COVID-19 update. Holding the line.

As anticipated, Kingston has seen a blip in COVID-19 cases in the past month. Students returning to post secondary facilities, people traveling outside our district or visiting from other communities, the arrival of cooler weather and more indoor activity, and a generally younger demographic acquiring and sharing the virus all triggered that predictable rise in cases.

Our little wave seems to have peaked – for now at any rate. This might be luck but I like to think it is the result of people within our Health Unit generally being responsible and taking care for themselves and our community. Congratulations and thank you for that.

As of this afternoon we have only five known active cases in our district of over 200,000 people.  This is very good news and generally indicates that the virus is under reasonable control in our environs.  It’s not the same for some other areas in Ontario including the GTA, Ottawa and even Hamilton where one “fitness studio” has been thought to have been a source for over 74 cases.

Other areas of Canada and around the world are struggling to contain this second wave.  Italy, France, and the UK, for example, are all experiencing case numbers that greatly exceed the peaks in March. Fortunately, because of improvements in management and the high number of cases in less vulnerable, younger adults, death rates have not shown the same peaks (although they are rising). The U.S. seems not to have ever escaped their first wave. This week their new case numbers are rivalling the highs seen in July.

Australia, after seeing very low numbers for months, had a dramatic surge in Melbourne in late July resulting in daily new cases of over 700. They took determined action to reduce spread, including shutting down that district. Today their new case rate for the country was 8.

So, you see, it is possible to keep a lid on this virus but it requires discipline and following the recommendations from our Public Health authorities. These recommendations might vary from district to district depending on the numbers of new cases, whether there is evidence of community spread (ie not from travel outside the district or as a direct close contact of a known case) and whether our health care/hospital resources are being stretched.  As far as I can determine, despite our recent Kingston wave, no patients were hospitalized.  Since the beginning of the pandemic in March, we have had no cases acquired in our health unit that have required ventilation.

Let’s work on keeping it that way. How can we do that?  It’s pretty simple, really. 

Wear a mask/face covering when indoors with others in stores, theatres, churches, or any closed space – or even outdoors when social distancing is not possible. Wash hands often.

Keep our social interactions limited to a few close friends and family who we know are also being careful. Avoid indoor gatherings of several people when social distancing will be difficult to maintain.

Avoid traveling outside our community or having friends or family from elsewhere come to visit. 

Stay home if we are ill and, if we have symptoms that we think might be COVID-related, get tested and isolate until the test proves negative.

Download the COVID app so we can be notified if we have unwittingly stood beside someone at the grocery store for a few minutes and they have subsequently tested positive.

Get a flu shot. They are now available. I’ve had mine. It won’t prevent COVID-19 but will lessen the circulation of influenza viruses.

We will have to follow these recommendations for the next several months.  But eventually this will subside. We are all experiencing COVID fatigue but these inconveniences far outweigh the perils of  increased community spread or the necessary economic lockdown that would be precipitated by increasing prevalence.  If we are able to keep new cases low, our Health Unit will be able to trace and quarantine patients early. This, too, will limit the spread in the community.

I continue to feel encouraged that management of severely ill COVID-19 patients will continue to improve and that more effective medical management will reduce deaths.  A vaccine will be on the horizon soon although it will take a while to dispense it. We may be thwarted from quickly reaching herd immunity by people who decline immunization but eventually those of us who do accept vaccination will help lower the prevalence of virus within our community and this will benefit everyone. 

There will soon be a rapid test for the virus and saliva tests will become more common than the usual nasopharyngeal swab.  The increased number of testing sites, including in two local pharmacies opened this week for asymptomatic clients, will make it more convenient to be assessed and hopefully lead to earlier detection and isolation of infected  people.

We are in a much better place now than we were in March and we have been really fortunate in the KLFA Health Unit to have been less affected than many districts in Canada or worldwide.  

Can we hold the line?   I hope so. Stay the course.

COVID-19 update. Back to school. It’s time.

