Dr. Carson’s 4th COVID-19 Update April 11, 2020 

















Dear Patients,  

This is our 4th COVID-19 email update for patients. We will also upload this info onto our website sportmednorth.com. I hope this email finds you and your families healthy and coping well during this pandemic.  Given how rapidly the information surrounding COVID-19 changes, and the rise of misinformation flooding the internet and social media, I wanted to provide you with trusted updates, and to remind you of the many resources available to assist you during this challenging time. Although many of the resources mentioned in our 3 prior email updates are still valid, some of the testing criteria or other advice has been replaced by newer information.  

Our local medical leadership has asked me: “Please encourage patients in your family practice to call in to your office with symptoms. The emergency department is seeing an overall decrease in volumes but an increase in advanced presentations of conditions including heart attacks and near-perforated appendicitis. The majority of our specialist colleagues’ practices remain open, so please refer. “ 

In April, many of our patients are celebrating one or more of Easter, Passover, Ramadan, Vaisakhi, Bengali and Tamil New Year. This year it is urgent to stay home and to do virtual gatherings with extended family members and friends for these important occasions.  Several online programs (such as Zoom) make this workable, even though it’s not the same as a real gathering to celebrate.  


With the shift toward working from home many people have been forced to redesign their daily schedule, living environment and mindset.  This can be a smooth transition for some while causing significant challenges to others.  To help ease the transition, here is a list of tips to consider: 

Make a schedule – attempt to maintain a soft schedule that maintains appropriate wake and bedtimes, in order to feel in control of your day, and stay productive. 

Take breaks – build breaks into your schedule, that are “screen-free”, in order to give your brain a chance to recharge and not become overly stimulated.  Do something that requires you to change your environment and your activity.  If you’ve been indoor and sedentary, step outside and get moving. 

Get dressed – it’s tempting to stay in your pyjamas or leisure wear all day but by getting dressed and ready for work in the same manner as you would if you were leaving the house, you are more apt to establish and maintain a productive mindset. 

Don’t get caught up in setting boundaries – life has changed, and we’ve had to adjust in so many areas of our lives. Trying to follow the same rhythm and parameters you had pre Covid-19, may cause unnecessary stress.  Try to loosen expectations and remember that we’re all in this together. 

Increase communication – there’s a lot we can communicate by visual interaction and when physical contact isn’t possible it’s important to find ways to maintain the flow of non-verbal messages.  There are several video chat platforms you can use to make sure you’re staying in touch and on track with the people you work with.  If not possible, then a phone call is still an important tool to maintaining communication. 

Be respectful – the pandemic has touched the lives of people in many ways.  Now, more than ever, it’s important to acknowledge the challenges that your co-workers may be experiencing, and simply asking how they are doing.  We all need to work together and provide support during these uncertain times. 

Avoid scams – with the transition from the office away from home to the home office, cybercrimes are on the rise.  It’s important to ensure that you do not share sensitive information or open attachments that can put your home or work networks at risk. 

For more information, check out the link: Working from Home During Covid-19  



For the past several weeks, I have kept you informed of the changing criteria surrounding testing for COVID-19.  As of April 6th, York Region has increased its testing, FOR RESIDENTS OF YORK REGION ONLY, and is encouraging ALL patients with respiratory symptoms to consider presenting to one of the COVID-19 Assessment Centres below, to be assessed for testing.  

Markham Stouffville Hospital 

Mackenzie Health, Richmond Hill 

Southlake Regional Health Centre, Newmarket 

If you are concerned about symptoms that may be related to coronavirus, please use the COVID-19 self-assessment tool from Public Health Ontario: COVID-19 self-assessment tool.  

This tool takes you through a series of questions and makes recommendations about next steps. If you are well or have mild respiratory symptoms, you likely do NOT need to see a doctor, but those with symptoms in York Region should still consider getting tested at an Assessment Centre. They still may decide to NOT test you if you go. 

If you do have any symptoms, you should otherwise stay at home and self-isolate! This will protect all of those around you, especially those who are at higher risk.  

If you are unsure about any symptoms you have, whether related to COVID-19 or not, please don’t hesitate to call our office with your concerns.  

