Dr. Carson’s March 13, 2020 added COVID-19 reading/info for patients

Dear patients,

This situation and the advice available are fluid and may change over the next few days and weeks. Thus this information is current, today March 13th. I will attempt to disseminate more info as the need arises over the coming weeks.

LET’S START WITH GRATITUDE

If you are like me and you love to watch sports on TV, you now have more time to read this very long file thoroughly ;-(

I am uncertain whether the reunion and celebration for the 40th anniversary of my medical school graduation will actually take place at the end of May. Regardless, like many of my classmates, I believe that one of my greatest gifts received is the opportunity to teach young doctors. Over my 4 decades in family medicine practice, I have thanked my patients and my staff on many occasions, in our bulletins and in person, for allowing me to teach young doctors. I try early in our time together with a learner to impart a philosophy about family medicine that you can easily find online. It looks like this…

The Four Principles of Family Medicine

1.    The family physician is a skilled clinician. ...

2.    Family medicine is a community-based discipline. ...

3.    The family physician is a resource to a defined practice population. ...

4.    The patient-physician relationship is central to the role of the family physician.

Therefore in a pandemic scenario, there is much that I can do for you, my patients. It is in the essence of the number 3 item above (resource to a defined practice population) that I send this email to you. Much of the social media response is hyping people up and scaring them. Thus I want to assure you that being prudent and cautious is wise but panic is unwise.

HOW IS THIS ILLNESS SPREAD?

Viruses like this are spread through droplets, which can be inhaled or get into your system from your hands touching your face. The virus does not last for more than a few hours on a surface such as a washroom door handle.  Washing hands and/or using hand sanitizer helps hugely. Wearing face masks in public does not! Those who wear these are touching their face more often to adjust the mask or take it off. Medical personnel need masks, especially since if there are a large number of cases, any health care worker who gets ill is no longer available to deal with the surge of ill patients. If you were destined to become infectious, it takes a few days of what is called an incubation period. You are not contagious from first contact with an ill person, but only some time later.  If a person is a contact but not having any symptoms, it is very unlikely that you will catch it from them.

THIS PAST WEEK

As you know, everything changed this week.  By last weekend, we knew already that much of Italy was in “lock down mode”  - but “out of sight, out of mind” - Italy is so far away. I became a little unnerved walking through Costco last weekend and finding no toilet paper for sale! Personally, I love to watch the Raptors. I started this week late Monday evening watching TV, enjoying the Raptors winning a close game against the Utah Jazz. Little did any of us know that during that game the entire Raptors team became contacts of the Coronavirus (Covid-19) because of an opponent who has since tested positive.  Could you imagine the entire Raptors team is now in self-quarantine? In just a few days all the NBA, NHL, the Juno Awards, March Madness, PGA (OMG no golf on TV!!!) etc. have been put on hold. March break for students has been extended and schools will not reopen for weeks. The Prime Minister’s wife has tested positive and the Prime Minister is in self-quarantine. I had an idea to send an email to patients a few days ago, however I decided that a message to NOT PANIC, sometimes is interpreted in the opposite manner.

Thus I waited until I had more clarification upon some essential information that will be useful for my patients. I started collecting some articles and thoughts on the COVID-19 earlier this week. This info can be seen below. I have shared this collection with a few of my patients and some of my family members who needed reassurance. They were concerned about many print and broadcast media stories and social media items, which were NOT reassuring. Speaking with patients who requested more info has made me decide that my info should now be disseminated in a mass email to patients.

VIDEO CONFERENCING

Since Wednesday, our office started video conferencing with our patients who needed advice but who were either ill (not necessarily suspected COVID-19) or unable to come in.  We are having about 75% success with the Ontario Telehealth Network (OTN) secure video call setup. It is almost like an office visit and patients have been quite satisfied. For the 25% for whom we had technical issues, I just spoke to them on the phone. Phoning was all I was able to do for ill patients during the SARS crisis in 2003. FYI, during that time some of our patients did become ill and we all got through it together. If you are ill and want to video conference with me, just call our office (Monday).

POLICY CHANGES

We have decided to use an abundance of caution. It is imperative that patients understand a few office policy changes. I am wearing the N95 mask with every patient now.  Like all my medical colleagues, I cannot serve you if I am either ill or in self-quarantine for 2 weeks. Similarly, if my staff becomes ill, I cannot serve you effectively. Our office staff is now screening via phone whether anyone coming here has a cold, cough, fever or runny nose. We are doing this for booking new appointments by phone plus if you have already booked an appointment. If you answer yes, a video conference is preferable. When you come to our office door, signs reinforce that policy.  We are happy to advise you, just maybe by other means than an in-office visit if you are ill.  Please do not just drop in without calling us first.

*** If you booked your upcoming appointment for a different reason but are now ill, call us…DO NOT COME HERE IF YOU ARE ILL without informing us by phone first! We must decrease any chance of a suspected COVID-19 case presenting in our office.

COVID-19 TESTING CENTRES

Similarly, patients who do get mild virus symptoms should not go to the emergency department or any of the COVID-19 assessment centres due to open Monday March 16th.  WHY? Because if you do not have the COVID-19 when you walk in, you may become infected there with the COVID-19 before you walk out. NOBODY SHOULD EXPECT OR DEMAND A COVID-19 TEST IF THEY HAVE NO SYMPTOMS. STAY AWAY! My colleagues tell me that there is a centre already open in Brampton and one patient has gone to a centre at North York General, which appears to be open already. I read that there is one open on Coxwell near the Danforth at the Michael Garron (TEGH) Hospital. The 2 centres closer to our office, that we know will open Monday the 16th, will be at MacKenzie Health in Richmond Hill and at the Birchmount Campus of the Scarborough Hospital (the old Scarborough Grace). The hours will be 9 am – 6 pm. However they will NOT BE WALK-IN! You must phone the public health department first. If you live in York Region, call Public Health at 1-800-361-5653 first! Expect there to be a wait both on the phone and at the centre. The Toronto Public Health number is 416-338-7600 during business hours (Mon-Fri) 8:30 am to 4:30 PM. Or call 3-1-1 after hours.

