Good news | johnageddes

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.

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.