Every Emergency Department is still open for business to assess and treat all conditions as they always have been. If you are unwell, particularly with severe symptoms associated with possible COVID-19 infection (shortness of breath, chest pain, confusion, lethargy, unwell), please do not avoid getting properly assessed in the ER.  

People who do not have symptoms should not seek testing. Physical / social distancing and proper handwashing are your best defense to avoiding illness and spreading the virus. 


  • STAY HOME and only go out if you need to pick up groceries, medications, or work for an essential service. 
  • PHYSICAL / SOCIAL DISTANCE yourself from others.  Remain at least 2m / 6 ft away from people outside your household at all times. 
  • WASH YOUR HANDS frequently using soap and water or alcohol-based hand sanitizer for at least 20 seconds. 
  • AVOID TOUCHING YOUR FACE (eyes, nose, mouth), as much as possible to prevent the virus from entering your body. 
  • Wear a homemade mask in public if you feel it is necessary (see mask topic below), or if you feel that it will protect others around you, and ensure that it fits snugly so you do not need to touch your face to make frequent adjustments. 
  • If you are not sick and not practicing self-isolation, it is still safe to go for a walk while maintaining a safe physical distance from others. 
  • If you are over 70, or have any chronic medical conditions (heart disease, lung disease, kidney disease, immunosuppression, diabetes, cancer, auto-immune disease, asthma) you are particularly susceptible to complications related to COVID-19. Please take extra care to stay safe by strictly following the suggestions above. 
  • Maintain connections with family and friends through the phone or video chats.  It’s important to keep in touch with others, check in on people who are vulnerable or in need, and offer support while maintaining physical distance. 
  • Avoid taking advice and listening to information from sources that are not credible.  If you cannot find the resources you require in the email updates I’ve sent, please call the office for assistance.  

York Region Public Health 

Public Health Ontario 

The Public Health Agency of Canada 

Here is the April 9th Statement from the Chief Public Health Officer of Canada on the release of national modelling on the COVID-19 epidemic in Canada. 


We have moved about 95% of our patient visits to virtual care. If you or your baby needs an injection, you likely will need to come in. However, you will be screened on the phone by our staff and will have your visit deferred if you have any respiratory symptoms. We do not have adequate PPE (Personal Protective Equipment) to see any more patients in the office for the next several weeks at least.  

However, our office is able to provide medical care for our patients for almost all of our usual office visit reasons. We have used several methods including OTN, Doxy.me, Zoom, FaceTime and the good old telephone. We aim for the most secure video conference, however if the video or audio is failing us then we will switch to another method. Our staff will give you an estimated time (usually early afternoon) and then they will call you just prior to the video conference with the doctor.  

Please note... We endeavour to alert you prior to each video conference regarding the nature of that type of visit. Here is what we will enter into each chart: 

Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary. 

Here is how the OMA suggests doctors explain this... 

COVID-19 is placing stress on Canada’s public health system. Our clinic is starting to offer virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using video and audio technologies for some patient visits rather than asking all patients to come into our office. Some of these technologies are provided by the Province. Others have been provided by vendors like Google, or Apple to help make discussions with your care provider as easy as possible during these difficult times. Some health concerns can be addressed with virtual care alone, but in some cases your doctor may ask you to visit a hospital or other health care facility if necessary, for a physical examination. 

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can: 

• Understand that this method of communication is not secure in the same way as a private appointment in an exam room. 

• Use a private computer/device (i.e., not an employer’s or third party’s computer/device) and a secure internet connection. For example, using a personal computer or tablet is more secure than at a library, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection. 

You should also understand that virtual care is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required). 

If you are concerned about using video or audio tools for virtual care, you can ask our office to arrange for you to visit a different healthcare provider or other health care center where you can be seen in person. However, please note that visiting a health care provider in person comes with a higher risk of coming into contact with COVID-19 and the possibility of spreading the virus. 

By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care.  


In addition, our staff has started making phone calls to patients I feel need to hear from us sooner rather than later.  These patients will receive a call from our office to set up a time for our staff to check-in and have a detailed conversation with you. Please be aware that since our staff may be calling from outside of our office, a private caller ID may show up on your phone’s display.  You will not be asked for any personal information such as credit card numbers or other banking information.  This is not a call from the doctor but it will determine your current condition and possible requirements. 


