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. 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.