advised since the beginning of the pandemic.  We were tired of the restrictions and our Health Care System was managing, so we let down our guard.  Although we ought to have heeded the February warnings about variants on the horizon that had caused high caseloads in the UK, Brazil and South Africa, we ignored those foreboding predictions and continued to be open for business with minimal personal or business restrictions.  We responded too late and too little. Can we find any hope in looking at how other countries have emerged from this dilemma that is pushing our provincial health care systems to the breaking point?

Bear with me as I throw a few graphs your way. My story ends with a possible positive outcome if that will encourage you to read on. Not surprisingly, it appears that successful reduction in COVID-19 case numbers relates directly to vaccination rates and countries following disciplined public health restrictions.

Not long ago the UK was in bad shape with COVID-19. The new B117 variant that is plaguing us now had gained hold there and was causing surging in caseloads that peaked in January  They locked down and vaccinated extensively, mainly using the Astra Zeneca vaccine. What happened? Their number of new cases has been dropping continuously. Today they report that over 50% of their population has had at least one dose of vaccine.  Persistence with lockdown restrictions and a good uptake of vaccinations seems to have helped to turn the COVID corner for the UK. They now have a graduated schedule of return to “normal” that will slowly open things up, stretching until late June. 

Is this just a fluke? We can also look at Israel’s experience where the combination of lockdown and vaccination (mostly Pfizer) also had a significant effect.  In January, Israel was also experiencing a serious second wave of COVID-19.  However, they got an early start with aggressive vaccination while imposing  significant restrictions including mandatory mask-wearing outdoors, school closures and restricted travel into the country .  Now their numbers are very low and they are starting to open up and have reduced restrictions. Last week Israel reported their first day in 10 months without a COVID-related death in the country.  They are being cautious as they slowly reopen but it appears that things are getting back to “Normal”. 

 India, with a huge population, had a false sense of security when numbers started to abate early in 2021 and led to them quickly reopening the country to things like large social and religious gatherings and sporting events.  Even though they produce vaccine, some of which has been sold to Canada, their own programme has been slow to develop. They are now faced with a new variant and in the past few days their numbers have been astronomical and the death toll is staggering.  The current surge in cases and deaths is having an absolutely devastating effect in India that will be felt around the world.  The COVID virus knows no boundaries and as millions become infected quickly there is even more potential for new mutations to occur that could cause international concern.

Here in Canada we have been dependant on vaccine supplies from abroad  that were slow to arrive and the process was complicated by international bartering.  In the past month, things have ramped up well and  we are projected to receive increased supplies over the next few weeks. In Ontario we are now vaccinating at a per-population rate that is second only to the U.S. That will certainly help us to achieve a lower rate of infection if we can continue to disperse vaccines at this pace and a significant proportion of our population accesses them. The Globe and Mail reported today that if our vaccine supplies arrive as scheduled, all eligible Canadians could be fully vaccinated by the end of July!

What can we learn from what we have seen in other countries?  It appears  that keeping the long-requested restrictions on mingling, shopping, meeting indoors, and traveling combined with aggressive roll-out of vaccination is the key to gaining some control over the virus.  In the past week our COVID new case numbers in Canada seem to be plateauing but it is discouraging that they do not seem to be dropping very quickly.  In Kingston where over 40% of our population  have received one dose of vaccine and have been under a “stay at home” order for the past two weeks, new case numbers are not falling significantly (yet).   Our Canadian provincial governments, faced with Health Care systems that are at capacity, have needed to impose increased restrictions. We all  have been quite aware what we need to do but many of us are just not following the requested behaviours.  We will soon have four vaccines  available with age limits dropping almost daily. Vaccine supplies will be coming at a much better rate in May and June. If Canadians accept whatever vaccine they can get soonest there will be more of us who are protected and the virus will have fewer hosts to infect. We are doing pretty well, in fact, with almost 40% of our population having received at least one dose of vaccine. According to the graph below, this puts us about two months behind the UK and three months behind Israel in this regard.  So, if we keep the restrictions in place for a while longer, comply with the requests of our Public Health officials and reopen gradually,  and if vaccine supplies continue as predicted and are administered as quickly as possible to a willing population we should be able to see great improvement over the next few weeks.  

Does it matter which vaccine you get?  In the long run, not really.  The numbers are sometimes confusing and variable but the bottom line is that they are all effective at significantly reducing infection and all are very effective at preventing severe illness if you do become infected after two doses.  Although there is some benefit two weeks after the first dose, this is variable and may not protect quite as well against the Variants of Concern.  After one dose only, we are advised to still protect ourselves and others as though we have not had the vaccine yet.  The delay of the second dose to complete the vaccination protocol will help our communities to achieve at least partial protection in that vaccines can be distributed to more people as first doses and offering at least partial protection to more people and bring down case numbers. To me, this makes sense.  The booster dose, although delayed, will add to that effectiveness. 

