This week, I am feeling like a butterfly emerging from a cocoon. I probably look more like one of those cicadas that has spent 17 years underground.
I am two weeks past my second COVID shot so I am about as protected as I can get at the moment. I am also encouraged by Kingston COVID numbers dropping to barely countable and a steady drop happening across Ontario and Canada. We ended last week in Kingston with a case positivity rate in the past 7 days near zero and only 2 unresolved cases in the whole KFLA Health unit area of over 225,000 people. Across Canada over 75% of our adult population are reported as having had one vaccine dose and 20% have completed their regimen with two. This is all great news and something to celebrate.
Hopefully we will continue our upward climb of getting people vaccinated because in addition to following sensible Public Health measures, that is the key to breaking the hold COVID-19 has had on us for months. Canadians are stepping up in droves to be immunized, thereby responsibly protecting themselves and their friends and colleagues. After a very slow start, Canada now leads the world in proportion of the population with at least one dose of a COVID vaccine. We need the enthusiasm for first dose vaccinations to persist into acquiring second shots since complete two-dose immunization is more than twice as effective in protecting against the Delta variant which is catching hold now. Single dose vaccination only provides about 33% coverage for this variant. Regardless of which vaccine you have started with, it is imperative that you complete your full vaccination programme. People who had the A-Z vaccine for a first dose may now be complete their course with one of the m-RNA (Pfizer or Moderna) vaccines. In all likelihood we will all need a booster dose in a few months and this will likely be with an m-RNA vaccine that can be adjusted every once in a while to cover new variant mutations.
Unfortunately, there will still be some folks who decline to participate in the vaccination programme. They will get a free ride because the relative herd immunity that occurs when the rest of us get vaccinated will protect them as well. But their resistance will also put a limit on how far we can get to squash this virus. Ultimately they will likely pay a price for their reticence in that they may not not be able to travel on some public transport, go to some concerts or events or attend at some educational facilities as freely as vaccinated people.
I predict that the summer will be good – with more outdoor activities, a gradual reopening toward indoor options, continued care with regard to masking and hand washing and social distancing where necessary. My guess is that, even if we get a few local surges in virus activity across Canada, the worst is behind us. New variants may arise (it is normal for mutations to occur) but with time, vaccines can be altered to accommodate these changes. Until the whole world gets adequate vaccination coverage there is still a global threat that will continue to disrupt lives and economies worldwide. I have talked with my friends in Kenya where they are having more older or vulnerable people dying without much explanation. They do not have access to COVID testing in rural areas so they have no confirmation that it is COVID. And vaccines are a distant dream for them at the moment.
We are not out of the woods yet but the outlook is much more promising and encouraging that it has been for quite a while. For the next few weeks we must be patient and stay the course to gradual reopening. We are all eager to open up but the mistake Ontario made earlier this year that augmented the third wave numbers was to be too quick to try to resume normalcy and too slow to shut down. We all need to get fully immunized as soon as it is available to us and encourage those around us to do the same. We may need to stay masked for a while when we are in close contact with others indoors or even outdoors if we sense that we are not able to adequately distance particularly with folks who have not yet been able to get their full immunization in order to protect them from infection. Please respect the boundaries that others set regarding interaction. We all have different comfort with potential COVID exposure and some friends may want to remain more cautious than others for a bit longer.
Fully vaccinated people can safely enjoy connecting with others who also have completed their immunization schedule. Let’s enjoy the great Canadian outdoors and safely reconnect with friends and family. If we follow the Public Health guidelines we will soon get back to what might be close to “normal”. I am starting to remember what that felt like. And if feels good!
The next thing on my wish list is to get a much-needed haircut!
I started writing articles about COVID-19 over a year ago when we were not swamped with COVID information. But we are inundated now so I will put my COVID pen down. This will be the last of my COVID articles but I will continue to post about topics that interest me (and hopefully interest you as well.)
The COVID-19 news, both globally and in Ontario, has been discouraging in the past few weeks. In Kingston, we have done remarkably well throughout the pandemic but new cases are currently occurring at greater daily counts than our usual and today we have the highest active case count that we have had since all this began. A recent B117 outbreak involving a local construction site where there were “workers from multiple jurisdictions” will probably impact our community for some time as it can spread to close contact family members.
