Covid-19. Modifying the “Stay At Home” message.

Kingston has remained fortunate that the COVID-19 virus has not caught hold here as it has in some other Canadian communities.  Canada’s numbers have plateaued but not dropped significantly in the past week.  Ontario’s numbers actually went up a bit last week but today’s count is better. The GTA is the biggest contributor to new Ontario cases. The numbers do bounce around somewhat so looking at the trend (and deaths) gives a better sense of what is happening than daily counts. Canadians have been able to keep the demand on our Health Care facilities manageable and that was the initial aim of all the restrictions requested of us. But there is still risk of clusters of spread and we’ve seen that some folks are being somewhat defiant.

In Kingston, our only new COVID case in the past four weeks has been someone who reportedly went to the Greater Toronto Area and brought it back.   I don’t know the exact details but this does point out that Kingston’s greatest risk at the moment is introduction of the virus from people outside our district that we invite in (tourists, relatives) or Kingstonians who travel, don’t adequately physically distance themselves, and then bring COVID-19 home with them.   Initially we were asked to STAY HOME, meaning indoors and not going outside for anything other than groceries or something deemed urgent.  Most of us complied.  It worked.   Now the message is still STAY HOME but the definition of “HOME” could be expanded to be within our district.  The stats from the KFLA Health Unit for the past month would suggest that picking up COVID-19 in our district from people who have stayed inside our community is negligible.

Reported cases of COVID-19 in the KFLA Health Unit as of May 26. The last reported case was introduced from outside our district.

That is great news. Let’s not get complacent, however.  You don’t know who the interloper might be.

We have adjusted to a new social normal already.  In general, people are seeming to keep their distance in public places. No one is offended if you veer away from them on the sidewalk.   Most people walking together are courteous enough to move to single file to let others pass within a safe distance when the pathway is narrow.   I thought today how, in the past few weeks, I have said hello to many more strangers than I did in the past and I’ve been greeted with smiles and responses.

We will adjust to the changes required to keep us safe.  I remember, as a child, bouncing around in the back seat of my parents’ car without a seatbelt and how much of an unwelcome restriction it was to have to wear one. Do you recall how restauranteurs and bar owners thought that a no-smoking policy would ruin their business? Think about the changes in airport security that we accept now as normal when virtually none existed only a few years ago. 

If you can adjust to standing by your German Shepherd as it takes a dump by the fire hydrant, then bend over to scoop up the poop in a plastic bag that you carry nonchalantly on the rest of your walk, you can certainly adjust to putting on a mask when you go into a grocery store. 

There will be other societal changes to which we will acclimatize.  Cash will disappear.  That trend has already started in many countries but these events will accelerate that movement.  For some time, indoor gatherings like theatre or conferences or church will be discouraged.  And people will be reluctant to participate, even if they were to occur.   Limits to the number of people in a store will be common place.  Take out meals will be more comfortable than indoor dining for a while.  There will be sanitation changes required to public washrooms.  Travel will be cumbersome and awkward.  

We will adjust. We have done so to many other societal changes in the past.

Eventually this virus will run its course or become manageable with medical treatment and immunization. In the meantime, we must remain cautious but not scared, compliant with the recommendations made by our Public Health Unit, friendly from a distance and courteous and respectful of others.  As a community we can support each other and protect each other.  We already have, in fact.   Let’s keep that up, Kingston.

COVID-19 We’re just beginning

Let’s start with the good news first.

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.

Celebrating Spring in Kingston Ontario

Exactly three weeks ago I posted a blog with some photos I took along the shoreline of Lake Ontario in Kingston. (You can see them here) The lake was still covered in ice – enough, in fact, that people were out playing hockey and walking and ice-boating on the lake.

Today is Easter Sunday  – March 27.  It is a gorgeous sunny day. The ice is gone from all but a few corners of the lake. Folks are out with their kids and their dogs and cameras and even a couple of boats are in the water.  What a difference three weeks makes.

Here are some photos I took today, some of them from precisely where I took pictures of the ice on March 6.  I am happy today to be celebrating spring in Kingston.

KYC

Photo 1H

Fetch

 

JoggersTime 1SplashHarbourCity hallOntario St

Playing with friends

Remember when you were a kid and you used to pretend?  Cowboys and Indians (Native Americans)? Selling things from your “store”?  Or serving dinner with plastic veggies?

Well sixty years later I am still doing this.  Starting tonight, my Kings Town Players friends and I are dressing up and playing with each other and putting on a show for you.   I am having great fun playing the role of Charlie Aiken. Over the past few weeks,  I have gradually transfoimagermed myself into the dope-smoking, beer-swigging upholsterer from the southern U. S. A. who is caught up in one of the most dysfunctional families you can imagine.

August: Osage County is an award winning play that was made into a popular movie starring Meryl Streep and Julia Roberts last year.  I loved the movie but I think that the play has an intensity that can only be felt with live theatre.  We all can identify with the Weston family to some degree.  Are any of our families totally “normal”?  Or is this kind of dynamic more what “normal” is on some level?

Mattie Fay and Charlie Aiken in Kings Town Players production of August: Osage County

Mattie Fay and Charlie Aiken in Kings Town Players production of August: Osage County

There is a lot of very dark humour.  When we were rehearsing, I was almost embarrassed to laugh at some of the horrid things characters say to each other. The “ladies” are particularly foul-mouthed…and loving every moment of it.  We hope our audiences will relax and let go. You have permission to laugh out loud…in fact we are looking forward to hearing your guffaws.  Get ready for lots of startling moments as well.

The three-act play is also three hours long so come prepared to get your money’s worth.  You will feel like a voyeur, peeping through the windows of a family struggling with many demons.  Great live theatre.

We have worked hard to get this production ready. All we need now is an audience. Please join us for a dinner from hell.

August: Osage County runs Wednesday to Saturday from September 17 to 27 at the Rotunda Theatre, Theolological Hall, Queen’s University campus.  8 pm.  Tickets are $20 and available here ( http://www.kingstonboxoffice.com)or at the door.