Significant side effects caused by COVID vaccination are rare. Any medical treatment has the potential for significant adverse effects. Physicians are always weighing the Risk/Benefit ration when we prescribe anything or do any medical procedure.  Even low-dose aspirin can, in a small number of patients, cause serious gastrointestinal bleeding.  Unfortunately, bad news gains attention so we all learn first about the unlikely exceptions, rather than the rules. The potential for a rare blood clotting disorder (not at all similar to usual blood clotting problems like deep vein thrombosis or pulmonary embolus, by the way) may be real but is extremely rare.  The chances of serious consequences of a COVID-19 infection are much greater.

People who choose not to be vaccinated can make that choice but, in doing so, they may be giving up certain opportunities for travel or certain other activities or gatherings that will require a “vaccine passport”.  I think that is fair.  

Can we look forward, then, to achieving the kind of curve that has happened in Israel and the UK?  How will can we achieve that?  

We stick to the restrictions requested by our public health leaders and be glad if our politicians are careful about slowly reopening.  

We limit close indoor contact to a people within our household bubble.

We avoid spending time indoors at restaurants, gyms, churches or theatres until the virus is much better controlled.  We now know that airborne transmission is part of how this virus spreads so any indoor gatherings without a mask for any period of time puts us at risk for infection, no matter if we are 2 metres away or not so we avoid spending indoors with a group of people.

We avoid travel outside our district or having visitors from outside because this increases the risk of introducing new variants to our community. The MOH at the Kingston, Frontenac, Lennox and Addington Health Unit has repeatedly expressed that most of the surges in virus activity in our district have been initiated by travel in or out of our community.

We continue to wear a mask in stores and many other indoor settings and even outdoors if there are a number of people around and you can not adequately distance.  This may be a requirement for some time to come. 

We take whatever vaccination we can get soonest. The more of us who are vaccinated, the fewer will be vulnerable to infection and spread it to others.  It may be that a third or annual booster is required to keep us safe from new variants (much like annual Influenza shots).  

We stay off work and isolate from others as much as possible when we are ill.  Our provincial governments must not be too eager to drop the restrictions but follow a slow and graded reopening process.   

What might slow down progress?  New variants that are more easily spread and/or more virulent may arise spontaneously.  Hopefully the vaccines we  have and any modifications that ensue will be able to continue to be effective at combating them.  We also need a substantial acceptance of complete vaccination to achieve herd immunity. When it comes time to open up again it would be best to do it very gradually.  Reopening too quickly was a factor in making this third wave more serious.   We also need global cooperation and assist lower income countries because as long as the virus is not contained, spread internationally will occur. 

And finally, the Globe and Mail estimates that by the end of July, the country should receive enough doses for all eligible people to be fully vaccinated. When we complete our vaccination we can joyously dance the bhangra like Gurdeep!  

COVID-19. We have a choice.

COVID-19 numbers are escalating in Canada and around the world. This is no surprise. We have been warned for weeks that a “second wave” was likely to happen in the fall.  We have also been repeatedly told how to minimize the extent of this surge so as to keep ourselves and our communities safe. 

The dip in case numbers over the summer months gave us a false sense of security and allowed us to let down our guard. It was safer in the summer months to interact outdoors, socialize on patios and in parks and even visit family and friends or go to a movie or the gym.  We were lured into thinking that things were getting back to something close to “normal”.  But the virus was sleeping, not gone.

The weather has cooled. We are drawn indoors.  Schools are open. Post secondary students are back.  Restaurants are open for indoor dining.  Our social bubbles grew over the summer and we are resisting and reluctant to scale back again even though our politicians and public health officials are advising – begging – us to do so.

Projections released this week indicate that, without changing our present behaviour, we could have 20,000 new cases a day in Canada by late December.  Our current daily new case rate is about 5500 a day. We’ve been warned that If we neglect to follow the recommended paths it may be much worse by the end of December.  These forecasts are startling. And unacceptable.

Why is this getting out of control?  It’s human nature to look for someone or something to blame for this. Well, we can only blame ourselves.  We have been told repeatedly how we must restrict our activities and social interactions, wash our hands and wear a mask when less than 2 meters from anyone but our very closest family unit.  

Anyone who is not aware of the recommendations must have been living on a deserted island for the last few months. As a reminder, here they are again.

Wear a mask when not able to socially distance (2 metres) in the company of people who are not in our restricted close contact bubble (i.e. household contacts). This can apply outdoors as well as indoors.  Don’t mingle face to face with folks who are not in your immediate circle. 