COVID -19 will be a threat we have to deal with for the next several months and possibly years. So we need to find a way to reduce its impact on our physical and mental health and our society as a whole.

Part of that transition involves cautiously opening up the economy and getting kids back to school. This makes us all anxious because our generation has not been in this precarious position before. We find ourselves faced with a threatening new virus – a global pandemic. The whole world is wading through a quagmire where there is no sure footing.

I have children who are teachers, grandchildren who are pupils, family who are health care providers and I have been back to working as a physician and teacher of Medical Residents for the past three months both in a clinic and in a small group at Queens. I get it. I understand the angst about going back to work and school. Where I am working we are not doing things the way they were done before but we have been able to find a balance between providing service and taking care not to spark COVID-19 transmission. It has meant several adjustments, wearing a mask for several hours at a time, keeping a reasonable distance between people where possible and respecting others. It has not proved to be that hard to do. Schools will have a similar transition period filled with uncertainty and change and angst but I hope that, with time and inevitable adjustments, teachers and students will find a safe balance point.

There will be pockets of COVID-19 that spring up menacingly in localized schools, neighbourhoods and cities. We are in a much better place now to deal with those clusters than we were this spring. What we have learned about transmission and mitigation strategies may be able to help contain outbreaks and avoid a generalized surge that would require a more widespread shutdown.

Our Public Health authorities are preparing for these inevitable challenges, armed with better testing, improved availability of health care resources and ever increasing knowledge about the virus itself. We now know how to more effectively contain it and have improved management for patients who become severely ill. I have pointed out before that our Canadian numbers seem to be hovering for the past several weeks at a daily new case level of around 500 people per day. Despite this, our reported death rates are staying very low, averaging 4 per day over the past week. In May we were averaging around 150 COVID-19 related deaths per day in Canada! Let’s not lose sight of this good news. Are you aware that, by comparison, on average every day in Canada 11 women die as a consequence of breast cancer and around 12 people die of opioid overdoses? The Canadian Government reports that “Every hour, about 12 Canadian adults age 20 and over with diagnosed heart disease die.”

Now, this is not to downplay the consequences of the current COVID-19 pandemic in any way and other long-term consequences of having had a COVID-19 infection have not yet been determined with any certainty. We are being bombarded, however, with daily statistics about COVID-19 but we are not updated every day on how many Canadians (228 on average) have died in the previous 24 hours of cancer. COVID-19 is scary, but we have been made more frightened by the daily global focus on its statistics. Can we govern our behaviour based on responsible common sense rather than fear?

What do I think should happen now?

Cautious reopening of schools and offices is important to reestablish whatever normalcy we can find in this new pandemic situation. Children need to play and learn with and from each other. Following whatever public health guidelines are advised is important. Masks and social distancing as much as practical and minimizing opportunity for spread within a school cohort will be challenging but we won’t know until we work with it and make the necessary adjustments as time goes on and as we learn more.

What will I personally do In the next few months?

I will continue to work. I will follow the restrictions and Public Health guidelines that will, no doubt, change from time to time, particularly if there is some increase in COVID-19 in our community. I trust the judgement and advice of our local Public Health Unit and know that whatever recommendations they put in place are based on the best epidemiological and medical information available and done with the safety of our community in mind.

Consequences. We are all responsible for our behaviour.
Photos from Kingston Whig Standard and Queen’s Journal.

I was glad to see that the beach at the Gord Downie Pier was closed off entirely this weekend after a couple of days when young adults swarmed to the beach area and appeared not to be taking the required precautions. I hope that our city officials and public health can keep an eye on any elements in our community that are not respecting the current recommendations and move to enforce these with authority. If we don’t follow the rules, we will lose privileges. This applies to restaurants and businesses and movie theatre and schools and churches. And beaches

I will avoid crowded indoor environments. If I find myself somewhere that I think the required precautions are not being respected I will leave, and if I feel it is a significant infraction, I will report it to Public Health.

