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