Minimize indoor contacts as much as possible.  Be aware of breaks in your comfort zone in this respect in restaurants, stores, theatres and gyms. Close contact indoors without appropriate protection (face coverings, distance, barriers) is our biggest risk.

Wash our hands frequently.  This minimizes the unlikely chance that you will transfer the virus from to your face if you have touched something that has been contaminated by someone else’s sneeze or cough.  Spread in this way is much less likely than droplet spread from an infected patient but is not impossible.

Don’t travel outside our community. Stay put. This will stop spread from one community to another.  Dr Kieran Moore, in a recent press conference is quoted as saying the following. “Any of the major outbreaks in our area have been secondary to travel to the GTA or the other high-risk municipalities. The risk correlates to going into high-risk areas and the number of close contacts.”   Stay home.  Don’t have friends or relatives from out of town come to visit.  This is the best way to limit inter-community spread.  

      Postpone indoor gatherings with family and friends this Christmas season. Look forward to a huge celebration for many reasons on July 1, instead.  

      Set strict limits on the number of people that you interact with face to face. This is difficult but essential. 

Unfortunately, many of us seem unable or unwilling to follow these recommendations. The result is that case numbers go up, the demand on our health system increases and vulnerable people are put at risk.  This ends up with the government having to impose a lockdown as has happened in Toronto and Peel districts this week. In my opinion this is something that might have been avoided if collectively we had followed the rules. But enough people do not respect those guidelines and the result is that the restrictions have to be enforced. We have a choice. We can follow the advice that our politicians and public health officials have been giving us for the past several months or we can circumvent their recommendations and end up in lockdown.  

In Kingston, we have continued to be very lucky to have avoided the burgeoning numbers seen in some other cities in Ontario.  Our lower caseload in the KFLA district has allowed our Public Health workers to trace and isolate potential close contacts, thereby limiting spread in the community. In some other Canadian jurisdictions, this has become unmanageable and the virus is spreading quickly. We have seen, and will see, waves of COVID-19 activity that have the potential to swing out of control if we don’t buckle down.  There have been cases where the source is not clear and if this cohort increases it will mean that our risks of randomly being infected will increase if we are not extra cautious.

Recent vaccine news has been encouraging and eventually vaccination will bail us out of this situation if enough people elect to take it.  Although a number of vaccines may get approved soon, it will take several months to distribute them and have them be effective. My guess is that the current wave of infection will abate somewhat but there may be a third surge in late winter.  We will be needed to be extremely cautious until about May when vaccination has been introduced and the better outdoor weather is upon us once again. Please ask yourself if there is some way that you can tighten up a bit more for the sake of the your own well-being as well as that of your community. And then do it. 

The next few months will be a challenge.   Without widespread cooperation and discipline as we await more widespread suppression of the virus we will only prolong the pandemic and cause repercussions that will affect us either in terms of our community health or economic damage that is more severe than voluntarily complying with recommended interim personal restrictions.

If you have made it this far, here’s a bonus reward for your perseverance. This is an interesting YouTube video that talks about how the world coped with a similar pandemic 100 years ago. I found it encouraging to know that despite all the global disruption COVID-19 is causing now, there is hope to get back to a some sense of normal. Here’s to a Roaring 20’s decade!

COVID-19 update. Holding the line.

As anticipated, Kingston has seen a blip in COVID-19 cases in the past month. Students returning to post secondary facilities, people traveling outside our district or visiting from other communities, the arrival of cooler weather and more indoor activity, and a generally younger demographic acquiring and sharing the virus all triggered that predictable rise in cases.

Our little wave seems to have peaked – for now at any rate. This might be luck but I like to think it is the result of people within our Health Unit generally being responsible and taking care for themselves and our community. Congratulations and thank you for that.

As of this afternoon we have only five known active cases in our district of over 200,000 people.  This is very good news and generally indicates that the virus is under reasonable control in our environs.  It’s not the same for some other areas in Ontario including the GTA, Ottawa and even Hamilton where one “fitness studio” has been thought to have been a source for over 74 cases.

Other areas of Canada and around the world are struggling to contain this second wave.  Italy, France, and the UK, for example, are all experiencing case numbers that greatly exceed the peaks in March. Fortunately, because of improvements in management and the high number of cases in less vulnerable, younger adults, death rates have not shown the same peaks (although they are rising). The U.S. seems not to have ever escaped their first wave. This week their new case numbers are rivalling the highs seen in July.

Australia, after seeing very low numbers for months, had a dramatic surge in Melbourne in late July resulting in daily new cases of over 700. They took determined action to reduce spread, including shutting down that district. Today their new case rate for the country was 8.