Recently, Canada’s Chief Public Health Officer, Dr. Theresa Tam recommended that, for people who are unable to practice physical distancing (more than 2m/6ft apart), a homemade mask or “having an additional covering and a barrier to prevent you from spreading droplets to others … is a reasonable thing to do.” 

Although at this point, all medical and surgical masks should be reserved for health care and front-line workers, a homemade mask can be an effective device if worn properly. Especially in a crowded grocery store, this may be a better option than wearing no face mask at all. For information on how to make, wear, remove and wash a homemade mask, go to: 


Homemade cloth masks will help prevent the wearer from expelling droplets when they sneeze or cough on other individuals but, similar to the N95 and surgical masks, they do not guarantee 100% protection from contracting the illness.  Currently, however, there is increased reason for individuals who do not have symptoms, or those who have mild symptoms, to use a protective barrier to avoid spreading the virus, while continuing to practice safe distancing and frequent hand washing. 

If you choose to wear a homemade mask, Canada’s Public Health Agency recommends that you: 

  • Wash your hands before putting it on and taking it off 
  • Ensure the mask does not gape 
  • Do not share it with others 
  • Avoid touching your face 
  • Change your mask immediately if it gets damp or soiled 


Sunshine Centres for Seniors - Friendly Chat Line - Keeping You Connected During COVID-19
The Sunshine Centre for Seniors launched a variety of services to keep you connected and active during this challenging time.  You can call the Sunshine Friendly Chatline if you’re feeling lonely or just want someone to chat with.  
647-847-9853, Monday to Friday, 9:00 a.m. – 3:00 p.m. 

Mosaic Home Care Services and Community Resource Centre: 905-597-7000, Monday – Friday, 10:00 a.m. to 4:30 p.m., located in York Region
Website: mosaichomecare.com, email: www.mosaichomecare.com 

211 Ontario: dial 2-1-1, website: 211ontario.ca, email: officeadmin@211ontario.ca
Ontario 211 is a free helpline that connects you to community and social services in your area 24 hours a day, 365 days a year, in over 150 languages. 
Toll-Free: 1-877-330-3213
TTY: 1-888-340-1001 

Community Crisis Response Service: provided by the York Support Services Network, for persons living in York Region and South Simcoe, who are having a mental health crisis, and their family or friends.  Call the toll-free number 
1-855-310-COPE (2673) or (TTY) 1-866-323-7785 to speak with a crisis worker. 

Toronto Seniors Crisis Line: 416-217-2077 

Additional Crisis Intervention Resources in York Region: 

Central Health Line - https://www.centralhealthline.ca/listServices.aspx?id=10110&region=YorkRegion 

York Hills – Mental health services for children from birth to 18 yrs old, and their families.  Located in Aurora.  905-503-9560, TYY: 1-866-536-7608, website: https://www.yorkhills.ca/  email: yorkhills@yorkhills.ca 

Public Health resources can be found at: https://www.centralhealthline.ca  

Chats – Community and Home Assistance to Seniors - https://www.chats.on.ca/ - for a list of seniors support services 


Some of these resources were listed in our March 25th email and others below are new. With the uncertainty and changes to our lives that most of us have had to endure recently, it’s not surprising that many people are finding it difficult to cope and get through each day.  There are many resources available to assist you in dealing with any new or existing mental health problems.   

Emotional Well-Being and Speaking with Kids About Covid-19 

Morneau Shepell, an industry leader in HR services, has provided webinars to help deal with individuals’ mental, physical, social and financial well-being, that is currently under increased pressure due to the COVID-19 pandemic.  Visit the link below to watch “Emotional well-being during the COVID-19 pandemic”, and “Talking to your child about Covid-19”.

Mental Health Commission of Canada - Self-care and resilience guide
The Mental Health Commission of Canada has developed a self-care and resilience guide titled “Mental Health First Aid”, for dealing with the mental and emotional effects of dealing with COVID-19. The guide includes wellness tips, a worksheet for you to indicate strategies for your plan, and many resources to assist those suffering from one or more of the wide range of mental health issues.  Provincial and territory specific resources available.