I will wear my face covering in any situation where I am exposed to people outside my close social circle where I am not able to adequately distance myself. This includes all indoor spots like cafés or stores or offices but I will also put my mask on outdoors if I find myself in the midst of a number of people. And, by the way, the mask doesn’t work if you wear it below your nose.

I have installed the COVID app on my phone and hope that you do too. This will ensure that if I have been in close enough contact to establish Bluetooth connection with another phone and that person, who may have been standing in line behind me waiting for the bank machine for 10 minutes tests positive and subsequently enters a confidential code, I will be notified that I should watch for symptoms and maybe get tested as it appears that I have been close to a person who has COVID-19. This will only work if lots of people do it. It will help in Public Health tracing for community transmission. Do it, please.

I will stick to myself if I am sick in any way. If my symptoms include cough, shortness of breath or fever, I will get a COVID-19 test. This will become simpler over the next months when rapid tests that only require a saliva sample are approved and become widely available.

I will keep a small circle of social contacts who I trust are also being cautious. We have been enjoying outdoor summer patios and walks but as the weather closes in, this will become more difficult. Indoor dining at restaurants poses a higher risk of transmission and if there is any increase in community cases of COVID-19, I will stick to meals at home. I will try to help the food hospitality industry by ordering take out or home delivery. It is not the food that is a risk, but groups of people sitting around indoors for a period of time, all without masks as they eat and chat.

I will not go to bars or indoor parties.

I will not travel outside my community for a while, apart from occasional visits to kids and grandkids in Whitby.

I will be eager to get my annual flu shot and whenever safe COVID-19 immunization is available I will take it.

I will be respectful of people who have views who are not the same as mine (like anti-vaxxers and people who balk at wearing masks ) but that doesn’t mean I have to mingle with them. I have clear boundaries about what I will tolerate or how I will protect myself and others and will adhere to them.

I remain guardedly optimistic that we will pull through this unprecedented disruptive time with lots of inconveniences but hopefully with minimal serious illness or loss of life and manageable strain on our Health Care System. It requires cooperation and diligence from all ages and segments of our community. We are certainly in a much better position in September to manage the challenge than we were when this was all brand new in March. Stay the course. We will get there.

John A Geddes MSc MD CCFP. Kingston, Canada.

This is an op-ed. It is my opinion. Yours may differ. What we know about COVID 19 is changing every day and depends on the current situation in your district. We need to be flexible and adjust to new reliable scientific data.

COVID-19. Facing uncertainty.

If there is one word that I would use to describe 2020 it is uncertainty. There are lots of others but uncertainty in so many ways has been at the forefront.  When COVID-19 first emerged in the early part of the year we had no idea where it would lead.  Just another flu?  Contained in some far away countries? A plague that will wipe us all out?  

In March, we understood little about the virus – it was “novel” after all – and so there were many fears around that unknown part.  Could we get it from packages dropped off by the Amazon delivery man?  Would we need to wash our groceries? Will COVID-19 overwhelm our Health Care System?  Will the measures we put in place to isolate and reduce spread actually work?

Now, by mid-August we have settled into a new reality.  Standing on those little circles, wearing a mask and dealing with a cashier who is behind a plastic barrier has become the norm.  There is less fear about the risk of spread from inanimate objects.  Being able to interact with people outdoors has been a great boon.  Our Health Care System was not deluged and is back to functioning, albeit with some new COVID-19 modifications. It is prepared and well positioned to deal with any new increase in cases should a second wave happen in the fall. The virus, we now know, is primarily droplet spread so hand-washing, keeping a suitable distance from others and wearing a mask when closer approximation is inevitable should pretty much keep us and our community safe. 

Kingston has done remarkably well apart from the nail salon outbreak that was quickly contained. From what we are able to determine our community was COVID-free for over three of weeks until two new cases, both in their 20’s, were found on August 19.  Over 2500 tests have been done in our health unit in the last seven days with a 0.1% positivity rate. This has given us a chance to enjoy more social interactions outdoors with low chance of being infected. 

