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.

My Covid-19 update. ‘Social Distancing’ is imperative at this point.

Consider this.   Three weeks ago, on February 22, 2020, there were 11 known cases of COVID-19 in Italy.  Since then, there have been over 15,000 diagnosed cases and 1000 deaths in Italy alone that have resulted from this viral infection. Italy now has a COVID-19 case rate of 250 per million population. The country has an excellent health care system but it has been overwhelmed. One might expect that the death rate is going to go up more because many seriously ill people will not now be able to get the intensive care they need. There are just not enough resources to cope with the rapid spread of the virus.  The country is shut down and suffering badly both medically and economically.  

Today, in Canada, with a population half that of Italy we have 122 known cases, a rate of 3.2 per million. This changes by the hour. Where will that be three weeks from today?  We need to do whatever we can, and do it now, in order to mitigate the effects of this infection in our communities. 

In Canada, we have a couple of advantages. Italy has a slightly older proportion of people over 65, those who are at highest risk for serious consequences of COVID-19 (22%) compared to Canada (17%).  Their population of 60 million, nearly twice that of Canada’s, lives in a much smaller geographic area and therefore are living closer together in general.  Most importantly, North Americans have had some advance warning of what COVID-19 can do, how it is spread, and what measures can best be taken to control it.  Hopefully we can take what we have been able to learn from this head start in China, other places in the Far East and Europe and quickly – very quickly – change our behaviour in order to lessen the eventual impact this virus will have on our communities in Canada.

We have heard the “wash your hands”, “cover your nose when you sneeze” and “stay home when you are ill” messages and I suspect most of us are complying with those suggestions.

Another significant factor that has reduced the rate of spread of this disease and has been proven to be effective, both in the past and in some countries that have instituted it seriously for COVID-19 is Social Distancing.  The reason this works is because COVID-19 is spread by droplets, not by fine little viruses floating around in the air.  When an infected person sneezes or coughs, the droplet spray from their mouth or nose can travel a few feet but not more. If we are in the way, we are vulnerable.  It may also land around them and live for some time (there are varying estimates how long and I am not going to spread inaccurate information to you).  If  you pick up the virus with your hands touching the sprayed-upon item you might then transfer the virus to your face and nose and become infected.  Hence the hand washing advice.

So, increasing our comfortable social distance and minimizing close contact of numbers of people in close approximation to us is imperative.  This is why in the last 24 hours we have learned that all schools in Ontario will be closed for two of weeks after next week’s March break,  that the NBA and NHL have suspended the rest of its season (Netflix night in Canada replacing Hockey Night?), and that the Kingston Canadian Film Festival made the difficult decision to cancel the remainder of the festival after only one day.  We all need to be supportive of this strategy, both for our own benefit and that of our community.

In the next while we will all be significantly inconvenienced by school closures, lack of availability of some items at the stores from people hoarding, cancellation of entertainment events and sports competitions and we will all have our anxiety piqued by the general sense of panic around us.  Younger people may realize that their risk of death from this is much less than older people but it is not zero. They must also adhere to our community restrictions for the benefit of their neighbours and friends and parents and to avoid over-taxing our health care system which is already running at near capacity.  If we can “flatten the curve” of this illness we can deal with it  If it comes in a surge we are going to be overwhelmed.

 I am 72 and hate to be called “elderly” but, in this case definition, I qualify.   People over 70 have a 10% or more chance of becoming seriously ill with this virus or dying from it.  Seniors with health problems like heart or lung diseases are at even greater risk. They should pay even more heed to the social distancing message.

So, what is my advice?

If you are sick, stay home.   Don’t go to the Emergency Department.  You might call your Family Doctor’s office for advice and to know if you need to be seen.  There is no treatment for this illness at present so resting, taking medication to lower fever and drinking fluids is all that you can do.  If you are becoming increasingly ill, you need to talk to your family doctor’s office about where to present for assessment and treatment.  There will be designated regional assessment centres and you should not show up at the wrong place where you might contaminate other vulnerable people.