Is there any light at the end of this seemingly endless tunnel?
Unfortunately, Canadians were a bit smug about our case numbers when comparing them to other parts of the world, including the U.S.A. and U.K. We became complacent about continuing the recommended Public Health measures that have been advised since the beginning of the pandemic. We were tired of the restrictions and our Health Care System was managing, so we let down our guard. Although we ought to have heeded the February warnings about variants on the horizon that had caused high caseloads in the UK, Brazil and South Africa, we ignored those foreboding predictions and continued to be open for business with minimal personal or business restrictions. We responded too late and too little. Can we find any hope in looking at how other countries have emerged from this dilemma that is pushing our provincial health care systems to the breaking point?
Bear with me as I throw a few graphs your way. My story ends with a possible positive outcome if that will encourage you to read on. Not surprisingly, it appears that successful reduction in COVID-19 case numbers relates directly to vaccination rates and countries following disciplined public health restrictions.
Not long ago the UK was in bad shape with COVID-19. The new B117 variant that is plaguing us now had gained hold there and was causing surging in caseloads that peaked in January They locked down and vaccinated extensively, mainly using the Astra Zeneca vaccine. What happened? Their number of new cases has been dropping continuously. Today they report that over 50% of their population has had at least one dose of vaccine. Persistence with lockdown restrictions and a good uptake of vaccinations seems to have helped to turn the COVID corner for the UK. They now have a graduated schedule of return to “normal” that will slowly open things up, stretching until late June.
Is this just a fluke? We can also look at Israel’s experience where the combination of lockdown and vaccination (mostly Pfizer) also had a significant effect. In January, Israel was also experiencing a serious second wave of COVID-19. However, they got an early start with aggressive vaccination while imposing significant restrictions including mandatory mask-wearing outdoors, school closures and restricted travel into the country . Now their numbers are very low and they are starting to open up and have reduced restrictions. Last week Israel reported their first day in 10 months without a COVID-related death in the country. They are being cautious as they slowly reopen but it appears that things are getting back to “Normal”.
India, with a huge population, had a false sense of security when numbers started to abate early in 2021 and led to them quickly reopening the country to things like large social and religious gatherings and sporting events. Even though they produce vaccine, some of which has been sold to Canada, their own programme has been slow to develop. They are now faced with a new variant and in the past few days their numbers have been astronomical and the death toll is staggering. The current surge in cases and deaths is having an absolutely devastating effect in India that will be felt around the world. The COVID virus knows no boundaries and as millions become infected quickly there is even more potential for new mutations to occur that could cause international concern.
Here in Canada we have been dependant on vaccine supplies from abroad that were slow to arrive and the process was complicated by international bartering. In the past month, things have ramped up well and we are projected to receive increased supplies over the next few weeks. In Ontario we are now vaccinating at a per-population rate that is second only to the U.S. That will certainly help us to achieve a lower rate of infection if we can continue to disperse vaccines at this pace and a significant proportion of our population accesses them. The Globe and Mail reported today that if our vaccine supplies arrive as scheduled, all eligible Canadians could be fully vaccinated by the end of July!
What can we learn from what we have seen in other countries? It appears that keeping the long-requested restrictions on mingling, shopping, meeting indoors, and traveling combined with aggressive roll-out of vaccination is the key to gaining some control over the virus. In the past week our COVID new case numbers in Canada seem to be plateauing but it is discouraging that they do not seem to be dropping very quickly. In Kingston where over 40% of our population have received one dose of vaccine and have been under a “stay at home” order for the past two weeks, new case numbers are not falling significantly (yet). Our Canadian provincial governments, faced with Health Care systems that are at capacity, have needed to impose increased restrictions. We all have been quite aware what we need to do but many of us are just not following the requested behaviours. We will soon have four vaccines available with age limits dropping almost daily. Vaccine supplies will be coming at a much better rate in May and June. If Canadians accept whatever vaccine they can get soonest there will be more of us who are protected and the virus will have fewer hosts to infect. We are doing pretty well, in fact, with almost 40% of our population having received at least one dose of vaccine. According to the graph below, this puts us about two months behind the UK and three months behind Israel in this regard. So, if we keep the restrictions in place for a while longer, comply with the requests of our Public Health officials and reopen gradually, and if vaccine supplies continue as predicted and are administered as quickly as possible to a willing population we should be able to see great improvement over the next few weeks.