Many European countries, often using strict social distancing regulations, were able to bring their epidemics under control. They subsequently re-opened their economies, schools and tourist industry. Many are recently seeing upsurges in new case rates. Even Austria (and Australia, too), for some time held as a great example of success at suppressing the virus has had an upswing in cases.  Good news is that, despite this uptick, death rates have not seen the same shift – yet.  This reflects that we now have a better understanding of how to manage serious cases, more knowledge about  transmission, and more diligence around protecting long-term care facilities and vulnerable people. We are seeing a lower rate of infection in older people who are at more risk of serious outcomes. Maybe they are being more cautious than people in their 20’s appear to be. Canadian new case rates have kind of stalled at about 350-500 per day  but our daily death rates for the whole country in the past couple of weeks have ranged from 4 to 10.  This compares to 150-200 daily deaths in early May.   

But, There is always a but, right?

The uncertainty is still there and will likely increase in the next few months as we attempt to get back to “normal”. Cooler weather is approaching which will take us indoors. School for elementary and high school students will resume in September. We can’t keep kids away from school forever and our social and business needs will resume. There has been an obvious increase in tourism in Kingston in the past two weeks.  Downtown patios are full.  People can be seen wandering in clusters many are not wearing masks even when they are in a group.  Restaurants have opened for limited indoor dining.  Students will be returning to Queens and St Lawrence College and we know that this age group have contributed heavily to the Canadian new case figures in the past few weeks and might be less diligent in adhering to Public Health recommendations.  

We will all feel anxious as these new parameters enter the mix.  How can we deal with that anxiety?

Unfortunately, this virus is going to be with us for a while. Maybe forever. We will have to figure out how we best deal with it until effective immunization is available to a large proportion of our population.Even then there will be some folks who refuse to be immunized, lowering the effectiveness for achieving herd immunity. 

There will be new outbreaks. But if they can be contained they will not lead to another shut-down.   We will, no doubt, be inconvenienced and restricted from time to time.  Over the next year, you may be required to isolate for a couple of weeks or your school/classroom/business might have to temporarily close.  The ongoing surveillance, testing and quick responses to new cases by our local Public Health authorities has been impressive and has contributed to keeping our community safe. Ongoing cooperation with our Public Health officers is the essential key to success.  If we continue to identify new cases early and squash opportunities for  transmission, however, we will, as a community, be able to keep functioning.  Advances in management will also lead to a reduction in serious complications of the infection.

The highest risks remain groups of people gathering, particularly indoors, with no social distancing and no facial coverings – especially parties or bar gatherings with clients “speaking moistly” and bending the rules for social distancing. My recommendation is to stay away from these situations and avoid any activities where people are not following Public Health advice.  If you think you are in a situation where  you can not keep the recommended social distancing, indoors or out, wear a facial covering. It will help to protect both you and others.  Continue to wash your hands and keep your cohort of close contacts small.

We have already adjusted to the many changes in the way we interact socially.  Our long term success in coping with COVID-19 will depend on our ability to continue to adapt and to follow the guidelines that our medical experts advise.

John A Geddes MSc MD CCFP

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.

COVID-19 update. Whew!

We were doing so well, Kingston! For several weeks in May and June the Kingston, Frontenac, Lennox, and Addington (KFLA) Health Unit district, serving over 200,000 people had only two cases of COVID-19 , both having entered the community from the GTA.  In late June, however, we all squirmed as we collectively felt the equivalent of fingernails on a chalkboard.  A series of cases that started in a nail salon were reported. This led to a significant increase in numbers for our area.  Our COVID-19 case total, plateaued at 63, quickly rose to 105. Thankfully this figure has held steady with no new cases in our district reported in the past week. The one patient requiring hospitalization has been discharged. The outbreak appears to have been squashed.

The surge we experienced was discouraging but not at all unexpected.  We can anticipate that pockets of COVID-19 will break out over the next few months.