Wash your hands whenever you come in from being out somewhere or use hand sanitizer if you can find it available.

Cover your nose and mouth when you cough or sneeze

Be ready to be in isolation for 14 days if you become infected.  Develop a circle of friends or relatives who can support each other by bringing groceries and leave them on your doorstep if you are in isolation.  It is probably reasonable to have some extra pasta or soup or cereal in your larder but hoarding should not be necessary and even makes things worse for others.  In Italy, where most of the country is currently shut down (including tourist sites, restaurants, cafes, churches) the grocery stores and pharmacies have remained open.

When you do go out, think about keeping a reasonable distance (at least a metre) from others.  Don’t shake hands or hug when you meet a friend or colleague.  The old elbow bump would be more appropriate (if you have not just sneezed on our sleeve, of course.)

If you are over 70, you might want to limit your exposure by staying away from group events, exercise classes, theatres, festivals and even church if you can not keep a metre between you and your neighbour.  The more you are exposed in a group, the more chance you have of being infected.  Even people who are in the incubation phase with no symptoms can shed virus and be infectious for a couple of days before they realize they are sick.

Help each other.  We are all in this together. We need to be cooperative, to listen to our Public Health Leaders and to follow instruction.  This is a time to think about our community, manage our health care resources and support our family and neighbours.  The measures i have talked about have been proven effective.  But only if we follow them.  

Although i am a pretty fearless traveller, I have decided that, until this has all stabilized in some way, I will stay in Canada where I can access my health care, not have to worry about international travel restrictions or being quarantined in some other country.  There will, no doubt, be good travel deals to be had while the tourist industry is struggling but I prefer the safety and security of home for the time being.

Our municipal,  provincial and federal governments, led by public health experts, are evaluating the best course to be taken to reduce the stress of this outbreak on our communities in terms of health and economics.  There is no right answer.  This is unproven ground and you can see that the situation changes daily.  I think we need to be patient and trust that our community leaders are assessing and making decisions that are in our best interest and I am glad that they will guide us through this turbulent time.

I was astounded when my previous blog article was shared and read by over 40,000 people in three days. I thought I was writing it for 50 of my Facebook friends who were asking me questions. https://johnageddes.com/2020/03/08/coronavirus-in-kingston-canada-my-take-on-what-we-might-expect/

I soon realized that there is a thirst out there for some common sense advice from a regular Family Doctor and so I hope that this is helpful as an update for a crisis that seems to change by the hour.  I have had lots of questions in the comment section of my previous article and am willing to answer any that I feel qualified to answer if you post it in the comments.  I am not claiming to be an “expert” but I try to be a rational, down-to-earth family physician who has tried to keep up on the medical writings about this serious and unique health crisis. I hope these suggestions are helpful to you in wading through this quagmire of information about COVID-19.

John A Geddes  MSc MD CCFP

Kingston, Canada

March 13, 2020

Check out this article about how social distancing (or lack of it) was shown to have an effect on spread of influenza in the 1918 epidemic in the US.

Restrictions applied in Italy on March 8 to curb spread of COVID-19

March 8 (GMT):

 ITALY EMERGENCY MEASURES

16 days after the beginning of the outbreak, the Italian government took decree today to take exceptional measures to contain about 16 million Italians living in 14 provinces in the north of the country, as well as restrictive measures covering the whole country. [source]

Northern Italy under lockdown

– Lombardy region (entire region, all provinces)
– Piedmont (provinces of Alessandria, Asti, Novara, Verbano Cusio Ossola, and Vercelli)
– Veneto
(provinces of PaduaTreviso, and Venice) 
– Emilia Romagna (provinces of Modena, ParmaPiacenza, Reggio Emilia, and Rimini)
– Marche 
(province of Pesaro UrbinoIn the above areas:

  • Travel in and out of the area, as well as within the area, will only be possible in response to “duly verified professional requirements, emergency situations, or for health reasons”
  • People with symptoms of respiratory disease and fever of 37.5 Celsius or above are strongly encouraged to stay at home and limit social contact as much as possible, including with their doctor
  • Avoid gathering
  • All schools and universities must be closed
  • All museums and places of culture will be closed
  • All cultural, religious or festive events are suspended
  • Cinemas, pubs, theaters, dance schools, game rooms, casinos, nightclubs and other similar places shall remain closed
  • All sporting events and competitions are suspended
  • Ski resorts are closed until further notice
  • Swimming pools, sports halls, thermal baths, cultural centers and wellness centers must suspend their activities 
  • Bars and restaurants can remain open from 8 a.m. to 6 p.m. provided they respect the safety distance of at least 1 meter between customers – this provision also concerns other commercial activities
  • Shopping centers and department stores must remain closed on public holidays and the days preceding them
  • Places of worship remain open, provided that the safety distance of at least 1 meter is respected, but religious ceremonies (marriage, baptism) are prohibited until further notice 

National restrictions

  • As in the north of the country, cinemas, theaters, museums, pubs, game rooms, dance schools, discos and other similar places will be closed
  • Sports competitions are suspended with some exceptions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This virus is readily transmitted by droplet spread. 

We have no treatment to cure it.

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

It has a high death rate for vulnerable people. 

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

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

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

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

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

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

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

John A Geddes MSc MD CCFP

March 8, 2020

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

Stepping out – October in Kingston

I have continued my walks around Kingston this month and have enjoyed the fresh air and great autumn colours. Here are three composite videos that I have made of photos I have taken on my walks around Kingston this month. Enjoy.

The photos were all taken with my iPhone 11 Pro and edited and compiled on the iPhone and iPad using QuikStories and Kinemaster.

Stepping out – Little boxes

This week I have found a few little boxes on my walks that have drawn my attention. I came across the “Tiniest Art Gallery in the World” on Cherry Street. (A gallery is defined as a place where works of art are displayed so I guess it qualifies) It consists of a little wooden box on a post by the sidewalk with room for one piece of art. I understand that it changes once a month. This month there were a couple of ink on paper tattoo designs. Something to stop for a moment to enjoy as you stroll past.

The world’s tiniest art gallery.

I also found a little lending library in a similar box on Patrick Street that had a Betty’s Library sign over it (and some milkweed in the garden for the Monarchs). What a delightful idea to have this little sharing library in the neighbourhood.

Earlier in the summer I had spotted a cheerful little kids library on College Street, complete with a swing and a pair of little chairs for kids to stop and sit and look at a book.

With the cooler weather setting in I have picked up my walking a bit more. The summer was too hot to walk farther from the breezes by the waterfront. Since May, have been able to cover most of the streets in the Kingston core. It is a bit more difficult to do those farther from home now since once I walk to the more peripheral neighborhoods I am ready to turn around. I may have to drive there and explore on foot from where I park.

Throughout the summer, I have mentioned that the flowers have been spectacular and they continue to delight me as I walk. Here are a just a few from the past week. I am looking forward to some autumn colour as well before winter sets in.

Stepping out – taking a break – and a recipe for Irish Soda Bread!

The weather has been warm and I have covered most of the territory in Kingston core that is surrounding where I live so to complete my personal challenge of walking all the streets in the core, I will have to go a bit farther afield. When the cooler fall weather hits, I will try to do that.

Today, rather than walk this morning, I elected to make some Irish Soda Bread in my cast iron skillet. I took it out to my balcony in the September sunshine and enjoyed it with coffee and some fresh peaches and blueberries. A couple of friends have asked for the recipe so here it is:

Irish Soda Bread in the Cast Iron Skillet

Ingredients:

3 cups flour

1 1/2 Tbsp sugar

1 tsp salt

1 tsp Baking Soda

3 Tbsp cold Butter, cut in little chunks

1/2 cup raisins

Some candied orange peel cut in small pieces

1 egg

1 1/2 cups Buttermilk ( I substitute 1 1/2 Tbsp white vinegar made up to 1 1/2 cups with milk)

Preheat the oven to 425 degrees F with the cast iron skillet (about 9-10 inch diameter) in the oven to get hot as well.