Does it matter which vaccine you get? In the long run, not really. The numbers are sometimes confusing and variable but the bottom line is that they are all effective at significantly reducing infection and all are very effective at preventing severe illness if you do become infected after two doses. Although there is some benefit two weeks after the first dose, this is variable and may not protect quite as well against the Variants of Concern. After one dose only, we are advised to still protect ourselves and others as though we have not had the vaccine yet. The delay of the second dose to complete the vaccination protocol will help our communities to achieve at least partial protection in that vaccines can be distributed to more people as first doses and offering at least partial protection to more people and bring down case numbers. To me, this makes sense. The booster dose, although delayed, will add to that effectiveness.
Significant side effects caused by COVID vaccination are rare. Any medical treatment has the potential for significant adverse effects. Physicians are always weighing the Risk/Benefit ration when we prescribe anything or do any medical procedure. Even low-dose aspirin can, in a small number of patients, cause serious gastrointestinal bleeding. Unfortunately, bad news gains attention so we all learn first about the unlikely exceptions, rather than the rules. The potential for a rare blood clotting disorder (not at all similar to usual blood clotting problems like deep vein thrombosis or pulmonary embolus, by the way) may be real but is extremely rare. The chances of serious consequences of a COVID-19 infection are much greater.
People who choose not to be vaccinated can make that choice but, in doing so, they may be giving up certain opportunities for travel or certain other activities or gatherings that will require a “vaccine passport”. I think that is fair.
Can we look forward, then, to achieving the kind of curve that has happened in Israel and the UK? How will can we achieve that?
We stick to the restrictions requested by our public health leaders and be glad if our politicians are careful about slowly reopening.
We limit close indoor contact to a people within our household bubble.
We avoid spending time indoors at restaurants, gyms, churches or theatres until the virus is much better controlled. We now know that airborne transmission is part of how this virus spreads so any indoor gatherings without a mask for any period of time puts us at risk for infection, no matter if we are 2 metres away or not so we avoid spending indoors with a group of people.
We avoid travel outside our district or having visitors from outside because this increases the risk of introducing new variants to our community. The MOH at the Kingston, Frontenac, Lennox and Addington Health Unit has repeatedly expressed that most of the surges in virus activity in our district have been initiated by travel in or out of our community.
We continue to wear a mask in stores and many other indoor settings and even outdoors if there are a number of people around and you can not adequately distance. This may be a requirement for some time to come.
We take whatever vaccination we can get soonest. The more of us who are vaccinated, the fewer will be vulnerable to infection and spread it to others. It may be that a third or annual booster is required to keep us safe from new variants (much like annual Influenza shots).
We stay off work and isolate from others as much as possible when we are ill. Our provincial governments must not be too eager to drop the restrictions but follow a slow and graded reopening process.
What might slow down progress? New variants that are more easily spread and/or more virulent may arise spontaneously. Hopefully the vaccines we have and any modifications that ensue will be able to continue to be effective at combating them. We also need a substantial acceptance of complete vaccination to achieve herd immunity. When it comes time to open up again it would be best to do it very gradually. Reopening too quickly was a factor in making this third wave more serious. We also need global cooperation and assist lower income countries because as long as the virus is not contained, spread internationally will occur.
And finally, the Globe and Mail estimates that by the end of July, the country should receive enough doses for all eligible people to be fully vaccinated. When we complete our vaccination we can joyously dance the bhangra like Gurdeep!
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.
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.
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.
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.
Kingstonians can continue to breathe a collective sigh of relief as we enter this holiday weekend, knowing that there has been no new COVID-19 case identified in our Health Unit cohort for over two weeks. All 61 of the previously identified cases have been declared “resolved”. This is reason for appropriate celebration and considerable relief that we have passed a first wave of COVID-19 without experiencing the feared, overwhelming situations like those we have seen in some other centres around the world.
