Guidelines | johnageddes

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.

We are social beings. We all need connection. Some of us more than others. This Social Distancing thing is urgently important so we can minimize the anticipated surge in cases of COVID-19 in our communities in the next few weeks. Unfortunately, the need to socially distance ourselves is not going to go away soon.

Social distancing is not the same as quarantine or self isolation. Those measures apply to people who are returning to Canada from international destinations, people who are symptomatic and awaiting COVID-19 test results, those who have had a COVID-19 diagnosis confirmed and people who have had direct contact with COVID-19 positive cases. These folks should not mingle at all with others for 14 days or until they are deemed cured.

Of course, if you are sick you should stay home, even if it is not COVID but is another Acute Respiratory Infection. This will minimize spread but also not lead to so many others getting a cold and then worrying it is COVID-19

All the rest of us need to practice Social Distancing. This means we minimize as much as possible close contact with others as well as follow all the other the routine advice for hand washing, elbow-sneezing, avoiding hugging or handshaking and not collecting in clusters of people.

I will share with you some practical strategies that I am adopting so I can comply with the need for social distancing over the next several weeks.

First of all, I will, at this point, go for walks outside. I need to get outdoors and have some exercise. We are lucky that spring is around the corner so we can actually get some fresh air. BUT that comes with the caveat that we must keep our distance from others. The advised two metres is best. I have a couple of friends who are also following the rules with whom I will meet periodically so we can smile at each other, have a bit of a laugh together and share some conversation. But we will work to maintain the required physical distance as best we can.

When I am out I don’t touch anything that I don’t need to touch. I don’t sit on a public bench, for example. I carry a small microfibre cloth in my pocket so if I have to open doors or carry a basket in the grocery store, I can use the cloth to make the contact. When I get home I throw it in the wash. (I have a pack of 5 that I got at Dollarama). If I can open a door using my elbow or hip or a push button or Key fob I do that rather than touch the handle. I am also putting my clothes in the laundry basket if I have been out somewhere during the day so I can start with fresh clean clothes every morning. Although the virus has been shown to live on plastic and metal for up to 72 hours, it can also remain viable on clothing or cardboard for a day or so. Better safe than sorry.

When I pass someone on the street I am attempting to say Hello or Good Morning even if they are strangers. It is always pleasant to be greeted and a brief verbal hello might just make someone’s day.

I will try to go to stock up on groceries at off-peak hours. I live only 10 minutes from my usual grocery outlet so I will walk there early in the morning or go in the last hour before closing to avoid the busiest times. We are being assured that generally the food supply will not be affected. The empty shelves that you may have experienced last week are the result of exceptional panicked buying and hoarding. It will take a while for those folks to use all that toilet paper they have in their garage so that will leave some for the rest of us when we need to buy it. Same with meat and pasta and rice and flour and… There will be food. Don’t panic. And while I am at it, I will extend our thanks to the people who are working to keep us supplied – clerks, shelf stockers, truck drivers, all of you. We need you and appreciate this service.

I will still see my family who don’t live with me from time to time. We will avoid hugging or touching and we will be careful to wash our hands or anything that we might have touched. We will keep our distance as much as practical. If any of us are sick at all we will self-isolate and not expose the others.

For example, I spent a couple of hours this morning with my 8-year-old granddaughter. Kids are scared. They know what is going on and they also know that their family and friends are scared too. We were able to have a great visit, taking extra care to avoid close contact, washing our hands after handling anything and playing interactive games that we streamed to the TV. We talked about COVID, how to look after ourselves and our worries. When she went home, we both felt infinitely better. She was happy and so was I.

I have been making a point of connecting with others both locally and internationally by using FaceTime or Messenger or Skype for audio/video chats. We need to stay connected. Text messaging is fine when we are busy and have the opportunity to interact face to face easily but a smile or the sound of someone’s voice does a lot to sooth that need for connection.

The economy is also taking a hit right now and where that leads is uncertain for all of us. We have enough to worry about now without being fussed about things we can not control. None of us know what the next month or six months or year will bring. It is futile to try to plan that far ahead right now so I am refusing to spend my energy trying to plan that far in advance or think about what situation I or, for that matter, the world, might be in by then. It is best to set priorities about what we need to do now. Currently my priority is to be responsible to my community, my friends and family and to myself so as to dodge as much as possible the immediate effects of COVID-19. Catastrophizing (is that a word?) is counter-productive and I will try to avoid going that route in my head.

There have been an absolutely phenomenal number of individuals, entertainers and groups that have reached out online to help us stay upbeat and mentally busy in our distancing mode. I have looked for those and will definitely join in to pass the added alone time. I will also break out a jig-saw puzzle soon.

This will pass. Unfortunately, the need to socially distance ourselves and the drastic disruption to our normal routine is going to last for weeks or even months. It will definitely get tiresome and I am afraid that it will be too easy to put these thoughts aside and let our guard down when the sun is shining and the weather is encouraging. In order for it to work, however, we will need to stay the course. Remember that it will take some time before we reap the benefits of this challenging change in our social interactions.

Hang in. Help others. Support each other.

John A Geddes MSc MD CCFP

Kingston, Canada

March 20, 2020