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.

COVID-19. Is there any good news?

We are all traumatized by the incredible changes in our lives that have happened in the past couple of weeks. We also worry about what is to come. Canada could be swamped in the next few weeks with cases of COVID-19.  Just how swamped will depend on how much we pay attention to the physical distance warnings we have been receiving from all directions.

We are being deluged by the worst case scenarios that are being presented to us in order to make us sit up and take notice and do something now to try to reduce the inevitable increase in numbers of sick people and the extraordinary strain on our Health Care System and other resources in general.  We know, from our experience in the past couple of weeks, that it is impossible to predict how this will have unfolded a month from now.

Rather than dwell on only an apocalyptic view of the future, I think we need to be aware that there are glimmers of hope out there.  What I will present here is entirely my own opinion but it is these thoughts that give me some hope that we can eventually get past this challenge.  

At the moment, the number of cases in Canada is rising.  This is certainly discouraging but is entirely expected.  They will continue to rise in the next couple of weeks as people who have been infected prior to our physical distancing efforts, people returning from international destinations and cases that have not been counted yet rise.  We can not expect this curve to flatten until we get over this initial phase.  I continue to watch the cases per million number on the Worldometer site and Canada is sneaking up but not near with the slope that we see in the USA for example.   I am hoping that this slope will flatten after a couple of weeks to keep our total number of cases per million at a manageable number.

How “flat” we can make that curve is yet to be seen.  At the moment, we are buying time to make the current escalating situation more manageable and until some more definitive management can be in place. It may not be working quickly or as much as we would like but we are having some influence by our combined efforts to reduce spread. Keep working on this, Canada.

We are still not able to determine with certainty just how many cases are really out there in the community because testing has been limited and mainly used to test those who are either at significant risk or seriously ill.  If this virus infects some people who develop few symptoms or even with symptoms that have been diagnosed as “flu”, there may be a cohort out there who have already had it or even have it now.  This is both encouraging and discouraging because it would mean that there are folks who have some immunity in the community, lowering the number of people at risk, but it also means that there are people who have been spreading this virus unknowingly. 

Availability of testing has been limited although we are doing better than many countries at testing high risk people. Testing resources are becoming more available and will ramp up in the next while. There will be a lot of folks who may have, or have had, this virus who are under the radar in terms of confirmation.  We don’t know how many who have had an Acute Respiratory Illness and have been told to isolate themselves and treat it symptomatically might have had COVID-19. But that, in some creepy way, is good news in that they are recovering without needing special medical care and they will be developing, we hope, antibodies to this virus.  The more people who have antibodies, the fewer in the population who can be infected or spread it.  Herd immunity is something that will help down the road. But it may be a while before that herd is big enough to affect the numbers.

Current tests for COVID-10 consist of a swab from the back of your nasopharynx that identifies specific COVID-19 RNA. It takes time to process and is not comfortable to obtain. Researchers have developed a rapid blood test that will show whether someone is infected or even has immunity from prior infection.  It is done with a finger prick of blood and results are available in 15 minutes.  The results would read as negative (not infected and not immune), having IgM antibodies (the first antibodies that are produced in response to an infection and suggest active infection) and IgG antibodies (the later immunological response we get when we develop some sort of longer lasting immunity to a particular infection).  Imagine if we could immediately test everyone presenting to a hospital, for example, like this.  It would allow us to isolate those who are infected immediately. We could also know what health care workers, store clerks, and other front line workers were already protected somewhat by their past exposure and antibody titres.  We could identify the silent asymptomatic carriers so they could isolate until they have recovered and not spread the virus to other vulnerable people.  Having this available will make a huge difference to understanding the prevalence of the virus in our communities. It will also help with management and control. It is on the horizon. Not sure when but it is something that provides me some hope. It might be the first significant tool to help manage this pandemic.  

I also think that we will likely come up with some sort of antiviral or medical management that can be safe and effective for helping to treat those with severe disease.  I don’t want to sound like “you know who” on this because it is a bit down the road, but I think it will eventually happen.  Medical researchers in the entire world are working ( I was going to say feverishly, but that might be a poor choice of words right now) to find effective medical management.

There will eventually be immunization for this virus.  It may take a year to get it on  the market and we will have to produce millions/billions of doses but, if combined with the antibody test, those who are not yet immune and vulnerable service workers could get the immunization first if supplies are limited. The caution is that, like influenza, this virus might change over time so keeping up with the specific viral mutations could be a challenge.  With any luck, the combination of acquired immunity and immunization will be able to bring some element of control. Widespread immunization is still months away but it will happen.   

Don’t take from this that I am underestimating the serious consequences that we might face soon as a result of the impending viral surge. However, in addition to heeding the warnings and scary projections, we should keep in mind that there will be advances that help us to get out from under this oppressive threat to our community health and our economy.

Prime Minister Trudeau, this morning, put it this way. “The best way we can work together is by staying apart.”

Stay the course, Canada. We can do this.