So, you see, it is possible to keep a lid on this virus but it requires discipline and following the recommendations from our Public Health authorities. These recommendations might vary from district to district depending on the numbers of new cases, whether there is evidence of community spread (ie not from travel outside the district or as a direct close contact of a known case) and whether our health care/hospital resources are being stretched.  As far as I can determine, despite our recent Kingston wave, no patients were hospitalized.  Since the beginning of the pandemic in March, we have had no cases acquired in our health unit that have required ventilation.

Let’s work on keeping it that way. How can we do that?  It’s pretty simple, really. 

Wear a mask/face covering when indoors with others in stores, theatres, churches, or any closed space – or even outdoors when social distancing is not possible. Wash hands often.

Keep our social interactions limited to a few close friends and family who we know are also being careful. Avoid indoor gatherings of several people when social distancing will be difficult to maintain.

Avoid traveling outside our community or having friends or family from elsewhere come to visit. 

Stay home if we are ill and, if we have symptoms that we think might be COVID-related, get tested and isolate until the test proves negative.

Download the COVID app so we can be notified if we have unwittingly stood beside someone at the grocery store for a few minutes and they have subsequently tested positive.

Get a flu shot. They are now available. I’ve had mine. It won’t prevent COVID-19 but will lessen the circulation of influenza viruses.

We will have to follow these recommendations for the next several months.  But eventually this will subside. We are all experiencing COVID fatigue but these inconveniences far outweigh the perils of  increased community spread or the necessary economic lockdown that would be precipitated by increasing prevalence.  If we are able to keep new cases low, our Health Unit will be able to trace and quarantine patients early. This, too, will limit the spread in the community.

I continue to feel encouraged that management of severely ill COVID-19 patients will continue to improve and that more effective medical management will reduce deaths.  A vaccine will be on the horizon soon although it will take a while to dispense it. We may be thwarted from quickly reaching herd immunity by people who decline immunization but eventually those of us who do accept vaccination will help lower the prevalence of virus within our community and this will benefit everyone. 

There will soon be a rapid test for the virus and saliva tests will become more common than the usual nasopharyngeal swab.  The increased number of testing sites, including in two local pharmacies opened this week for asymptomatic clients, will make it more convenient to be assessed and hopefully lead to earlier detection and isolation of infected  people.

We are in a much better place now than we were in March and we have been really fortunate in the KLFA Health Unit to have been less affected than many districts in Canada or worldwide.  

Can we hold the line?   I hope so. Stay the course.

COVID-19 update. Back to school. It’s time.

COVID -19 will be a threat we have to deal with for the next several months and possibly years. So we need to find a way to reduce its impact on our physical and mental health and our society as a whole.

Part of that transition involves cautiously opening up the economy and getting kids back to school. This makes us all anxious because our generation has not been in this precarious position before. We find ourselves faced with a threatening new virus – a global pandemic. The whole world is wading through a quagmire where there is no sure footing.

I have children who are teachers, grandchildren who are pupils, family who are health care providers and I have been back to working as a physician and teacher of Medical Residents for the past three months both in a clinic and in a small group at Queens. I get it. I understand the angst about going back to work and school. Where I am working we are not doing things the way they were done before but we have been able to find a balance between providing service and taking care not to spark COVID-19 transmission. It has meant several adjustments, wearing a mask for several hours at a time, keeping a reasonable distance between people where possible and respecting others. It has not proved to be that hard to do. Schools will have a similar transition period filled with uncertainty and change and angst but I hope that, with time and inevitable adjustments, teachers and students will find a safe balance point.

There will be pockets of COVID-19 that spring up menacingly in localized schools, neighbourhoods and cities. We are in a much better place now to deal with those clusters than we were this spring. What we have learned about transmission and mitigation strategies may be able to help contain outbreaks and avoid a generalized surge that would require a more widespread shutdown.

Our Public Health authorities are preparing for these inevitable challenges, armed with better testing, improved availability of health care resources and ever increasing knowledge about the virus itself. We now know how to more effectively contain it and have improved management for patients who become severely ill. I have pointed out before that our Canadian numbers seem to be hovering for the past several weeks at a daily new case level of around 500 people per day. Despite this, our reported death rates are staying very low, averaging 4 per day over the past week. In May we were averaging around 150 COVID-19 related deaths per day in Canada! Let’s not lose sight of this good news. Are you aware that, by comparison, on average every day in Canada 11 women die as a consequence of breast cancer and around 12 people die of opioid overdoses? The Canadian Government reports that “Every hour, about 12 Canadian adults age 20 and over with diagnosed heart disease die.”

