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.

Stepping out – Week 9

It’s crazy, really. Why do we think we need to go farther afield to find interesting things to explore. Within a few blocks of where I live are two absolutely beautiful cathedrals. I rarely go into them. But when I travel, if I see a church I always go in, sit for a few moments to soak up the ambience and reflect.

St Mary’s Cathedral on Johnson Street in Kingston is really magnificent inside. The cornerstone for the present building was laid in 1843 and the cathedral, much as it remains today, was constructed over the next five years. Over a few years around 1990, a seven million dollar restoration of the original building was done. The limestone was carefully restored or replaced and one of the walls and buttresses was replaced.

The interior of this building is stunning and inspirational. Guided tours are available throughout the summer on Weekdays (except Wednesday) from 1-5. Check this wonderful building out.

St George’s Cathedral is more familiar to me as I have been to concerts there (the acoustics are wonderful) and even last Christmas Eve I wandered in to just sit in the back pew and absorb the peace. St George’s Cathedral was built in 1862, replacing a smaller wooden St George’s church that, from 1792, was located opposite the Market Square ( about where Morrison’s Restaurant is now) . It was enlarged between 1891 and 1894 but then much of the roof and interior was destroyed by fire in 1899. It was quickly repaired to be as it appears now, 120 years later.

St George’s also has a beautiful interior and throughout the summer the doors are open for visitors to come into the church and witness its grandeur.

I suspect that many visitors to Kingston admire these churches but how often do local residents who are not part of these congregations drop in to spend a few moments of quiet and absorb the grandeur that is part of our community? Both are worth a visit.

To show just how close to home these wonderful churches are to me, I took this photo from the rooftop of my apartment building. The spire of St Mary’s is in the left upper horizon and the dome of St George’s is in the middle right third of this photo.

Stepping out – Week 8

As summery weather finally hit us this week, I took the opportunity to get up early to watch the sun come up on my own home town. When I travel I often post video montages of the cities in different countries so I thought it appropriate to share one of my own home town, Kingston, Ontario, Canada.

These scenes were shot between 5:30 am and 6, all within a few blocks of home, when the streets were quiet and serene. Enjoy this little tour of my neighbourhood.