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.