This applies internationally, as well as locally.  Australia and Israel, for example, both looked like they had reduced their COVID load to minimal for a few weeks but recently they have experienced increased numbers that have made them backtrack with their re-opening strategies.

In Kingston’s nail salon outbreak, the cluster was rapidly investigated by our local Public Health officials. Testing was ramped up and  contact tracing aggressively pursued.  Our Public Health Unit, led by our MOH Dr Kieran Moore, was ready and acted quickly.  From the outset this leadership in our community with response to COVID-19 has been instrumental in keeping our city and environs as safe as possible.  Dr Moore has also been updating the community with regular You-tube videos that can be found here.

Kingstonians turned out in droves to get tested and over 7000 tests were done over a couple of weeks.  A few hundred people with probable exposure were advised to self-isolate. In addition to aggressive testing and tracing of contacts, the Health Unit quickly implemented a mandatory face-covering policy in indoor stores, restaurants and gatherings.  Other communities across Ontario have subsequently followed suit.   

Management of COVID-19 has also been successful lately in the rest of Ontario and across Canada with case numbers hovering at a manageable level and COVID-19 death rates dropping significantly.  We all watch in horror, however, as COVID-19 spirals out of control in many parts of the United States. In the past week, Canada’s daily new case reports have averaged 290 and daily reported COVID deaths averaged 12. In the United States, with a population about 8 times that of Canada the corresponding numbers are an astonishing 58,000  for daily new cases (hitting 70,000 yesterday) and 650 for daily deaths.  The US deaths are expected to rise in the next couple of weeks since deaths follow the diagnoses by two to three weeks on average.  

These differences in numbers are not just a result of increased testing.   For example, in our KFLA district, the testing rate per 100,000 population has exceeded 13,000 with a positivity rate of 0.4% (4 per 1000).  In the US, the test rates despite being touted as more than anywhere in the world are lower than ours at 12,000 per 100,000 but their positivity rates average 9% (90 per 1000) with a recent high of 19% in the state of Florida.

What can we learn from all this?

Canada, Ontario, and particularly our Kingston district have done a good job of mitigating the consequences of COVID-19 so far.  We had an initial manageable surge as predicted but our numbers have dropped and are plateauing.  We can ascribe this success to a disciplined, coordinated, non-partisan, science-based approach by our governments and Public Health officials.  All Canadians also need to take credit for a concerted attempt to follow the guidelines set out by our leaders. In general our habits have changed to protect ourselves and our communities and our efforts have paid off.

It would be nice if this would just go away all together.  But it won’t. At least, not soon.

We are going to see clusters of COVID-19 outbreaks occur in neighbourhoods, communities and provinces over the next several months.  If we are able to keep these numbers low, we can continue to contain the spread through testing, self-isolation and contact tracing.   Scattered communities may intermittently need to be more aggressive with local restrictions varying from time to time according to diagnosed cases or pockets of infection. 

There will still be some uncertainty when schools open to some extent in the fall.  Cooler weather will have us more indoors where spread happens much more readily than outside.  More university and college students, who have been hunkered down with their parents in home communities will return to Kingston. Eventually the border between the USA and Canada will reopen for non-essential travel.  Canadians overwhelmingly hope this will not occur until the USA has their house in order with regard to COVID-19.   All of these factors bring some uncertainty to what will happen with regard to COVID-19 in the months ahead.

Management  strategies to treat severe cases are improving every week.  If we can keep the strain on our Health Care system as it is currently, we can manage until effective immunization or a specific treatment or prevention  is found.  Effective medical advances will certainly happen but realistically we will be in this limbo period for several more months. 

The rapid containment of our recent local cluster is encouraging and reassuring. We have shown that if we  follow the requests and recommendations of our Public Health and political leaders we can feel confident that we can bring new outbreaks in our community under control and avoid the distressing situation we see south of our border.

It is not that hard to act responsibly.  Wear a face covering where indicated.  Wash your hands.  Avoid prolonged indoor contact with others, particularly in groups.  Keep social distancing where possible. Stay vigilant and guard against complacency or impatience. Hopefully, with competent guidance and cooperation within our community we can continue to keep ahead of any new outbreaks. Stay safe.