Now, this is not to downplay the consequences of the current COVID-19 pandemic in any way and other long-term consequences of having had a COVID-19 infection have not yet been determined with any certainty. We are being bombarded, however, with daily statistics about COVID-19 but we are not updated every day on how many Canadians (228 on average) have died in the previous 24 hours of cancer. COVID-19 is scary, but we have been made more frightened by the daily global focus on its statistics. Can we govern our behaviour based on responsible common sense rather than fear?

What do I think should happen now?

Cautious reopening of schools and offices is important to reestablish whatever normalcy we can find in this new pandemic situation. Children need to play and learn with and from each other. Following whatever public health guidelines are advised is important. Masks and social distancing as much as practical and minimizing opportunity for spread within a school cohort will be challenging but we won’t know until we work with it and make the necessary adjustments as time goes on and as we learn more.

What will I personally do In the next few months?

I will continue to work. I will follow the restrictions and Public Health guidelines that will, no doubt, change from time to time, particularly if there is some increase in COVID-19 in our community. I trust the judgement and advice of our local Public Health Unit and know that whatever recommendations they put in place are based on the best epidemiological and medical information available and done with the safety of our community in mind.

Consequences. We are all responsible for our behaviour.
Photos from Kingston Whig Standard and Queen’s Journal.

I was glad to see that the beach at the Gord Downie Pier was closed off entirely this weekend after a couple of days when young adults swarmed to the beach area and appeared not to be taking the required precautions. I hope that our city officials and public health can keep an eye on any elements in our community that are not respecting the current recommendations and move to enforce these with authority. If we don’t follow the rules, we will lose privileges. This applies to restaurants and businesses and movie theatre and schools and churches. And beaches

I will avoid crowded indoor environments. If I find myself somewhere that I think the required precautions are not being respected I will leave, and if I feel it is a significant infraction, I will report it to Public Health.

I will wear my face covering in any situation where I am exposed to people outside my close social circle where I am not able to adequately distance myself. This includes all indoor spots like cafés or stores or offices but I will also put my mask on outdoors if I find myself in the midst of a number of people. And, by the way, the mask doesn’t work if you wear it below your nose.

I have installed the COVID app on my phone and hope that you do too. This will ensure that if I have been in close enough contact to establish Bluetooth connection with another phone and that person, who may have been standing in line behind me waiting for the bank machine for 10 minutes tests positive and subsequently enters a confidential code, I will be notified that I should watch for symptoms and maybe get tested as it appears that I have been close to a person who has COVID-19. This will only work if lots of people do it. It will help in Public Health tracing for community transmission. Do it, please.

I will stick to myself if I am sick in any way. If my symptoms include cough, shortness of breath or fever, I will get a COVID-19 test. This will become simpler over the next months when rapid tests that only require a saliva sample are approved and become widely available.

I will keep a small circle of social contacts who I trust are also being cautious. We have been enjoying outdoor summer patios and walks but as the weather closes in, this will become more difficult. Indoor dining at restaurants poses a higher risk of transmission and if there is any increase in community cases of COVID-19, I will stick to meals at home. I will try to help the food hospitality industry by ordering take out or home delivery. It is not the food that is a risk, but groups of people sitting around indoors for a period of time, all without masks as they eat and chat.

I will not go to bars or indoor parties.

I will not travel outside my community for a while, apart from occasional visits to kids and grandkids in Whitby.

I will be eager to get my annual flu shot and whenever safe COVID-19 immunization is available I will take it.

I will be respectful of people who have views who are not the same as mine (like anti-vaxxers and people who balk at wearing masks ) but that doesn’t mean I have to mingle with them. I have clear boundaries about what I will tolerate or how I will protect myself and others and will adhere to them.

I remain guardedly optimistic that we will pull through this unprecedented disruptive time with lots of inconveniences but hopefully with minimal serious illness or loss of life and manageable strain on our Health Care System. It requires cooperation and diligence from all ages and segments of our community. We are certainly in a much better position in September to manage the challenge than we were when this was all brand new in March. Stay the course. We will get there.

John A Geddes MSc MD CCFP. Kingston, Canada.

This is an op-ed. It is my opinion. Yours may differ. What we know about COVID 19 is changing every day and depends on the current situation in your district. We need to be flexible and adjust to new reliable scientific data.

COVID-19. Facing uncertainty.

If there is one word that I would use to describe 2020 it is uncertainty. There are lots of others but uncertainty in so many ways has been at the forefront.  When COVID-19 first emerged in the early part of the year we had no idea where it would lead.  Just another flu?  Contained in some far away countries? A plague that will wipe us all out?  