SHOULD YOU STAY HOME?

YES! If you have mild symptoms, ride out the virus at home. However, if you are a senior or have a chronic disease such as lung, liver or kidney disease, or any compromise to your immune system, you are at greater risk of worse disease from this virus. If you experience severe difficulty breathing, definitely go to your nearest emergency department.

MARCH BREAK / TRAVEL

Today (March 13th) is the start of March Break, Earlier today, Toronto’s Medical Officer of Health strongly encouraged everyone arriving in Toronto from any country, including the USA, to self-isolate for 14 days upon your return. Take that into consideration before departing Canada.  None of this will end quickly. It may not peak for a few weeks and may last until late May or even June. Cruise ships are a particular worry and I think that many cruises have been or will be cancelled soon.

HERE IS MY COLLECTION OF WORDS AND LINKS…

This first item is now several days old but rings true to me still. I heard this man interviewed yesterday on CBC Radio. These are wise words from Toronto’s University Health Network Infectious Disease specialist Dr. Sharkawy on COVID-19:

“I'm a doctor and an Infectious Diseases Specialist. I've been at this for more than 20 years seeing sick patients on a daily basis. I have worked in inner city hospitals and in the poorest slums of Africa. HIV-AIDS, Hepatitis, TB, SARS, Measles, Shingles, Whooping cough, Diphtheria...there is little I haven't been exposed to in my profession. And with notable exception of SARS, very little has left me feeling vulnerable, overwhelmed or downright scared.

I am not scared of Covid-19. I am concerned about the implications of a novel infectious agent that has spread the world over and continues to find new footholds in different soil. I am rightly concerned for the welfare of those who are elderly, in frail health or disenfranchised who stand to suffer mostly, and disproportionately, at the hands of this new scourge. But I am not scared of Covid-19.

What I am scared about is the loss of reason and wave of fear that has induced the masses of society into a spellbinding spiral of panic, stockpiling obscene quantities of anything that could fill a bomb shelter adequately in a post-apocalyptic world. I am scared of the N95 masks that are stolen from hospitals and urgent care clinics where they are actually needed for front line healthcare providers and instead are being donned in airports, malls, and coffee lounges, perpetuating even more fear and suspicion of others. I am scared that our hospitals will be overwhelmed with anyone who thinks they " probably don't have it but may as well get checked out no matter what because you just never know..." and those with heart failure, emphysema, pneumonia and strokes will pay the price for overfilled ER waiting rooms with only so many doctors and nurses to assess.

I am scared that travel restrictions will become so far reaching that weddings will be canceled, graduations missed and family reunions will not materialize. And well, even that big party called the Olympic Games...that could be kyboshed too. Can you even
imagine?

I'm scared those same epidemic fears will limit trade, harm partnerships in multiple sectors, business and otherwise and ultimately culminate in a global recession.

But mostly, I'm scared about what message we are telling our kids when faced with a threat. Instead of reason, rationality, open mindedness and altruism, we are telling them to panic, be fearful, suspicious, reactionary and self-interested.

Covid-19 is nowhere near over. It will be coming to a city, a hospital, a friend, even a family member near you at some point. Expect it. Stop waiting to be surprised further. The fact is the virus itself will not likely do much harm when it arrives. But our own behaviors and "fight for yourself above all else" attitude could prove disastrous.

I implore you all. Temper fear with reason, panic with patience and uncertainty with education. We have an opportunity to learn a great deal about health hygiene and limiting the spread of innumerable transmissible diseases in our society. Let's meet this challenge together in the best spirit of compassion for others, patience, and above all, an unfailing effort to seek truth, facts and knowledge as opposed to conjecture, speculation and catastrophizing.

Facts not fear. Clean hands. Open hearts.
Our children will thank us for it.”

#washurhands #geturflushot #respect #patiencenotpanic


 More excellent links...

https://www.theatlantic.com/health/archive/2020/03/coronavirus-what-you-can-do-help-slow-outbreak/607369/

https://www.theguardian.com/world/2020/mar/07/coronavirus-reasons-to-be-reassured

https://www.vox.com/2020/3/10/21171481/coronavirus-us-cases-quarantine-cancellation

There is lots of good info on the York website. Check out…

https://www.york.ca/wps/portal/yorkhome/health/yr/infectiousdiseasesandprevention/covid19/covid19

Yet some info is a bit dated as there are clearly some cases now where recent travel was not a factor. Our public Health department states…

If a resident should develop symptoms of COVID-19 they must immediately remove themselves from group settings, contact Health Connection at 1-800-361-5653 and self-isolate at home for 14 days.

If you feel extremely anxious check out one of my favourite websites…


Anxietycanada.com

Download their app and use it!

IN CLOSING...
Give us feedback on this email’s content....    drjamescarson@gmail.com

If you need advice you are welcome to call. We open again Monday at 9 am. However, if you do not have an urgent concern or need to discuss an appointment, please be mindful that our staff could get overwhelmed with too many simple inquiry phone calls.

Let’s all get past this crisis together. Be prudent and cautious but do not panic. Wash your hands!

EXPERT SPORT MEDICINE CARE

​​​ ↑​ SPORT MED NORTH