John A Geddes MSc MD CCFP July 10, 2020

COVID-19 Numbers, numbers, numbers

The COVID-19 numbers out there can be scary.  We have cocooned ourselves for the past several days and the stats are still going up.  Most of us have nothing much else on our minds but anxiety about where this is headed, particularly when we look at the devastation that has happened in Italy, Spain and New York City.   We wonder “Is Ontario next?”

Today the Ontario government released projection figures that are both disturbing and motivating.  We know how this virus tracks from how it has exploded in other parts of the world.  With those models as a predictor, Ontario, without any restrictive measures in place, would have anticipated 300,000 cases and 6000 deaths by the end of April.   If we follow the current recommendations to limit physical contact and stay at home most of the time, however, that number can be reduced to 80,000 cases and 1600 deaths by April 30.  Still an incredible burden but it means we will effect a significant reduction of over 4400 deaths in Ontario this month alone if we just stay the course.  If we restrict further (and further restrictions may ensue) that number could be reduced even more.

It may be frustrating to see that we are trying to stay in and stay apart and the number of cases and deaths in Canada keep going up.  But that was anticipated. For a while we were slow to get testing results so the statistics lagged by a few days.  We also had the influx of travellers returning to Canada and some bringing their virus with them.  Some of those didn’t self isolate as diligently as requested. Although they thought they were not infected or had minimal symptoms, they could have spread the virus to others. There is also a 7-14 day incubation period before the symptoms become evident and some people have minimal symptoms of infection. This means that people who were exposed two weeks ago might just now be showing symptoms and becoming ill enough to test. And others are simply unaware that they are infectious.

Don’t get too frustrated by the current increasing numbers.  From the charts of the various possible trajectories, it is evident that our current social isolation is actually working to reduce the otherwise catastrophic infection and death rate that would have happened if left unabated.


Another graph that was released today was also encouraging. (see below) It shows the possible numbers (in red) if no measures were in place and the anticipated numbers if we are compliant with the current stay at home  and physical distancing recommendations (in blue)   The two dotted lines represent the Ontario capacity for ICU management in the province both in place prior to the pandemic starting (the lower line) and now planned (the upper line).  We are fortunate that we have had time to anticipate this imminent glut of infection cases and our hospitals are putting additional capacity in place.  If we follow the blue curve we will be able to sneak under the expansion capacity line.  That is good news.  

Our COVID-19-associated death rate per million in Canada right now stands at 5 per million population as compared to 21 per million for the USA and 243 per million for Italy.  Remember that deaths occur later in the process so they will continue to rise for the next while. As long as we can stay under that dotted line and have adequate access to ICU beds, we will be better able to manage the seriously ill and more lives will be saved.  Many of the deaths in countries with very high rates were partly as a result of ICU capacity being suddenly overwhelmed and medical management simply not being available.

So, the message is that the potential for seriously devastating numbers is there but we are already going to have some effect on the curve with what we are doing now. With more dedication to these restrictions we can do even better over the next month. This will be a marathon, not a 100 metre dash.  Take some big breaths.  Settle in to our new temporary reality and know that it is making a difference, saving lives, and in the long run things will get better.

Through various medical connections and meetings, I have been impressed that our Public Health officers, Ministry of Health and local and provincial physician groups and clinics have been very actively anticipating and planning for the surge that we anticipate that we will experience in the next couple of weeks. I feel confident that in Kingston, Ontario, and across Canada, we will receive excellent care and support during this unprecedented challenging time.

For my neighbours in Kingston, as of this morning we have 48 confirmed cases and no COVID deaths in the KLF&A district with likely many more out there who are not ill enough to have been tested. General testing has been a bit restricted initially because of the need to ration available tests but this will likely loosen up a bit soon so more cases might be confirmed. This increased testing may lead to more confirmed cases being reported.