In March, we understood little about the virus – it was “novel” after all – and so there were many fears around that unknown part.  Could we get it from packages dropped off by the Amazon delivery man?  Would we need to wash our groceries? Will COVID-19 overwhelm our Health Care System?  Will the measures we put in place to isolate and reduce spread actually work?

Now, by mid-August we have settled into a new reality.  Standing on those little circles, wearing a mask and dealing with a cashier who is behind a plastic barrier has become the norm.  There is less fear about the risk of spread from inanimate objects.  Being able to interact with people outdoors has been a great boon.  Our Health Care System was not deluged and is back to functioning, albeit with some new COVID-19 modifications. It is prepared and well positioned to deal with any new increase in cases should a second wave happen in the fall. The virus, we now know, is primarily droplet spread so hand-washing, keeping a suitable distance from others and wearing a mask when closer approximation is inevitable should pretty much keep us and our community safe. 

Kingston has done remarkably well apart from the nail salon outbreak that was quickly contained. From what we are able to determine our community was COVID-free for over three of weeks until two new cases, both in their 20’s, were found on August 19.  Over 2500 tests have been done in our health unit in the last seven days with a 0.1% positivity rate. This has given us a chance to enjoy more social interactions outdoors with low chance of being infected. 

Many European countries, often using strict social distancing regulations, were able to bring their epidemics under control. They subsequently re-opened their economies, schools and tourist industry. Many are recently seeing upsurges in new case rates. Even Austria (and Australia, too), for some time held as a great example of success at suppressing the virus has had an upswing in cases.  Good news is that, despite this uptick, death rates have not seen the same shift – yet.  This reflects that we now have a better understanding of how to manage serious cases, more knowledge about  transmission, and more diligence around protecting long-term care facilities and vulnerable people. We are seeing a lower rate of infection in older people who are at more risk of serious outcomes. Maybe they are being more cautious than people in their 20’s appear to be. Canadian new case rates have kind of stalled at about 350-500 per day  but our daily death rates for the whole country in the past couple of weeks have ranged from 4 to 10.  This compares to 150-200 daily deaths in early May.   

But, There is always a but, right?

The uncertainty is still there and will likely increase in the next few months as we attempt to get back to “normal”. Cooler weather is approaching which will take us indoors. School for elementary and high school students will resume in September. We can’t keep kids away from school forever and our social and business needs will resume. There has been an obvious increase in tourism in Kingston in the past two weeks.  Downtown patios are full.  People can be seen wandering in clusters many are not wearing masks even when they are in a group.  Restaurants have opened for limited indoor dining.  Students will be returning to Queens and St Lawrence College and we know that this age group have contributed heavily to the Canadian new case figures in the past few weeks and might be less diligent in adhering to Public Health recommendations.  

We will all feel anxious as these new parameters enter the mix.  How can we deal with that anxiety?

Unfortunately, this virus is going to be with us for a while. Maybe forever. We will have to figure out how we best deal with it until effective immunization is available to a large proportion of our population.Even then there will be some folks who refuse to be immunized, lowering the effectiveness for achieving herd immunity. 

There will be new outbreaks. But if they can be contained they will not lead to another shut-down.   We will, no doubt, be inconvenienced and restricted from time to time.  Over the next year, you may be required to isolate for a couple of weeks or your school/classroom/business might have to temporarily close.  The ongoing surveillance, testing and quick responses to new cases by our local Public Health authorities has been impressive and has contributed to keeping our community safe. Ongoing cooperation with our Public Health officers is the essential key to success.  If we continue to identify new cases early and squash opportunities for  transmission, however, we will, as a community, be able to keep functioning.  Advances in management will also lead to a reduction in serious complications of the infection.

The highest risks remain groups of people gathering, particularly indoors, with no social distancing and no facial coverings – especially parties or bar gatherings with clients “speaking moistly” and bending the rules for social distancing. My recommendation is to stay away from these situations and avoid any activities where people are not following Public Health advice.  If you think you are in a situation where  you can not keep the recommended social distancing, indoors or out, wear a facial covering. It will help to protect both you and others.  Continue to wash your hands and keep your cohort of close contacts small.

We have already adjusted to the many changes in the way we interact socially.  Our long term success in coping with COVID-19 will depend on our ability to continue to adapt and to follow the guidelines that our medical experts advise.

John A Geddes MSc MD CCFP

COVID-19 update. Numbers, Numbers, Numbers.

I will start with some good news.  For the first time since late March, Ontario registered less than 100 new cases (76 to be exact) in the past 24 hours. Most of these cases were concentrated in a few districts that have had a particular struggle with the virus but even those regions are showing improvement.  Hospitalizations and COVID-19 deaths are also down across the province.  We shouldn’t get too smug about this, however, as the figures do vary from day to day and can change with very little provocation.  The trend, this week, is in the right direction.