Sift the dry ingredients together. Add butter and cut it in with a pastry cutter or crumble it in with your fingers until the mixture is coarse and even.

Mix in the raisins and orange peel.

Make a dip in the middle of the dry mix and beat the egg and add the milk to it. Mix it all together. (I use a wooden spoon and I only mix it enough to be sure that the dry ingredients have been incorporated.)

Remove the skillet from the oven (IT IS HOT. BE CAREFUL.) and put a bit (1/2 Tbsp?) of olive oil into it and coat the bottom and sides of the skillet. I have a little silicone brush that I use to brush it around.

Pour the batter into the skillet and even it out. Bake for about 40 minutes or until done.

I sometimes drizzle a bit of icing on it – made by combining some icing sugar with a few drops of milk to make it runny enough to drizzle onto the bread. If you add too much milk it is way too runny.

Serve warm with butter, jam or honey. Freezes well, too. Enjoy

And just for a bit more summery cheer before autumn closes in, here are a couple of photos of flowers I have taken in the past couple of weeks while walking around the hood.

Stepping out – Week 12

I stuck close to home this weekend. The sun was bright and the temperature around 28 degrees. Too hot to walk too far afield.

I started and ended my weekend with my GoPro camera. The weather was muggy and I was busy with the Kingston Storefront Fringe Festival but I managed to snag some photos of the Kingston core. All within a 10 minute walk of where I live. I am very lucky.

I have compiled these into two short videos. I hope they capture the weekend in Kingston from Saturday morning to Sunday evening. Enjoy.

Saturday morning between 8 and 9 am

Sunday evening between 8 and 9 pm

Cooling off

And here’s a reminder of what it looked like in January!

Stepping out – Week 11

The flower gardens as I have walked the streets of Kingston have been delightful this year. We had a cool, wet, slow spring and now it is hot and sunny. The flowers seem to have loved it. And so have I.

Here is a collection of flower photos that I have taken on my walks over the past several weeks. I hope they bring cheer to your day.

Even the geranium on my balcony has rewarded me with a plethora of bloom. Right now the one plant has 23 flowers on it.

Stepping out – Week 10

I have lived downtown for ten years and yet I did not know that there is a Sunday Market at the Memorial Centre (Kingston). In keeping with my goal of learning more about my community through walking every street in the Kingston core, I headed over to the Memorial Centre this morning.

I discovered a busy market with vendors from near and far selling local goods and produce.. I chatted with a baker from Kemptville and bought a bacon butter tart from them before they were all gone (by 10:15 am).

I also picked up some frozen Ukrainian Cabbage Rolls that I will have for dinner from a vendor from Lyn, Ontario. (I didn’t know where that is. It is a hamlet just west of Brockville.) There were also lots of stalls selling fresh local produce and greens, iincluding dandelion leaves in bunches that look like a head of lettuce and bunches of garlic scapes (the green tops with the little flower bud at the top).

If you are a Kingstonian and have not yet checked out this Sunday market, give it a go. I will be back for sure.

And while we were wandering the neighbourhood, Anne-Marie and Dave flagged us down to go for coffee at the nearby Coffee Way. We had lots of theatre chat and I learned about Connor’s little venture selling good condition LEGO sets. If you want some Vintage LEGO, let me know and I will put you in touch with him.

On my way along Montreal Street I encountered this delightful streetside garden, just a few steps from Blakey’s Flower Shop.

All in all it was a great Sunday morning. By noon I had walked 10 km, visited with friends, found a new market and come home with something special that I can warm up for dinner. Ahh, summer.