In addition the KFLA Health Unit figures indicate that only 18% of the cases in our district were “Community Acquired”, the rest being found in returning travellers or direct contacts of known cases. Our Health Unit serves about 215,000 people. That means that of the 61 diagnosed cases – I say “diagnosed” because we don’t know if there are others out there that we have missed because they were not tested – 11 of them arose from sources unknown or random community transmission. That is one such case in 20,000 people. Those are not bad odds.
Does this mean we can let down our guard? NO, indeed!
It means that the measures that have been put in place in our community have minimized the spread of the virus and it has had nowhere to go so it has temporarily petered out. But it is still there. And it is still there with a vengeance in Montreal, only 250 kilometres away. The reality is that our community remains highly vulnerable because we are still quite COVID-naive. So far, we Kingstonians are living in a bit of a bubble.
I wonder what will happen when we open up a bit or when people go to their cottage near Ottawa or when they visit their family in Toronto and return to Kingston. What will happen if we start to get people from Montreal coming for a summer weekend vacation? Or when some college or university students return to Kingston in September? If we become overly confident and let our guard down too much will we start to see more community spread of this virus that is still out there, waiting to find an entry point?
The World Health Organization this week has suggested that we are in for a long haul with COVID-19. Like HIV, it may be a pathogen that we will have to accept is here to stay. We will eventually develop some “herd immunity” that lowers its prevalence but it may always be there, lurking and threatening to surge if given the chance. There are also studies this week from both Spain and France suggesting that in these countries, where there has been a significant burden from disease this spring, only about 5% of the general population has antibodies. A similar study done in Boston and reported today discovered about 10% of the population had antibodies. This suggests that the prevalence of undiagnosed infection or sub-clinical infection is less than we had hoped for and that significant proportions of the population are still vulnerable to infection.
This week, the Canadian government approved an antibody test that will be very helpful in identifying what is happening in our various communities to track this infection and aid in management. It is not ready for widespread clinical use yet but this is a start.
Just like what has happened with malaria, and TB and influenza and HIV, I am confident that we will eventually come to learn much more about this novel coronavirus and develop strategies and medical managements that will lessen the impact or be able to treat it. We will develop better/quicker screening and testing for COVID-19 and be able to earlier identify and quarantine those with an active infection and their contacts. Maybe there will be a drug that can be taken by contacts that will suppress the infection proactively. Hopefully, we will come up with immunization that will help to improve the herd immunity. It will take a while to provide immunization to 7 billion people. Unfortunately, there will likely be a backlash and resistance from those who oppose vaccinations of any kind that will slow the process for the rest of us.
In the meantime we need to stick to what we have found is actually protecting us so far. Wash those hands often. Limit your close exposure to others. Don’t gather in groups where distancing is not practical and particularly in indoor closed areas. Work from home when you can. Consider wearing a mask when you are shopping or in a situation where physical distancing is impractical. When you are sick, stay home. Better yet, get medical advice and possibly a COVID test if it is advised so your recent contacts can be warned if you are infected and so you don’t spread it unwittingly to others. We will need to take particular care of those in Long Term Care facilities and, as a community, protect individuals whose co-morbidities put them at increased risk of serious consequences of the infection.
Although the last 9 weeks have felt like a lifetime, we are only just starting. The COVID-19 virus is new to the world. We are guessing to a certain extent, using scientific reasoning, how best to mitigate its effects at the moment but how this unfolds over the next couple of years is taking us down an unknown path. International cooperation and learning from the experience in other parts of the world has been helpful.
Some folks are eager and others might be understandably anxious about re-opening the economy. The bottom line is that we can’t remain in total isolation forever. My opinion is that if we proceed gradually in a responsible way and remain ready and responsive to deal with any emerging infection clusters that develop, we can go ahead with caution. It will be slower than we want and there will be challenges to working around new restrictions that will be in place for some time. We will adjust.
Life will change. Our societal habits will change. But humans are pretty resilient and flexible and we have science and technology that was not there for past pandemics on our side. Our short-term success shows that we can do it. It’s a long course ahead, however, and we will have to buckle down and accept that sobering reality.
John A Geddes MSc MD CCFP
Here is a message from our Local Medical Officer of Health posted today on the KFLA website.