Across Canada there are varied results.  Canadian numbers were generally trending downward until about 10 days ago when a definite uptick occurred.  At the end of June,  Canada’s new daily case rate was averaging  around 300 per day but it has been creeping up with recent averages being near 450.   Alberta and British Columbia, provinces that had been experiencing very low rates and were held as examples, have led the numbers of new cases.  Similarly in countries that had been deemed examples of low infection rates (eg. Australia, Israel, Hong Kong) there have been significant regional outbreaks and increases in both infection rates and deaths resulting in renewed lock-downs.

Canada’s death rates attributed to COVID-19 have remained low despite the increase in new cases.  This likely has several explanations.  The vast majority of early deaths due to COVID-19 were in elderly people with predisposing factors and associated with long term care facilities.  Many of the very vulnerable have succumbed. We are being more attentive and cautious with this population in order to lower their risks. Treatment options for those who are severely ill has also refined and become more effective as we learn more about the virus and what treatments are likely to bring better outcomes. 

Another somewhat worrisome factor is that in new cases the demographics have shifted to involve many more people in the under 40 age group. Although these folks would be less likely to be severely ill or die, it has been suggested that  some of those who have been infected may have undetermined long-term health consequences .  Minimally symptomatic young folks might also serve as a reservoir for the virus in the community and be a source of spread to people who are more vulnerable.

In the last month there have been ten new cases diagnosed in our KFLA Health unit.  Eight of those cases are reportedly people in their 20’s or younger.   Some are known contacts of other cases or associated with our previous nail salon outbreak but five are also listed as having travelled outside our region as where they acquired the virus. It is probable that travel was not the only risk since people in this age group are tending not to be so cautious with social distancing or wearing masks.  I often see collections of young adults on the street, not wearing masks and not keeping the proscribed six-foot distance from each other. Dr Kieran Moore, the KFLA Medical Officer of Health, continues to provide updates to the community. His most recent can be found here or at the end of this post.

Currently we have only 3 active cases, all in isolation, in Kingston.  This means our risk at the moment of acquiring infection in the community is low.  But it is not zero.  I worry that we will get complacent and lower our guard.

I wonder what will happen at the end of the month when college and university students from outside our area return to Kingston. Queen’s may be very diligent about contact on campus but many of these students will be living in houses together and I can imagine that house parties, known to be one of the main ways of transmission in North America in this young adult group, will happen. How can this be managed to avoid breaking our (so-far) very successful Kingston bubble? 

Bars will also be open and as cooler weather follows, so will the tendency to move indoors from the well-ventilated patios we are now enjoying.  Add other respiratory viruses to the mix and we may be in for a difficult fall and winter season.   Will elementary and secondary schools also be open and will it be practical or successful to be able to maintain distancing and lower risk of transmission in these indoor clusters? What happens when the border with the U.S.A. opens up? We will be entering a tricky new phase with more services open and activities moving indoors as fall approaches. 

We are going to have to continue to be diligent, or even more diligent than we are being now, when the cooler weather comes.  We must limit the number of people in any indoor space so we can keep physically distanced.  We will need to become accustomed to wearing a mask when gathering indoors, on public transport and even in some situations outside. It really is not that difficult. Like wearing a seat-belt in the car or a helmet on a bicycle, face masks will become second nature. Even if face coverings only make a small difference to transmission, that effect might end up being a significant help to protect our community.

It is encouraging to know that there are around 150 vaccines being developed around the world and five of them are either in 3rd stage trials or about to start.  This is the final step before approval but it will take a few months to reach the next stage.  Even when vaccines are approved (probably by the end of the year) it will take some time to have them produced, distributed and administered so it will be well into 2021 before we will be seeing an effect from vaccine-induced immunity. But it will come.

 Until that time, we are stuck with doing our best to curtail spread within our community.  We will have peaks and troughs of COVID-19 outbreaks happening sporadically in different geographical pockets.  In some cases this may lead to renewed  local shut-downs and travel restrictions. We have no choice. We must come to the realization that we need to keep disciplined and follow Public Health recommendations if we are to mitigate the effects this COVID-19 pandemic on our Health Care System, our economy and our families. It will end. But not before a few more months of responsible community effort.

COVID-19 update. Whew!

We were doing so well, Kingston! For several weeks in May and June the Kingston, Frontenac, Lennox, and Addington (KFLA) Health Unit district, serving over 200,000 people had only two cases of COVID-19 , both having entered the community from the GTA.  In late June, however, we all squirmed as we collectively felt the equivalent of fingernails on a chalkboard.  A series of cases that started in a nail salon were reported. This led to a significant increase in numbers for our area.  Our COVID-19 case total, plateaued at 63, quickly rose to 105. Thankfully this figure has held steady with no new cases in our district reported in the past week. The one patient requiring hospitalization has been discharged. The outbreak appears to have been squashed.

