Monthly Archives: July 2020

A few thoughts about planning for a fall/winter with COVID-19 in Ontario

This post is going to be a smorgasbord of thoughts, some directed at government and policy makers, some directed at business, some directed at health care professionals, and some directed at the public. Away we go….

  • Every community needs a cohesive plan of how community lab and diagnostic services will be offered to those who screen positive for COVID-19 (positive on questionnaire, not necessarily a positive test). Currently, our only options in many regions is to send these patients to the ER for diagnostic workup, or send them for a COVID-19 test and wait up to 48 hours for a negative test before we begin our workup. The former approach will overwhelm our ERs in the fall/winter. The latter approach will ultimately lead to unnecessary delays and likely increase morbidity and mortality. I’m not sure what the precise solution is, but part of this could include the government providing a “COVID-19 premium” to augment fees for diagnostics that are done on patients who screen positive. Depending on the geography, another option could include providing specific funding for designated facilities that commit to providing specific access to those who screen COVID-19 positive. There’s a fair degree of urgency to this one, and we’re actually fortunate it hasn’t had a significant impact on quality care already.
  • Along the same lines of access to community diagnostics, many hospitals have taken the approach to restrict ordering of diagnostic imaging to those with hospital privileges. Again, the ultimate consequence of this policy, in combination with a lack of community access to facilities for patients who screen positive, will simply be an overwhelmed ER. I leave this to the hospitals to decide how they want to manage their own resources, but I would simply emphasize to community physicians to not take risks with patients you are concerned about. If you can’t get the diagnostic test you need urgently, and the system isn’t responding, the ER is our only safeguard.
  • As hospitals work to restart specialist clinics and work through backlogs, I would hope that hospitals strongly encourage their specialists to sign onto eConsult as a means of decanting their waitlists further. Many family physicians will simply have a quick question that can be answered in seconds/minutes, without having the patient even step foot into the hospital. With the challenges that hospitals continue to face around the COVID-19 safety logistics of patient visits and volumes, this one is a no-brainer.
  • Do we have a plan for testing capacity in the days leading up to Thanksgiving, Christmas, New Year’s, Chanukkah, Rosh Hashanah, Yom Kippur, and many other holidays this coming fall/winter, when we know that individuals will understandably want to be tested prior to getting together with relatives? With our current policy of taking all comers who want a test, regardless of exposure or symptoms, we need to be prepared for this potential onslaught to our testing capacity. Our 25k per day in Ontario right now simply won’t cut it…
  • The federal government needs to continue to be strict at the border with ensuring that any traveller into Canada has a reliable plan for 14 days of quarantine, which needs to be in complete isolation from others in the house/dwelling who are not in quarantine. If the isolation cannot be guaranteed, the entire home must be confined to quarantine (this is not reliably happening now). We also need to ramp up in-person checks by quarantine officers, rather than strictly be over the phone as it is now. Lastly, it goes without saying, but our border needs to continue to be closed to non-essential travel. As the situations in our two countries continue to go in two opposite directions, the definition of what is currently accepted as “essential” must be seriously re-evaluated to minimize our risk.
  • Municipalities need a plan of how to keep our seniors physically active in the winter during a potential second wave, and we need to be creative. Telling frail seniors to go for walks in January is asking for trouble, and we can’t simply lock them away from October to March. Community centres, malls, arenas, pools, we need to think about all of our potentially-available large indoor spaces and how we can work to give seniors preferential access to these facilities while maintaining strict physical distancing and other precautions.
  • We know that our shelter and homeless populations will be extremely high-risk for COVID-19 transmission in the colder months, and municipalities need to continue their efforts to ensure that everyone is housed safely for the winter. As migrant workers were the obvious high-risk population in our summer months, it’s our homeless/shelter population in the fall/winter that we cannot afford to under-react to and play late catch-up. Get housing sorted out, ensure testing capacity is there, work with local agencies for trust-building and contact tracings, load the vulnerable with masks/santizer, etc.
  • The province and health units need to have a much more organized approach to distribution of influenza vaccines than they have in the past. We never know when exactly the supply is arriving, our initial supply is always far less than the demand for our high-risk patients, and this year we’ll have the additional complication of not being able to run flu shot clinics in busy offices due to distancing restrictions and IPAC protocols for cleaning. The province needs to be clear NOW what the situation is with influenza vaccine supply. Is it sufficient? What’s the timeline? Who is going to get the first batch of vaccine? Can we submit to the health unit the names and total numbers of patients who are in high-risk categories to ensure that we receive sufficient supply in October? Are pharmacies still going to be getting supply of influenza vaccine, even with a potential limited supply and the challenges that putting extra volumes of patients through an indoor facility will bring. We are in the early stages of planning in our office, but my tentative plan is to schedule a flu shot clinic for patients to remain in their vehicles in our parking lot and I will walk door to door administering vaccines. Those without vehicles will either be seen in the clinic or outside of our side door.
  • Businesses that are utilizing the outdoors right now for lines, services, etc., you need to be thinking of solutions for the fall/winter that don’t simply ignore physical distancing requirements. (I’m looking specifically at you, banks….)
  • Lastly, goes without saying, but a message to government: don’t open bars. Don’t even think about it.

We have a few months to plan for these predictable challenges, we can’t se the excuse of being caught off-guard by COVID-19 this time.