March 19, 2020 


Dear Patients, 


This is my 2nd COVID-19 update.

I will give you important updates that you will not see on the news or easily on social media. Be aware that prudent and careful behaviour will be necessary for many weeks. This public health crisis is “a Marathon and not a Sprint.” 


BONUS CONTENT:

Since I sent the email on March 19th, I have received this excellent link from CAMH re coping...


http://www.camh.ca/covid19?fbclid=IwAR2yWpPt8FDcaLyrtrLe5p3OQ18-xfzZmP3p2je6ZNRVLDhLh8ZJNQ3LPhs

OUR OFFICE 
Our office staff have been strong, resolute and reassuring. They have helped keep less ill patients away from the more urgent care facilities where health care personnel and crucial resources are most necessary. 

We are seeing only well patients in the office who need something urgently, for example an injection. 

We are having virtual office visits with many more patients each day. This is usually done by video conference, with Facetime and regular phone call as a backup. We may not be able to video conference with you for a few hours after you request this. 

If you want to video conference with Dr. Carson, please call between 9 am and noon. Our staff will give you some verbal consent for video conferencing info. The fine print at the end of this file gives the (very minimal) security concerns for video conferencing. 

There is a chance that we will answer our phones in the afternoon but best to call us in the morning. 

Our phone message will give you the name and contact info for our doctor on call after 5 pm until 8 pm. They will be doing phone screening also and will not see patients with upper respiratory illness in their offices. 

It is better to email us at drjamescarson@gmail.com because you are unable leave us a voicemail. 

If you need a prescription repeat, just have your pharmacy fax us (905-477-0065). During this crisis we will waive extra service fees. 

If you recently had a test and we would typically recall you for a results discussion, we will do that either with a virtual visit or with a real office visit once the crisis is over. 

If you are ill, we are likely much faster giving you information than any of the Public Health or Telehealth phone lines which are swamped.  

OUR COMMUNITY 
Here is a summary of info you need to know: 

Not every runny nose is COVID-19. If that is all you have, you will not get tested.  

Do NOT go to the hospital or assessment centre if you have no symptoms. 

Do NOT come to our office if you have any illness symptoms. 

Do you... “KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19?” Check out this graphic... 




















A better version can be viewed at...
​https://www.canada.ca/en/public-health/services/publications/diseases-conditions/self-monitoring-self-isolation-isolation-for-covid-19.html


If you have Mild symptoms, we advise you to self-isolate and monitor for worsening of symptoms. 

If you have Severe symptoms, such as increased shortness of breath, lethargy or chest pain then go to the Hospital Emergency Department, not to the Assessment Centre. 

We will advise you to go to an assessment centre if you have mild to moderate symptoms of fever and/or respiratory symptoms PLUS one of 

- underlying health condition (diabetes, heart/lung disease, cancer)* 

- age > 60* 

- health care worker 

- vulnerable population 

* For elderly patients and those with chronic illnesses, we will use our clinical judgement. If mild symptoms then you may be better to stay home and monitor with instructions on what to do if symptoms worsen. 

If you prefer this in a chart, check out this pdf... 













Note that these graphics cut off at the bottom...the better versions are in my email sent to patients on March 19, 2020. I do not have a link for this one.


The Markham Covid-19 assessment centre opened on March 18, 2020. It is a walk-in centre. No referral is needed. Patients go to a tent first that’s heated and get triaged by a nurse. Many people won’t get past that stage and are sent home. Others get triaged to the centre or the ER.  

Location: South side of Markham Stouffville Hospital 

Hours: 10 AM to 8 PM 

Website: 

https://www.msh.on.ca/about-us/covid-19-information-page#assessment 

Other nearby assessment centres:  

Mackenzie Health requires referral. More information and physician referral form can be found at  

https://www.mackenziehealth.ca/en/about-us/get-the-latest-information-on-covid-19.aspx

Scarborough Health Network – Birchmount Hospital, that is self-referral with an online preregistration form.  

https://www.shn.ca/covid19-assess/ 

If you need to go but these 3 locations are not convenient for you, then this website lists all the centres in Ontario. 

https://public.tableau.com/profile/oma.era#!/vizhome/COVID19_15840305246840/COVIDAssessmentSitesandPHUs?publish=yes 
 
WHO SHOULD BE SENT TO AN ASSESSMENT CENTRE? 

There is a fundamental shift in who are being testing, with more focus on 2 priority groups  

1) those at risk of spreading disease into vulnerable populations (patients/workers in healthcare settings, shelters, prisons & other vulnerable social populations) and  

2) those at risk of severe illness (elderly, chronic diseases). Note travel is not a criteria for sending a patient to an assessment centre. It is still a question the assessment centre will ask for case finding. 

For all other patients with mild respiratory illness, they should self-isolate until completely symptom free for 48 hours. Guide for self-isolation for patients and caregiver/household members is available on the public health website at:  

https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources

Not everyone sent to the assessment centre gets swabbed. Even if they appear to meet criteria. Turnaround time is currently around 5 days for swab result.  

Click on this link to obtain visualizations of date and charts explaining the impact of the COVID-19 infection to the public: 

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/?fbclid=IwAR29-4_ABwLIEpOF_WEjL3adDqOIh8ikG7HWf2hQDKzPw94bipPNXVUV_z8 

Click on link for advice for people that have traveled outside of Canada in the past 14 days: 

https://drive.google.com/file/d/1-y7WJw6Ffk1D7hJj7CJngXaMSpuKikpC/view 

Our last bulletin was high on reassurance and we remain that way. Let’s “flatten the curve” so that fewer Canadians get this virus and fewer Canadians get serious illness or die. Social distancing is key. Remember, cough into your elbow area or tissue. Frequent hand washing is your best defence.  

​​​ ↑​ SPORT MED NORTH 

EXPERT SPORT MEDICINE CARE