The surge we experienced was discouraging but not at all unexpected.  We can anticipate that pockets of COVID-19 will break out over the next few months.

This applies internationally, as well as locally.  Australia and Israel, for example, both looked like they had reduced their COVID load to minimal for a few weeks but recently they have experienced increased numbers that have made them backtrack with their re-opening strategies.

In Kingston’s nail salon outbreak, the cluster was rapidly investigated by our local Public Health officials. Testing was ramped up and  contact tracing aggressively pursued.  Our Public Health Unit, led by our MOH Dr Kieran Moore, was ready and acted quickly.  From the outset this leadership in our community with response to COVID-19 has been instrumental in keeping our city and environs as safe as possible.  Dr Moore has also been updating the community with regular You-tube videos that can be found here.

Kingstonians turned out in droves to get tested and over 7000 tests were done over a couple of weeks.  A few hundred people with probable exposure were advised to self-isolate. In addition to aggressive testing and tracing of contacts, the Health Unit quickly implemented a mandatory face-covering policy in indoor stores, restaurants and gatherings.  Other communities across Ontario have subsequently followed suit.   

Management of COVID-19 has also been successful lately in the rest of Ontario and across Canada with case numbers hovering at a manageable level and COVID-19 death rates dropping significantly.  We all watch in horror, however, as COVID-19 spirals out of control in many parts of the United States. In the past week, Canada’s daily new case reports have averaged 290 and daily reported COVID deaths averaged 12. In the United States, with a population about 8 times that of Canada the corresponding numbers are an astonishing 58,000  for daily new cases (hitting 70,000 yesterday) and 650 for daily deaths.  The US deaths are expected to rise in the next couple of weeks since deaths follow the diagnoses by two to three weeks on average.  

These differences in numbers are not just a result of increased testing.   For example, in our KFLA district, the testing rate per 100,000 population has exceeded 13,000 with a positivity rate of 0.4% (4 per 1000).  In the US, the test rates despite being touted as more than anywhere in the world are lower than ours at 12,000 per 100,000 but their positivity rates average 9% (90 per 1000) with a recent high of 19% in the state of Florida.

What can we learn from all this?

Canada, Ontario, and particularly our Kingston district have done a good job of mitigating the consequences of COVID-19 so far.  We had an initial manageable surge as predicted but our numbers have dropped and are plateauing.  We can ascribe this success to a disciplined, coordinated, non-partisan, science-based approach by our governments and Public Health officials.  All Canadians also need to take credit for a concerted attempt to follow the guidelines set out by our leaders. In general our habits have changed to protect ourselves and our communities and our efforts have paid off.

It would be nice if this would just go away all together.  But it won’t. At least, not soon.

We are going to see clusters of COVID-19 outbreaks occur in neighbourhoods, communities and provinces over the next several months.  If we are able to keep these numbers low, we can continue to contain the spread through testing, self-isolation and contact tracing.   Scattered communities may intermittently need to be more aggressive with local restrictions varying from time to time according to diagnosed cases or pockets of infection. 

There will still be some uncertainty when schools open to some extent in the fall.  Cooler weather will have us more indoors where spread happens much more readily than outside.  More university and college students, who have been hunkered down with their parents in home communities will return to Kingston. Eventually the border between the USA and Canada will reopen for non-essential travel.  Canadians overwhelmingly hope this will not occur until the USA has their house in order with regard to COVID-19.   All of these factors bring some uncertainty to what will happen with regard to COVID-19 in the months ahead.

Management  strategies to treat severe cases are improving every week.  If we can keep the strain on our Health Care system as it is currently, we can manage until effective immunization or a specific treatment or prevention  is found.  Effective medical advances will certainly happen but realistically we will be in this limbo period for several more months. 

The rapid containment of our recent local cluster is encouraging and reassuring. We have shown that if we  follow the requests and recommendations of our Public Health and political leaders we can feel confident that we can bring new outbreaks in our community under control and avoid the distressing situation we see south of our border.

It is not that hard to act responsibly.  Wear a face covering where indicated.  Wash your hands.  Avoid prolonged indoor contact with others, particularly in groups.  Keep social distancing where possible. Stay vigilant and guard against complacency or impatience. Hopefully, with competent guidance and cooperation within our community we can continue to keep ahead of any new outbreaks. Stay safe.

John A Geddes MSc MD CCFP July 10, 2020

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.