Anxiety Canada - self-help information and this website offers the Mindshift CBT app. I suggest this to many patients in the office and there is a link off our sportmednorth.com website. 
Headspace - offers free meditation for COVID-19 (see banner across the top of website) http://www.headspace.com 
Balance - (iOS App store) - Balance meditation app is offering a free one-year subscription. Email access@balanceapp.com for instructions 
Prana Breath App for Android - Calm & meditate. Free app for guided breathing 
Available on Google Play 

Calm App - Now offering free meditations, http://www.calm.com
Healthy Minds App - Training your mind is the key to your emotional well-being, also free   http://www.healthymindsapp.ca 
The Science of Well-Being - free 2-week massive open online course (MOOC) from Yale designed to teach you how to build healthy habits and increase your happiness  https://www.coursera.org 

BC clinical psychologist Dr. Catherine Costigan shares her suggestions for how health care providers can talk to their children about COVID-19. 
This link was originally directed to health care providers, but I think it is an excellent read for all parents of younger children. 
CAMH has a resource for coping with stress and anxiety during COVID-19 outbreak 

The American Psychological Association has excellent resources… 
In this podcast, the expert explains why we worry about new risks more than familiar ones, how to calm our anxiety and what are the psychological effects of being quarantined. 



for better mental health during this crisis consider daily...  

· Home exercise  

· Read online books...I get free books from the Markham Library online via the Libby app.  

· Video conference with family and friends  

· Don’t forget to optimize your sleep and nutrition 


...for home delivery and/or pick up orders. Be aware that you may wait longer than 1 week for delivery. 

Public Health officials recommend that each household attempt to limit grocery shopping to a maximum of once a week.  If you are unable to leave your home or are concerned about being unable to control physical distancing measures by visiting a grocery store or pharmacy, there are several services available to assist you. 

https://www.centralhealthline.ca/listServices.aspx?id=10933 - for a list of delivery services 

https://www.grocerygateway.com/store/groceryGateway/en - delivery service 

https://www.walmart.ca/en/online-grocery-shopping-pickup - delivery service 





For people in need of grocery delivery and additional assistance, you can contact the Good Neighbour Project, servicing Toronto, and surrounding GTA regions of York, Durham, Halton and Peel. (see below) 





This is one of the most difficult conversations. People who are at a higher risk of becoming ill, and especially those who are currently sick, should take the time to determine what their wishes are for treatment, care and how to handle their affairs if they are no longer able to make decisions.  It is especially important for people with terminal illness and in a palliative setting to make their wishes known about decisions such as transfer from home to hospital / ICU, methods of treatment provided, duration of critical care support and administering of life support, CPR, and mechanical respiration. 

One resource available to you can be found on the Speak Up Canada website.  


You can use the online interactive workbooks to view information that will help to guide you through the process, and it will allow you to share this information with others.  The workbook and guide allow you to record information about important documents, who your decision makers are, indicate your wishes, and other personal directives.  

At this time, it has become increasingly important for people to have the sensitive conversations around treatment options and advanced care planning.  Health care workers dealing with COVID-19 are under mounting pressure to provide appropriate respiratory care to a growing number of patients in need of ventilators and mechanical breathing devices and require as much direction as possible regarding your wishes for treatment.  


The Centre for Disease Control has developed a list of products you can use to help kill a coronavirus.  These products include: 

Rubbing Alcohol (70% concentration).  They suggest that you clean the surface first with soap and water, then allow the rubbing alcohol to sit for at least 30 seconds before wiping clean. 

Bleach - 4 tablespoons to 4 cups of water.  Test the surface first to make sure it doesn’t damage or discolour it and wear gloves to protect your hands.  Use caution to protect your eyes, skin, clothing, from damage and/or discolouration, and keep the area well-ventilated. 

Soap & Water – soapy water is still a reliable method to kill the virus, which is why you are being asked to practice frequent hand washing to avoid getting ill or spreading the virus. 

Hydrogen Peroxide – (3% concentration).  There’s no need to dilute the solution but you should allow it to sit on the surface being cleaned for at least one minute before wiping clean.  Use caution on surfaces and around materials that may become damaged or discoloured upon contact with the solution.  


In a time when our lives might feel a bit out of control, the act of giving back can help us to regain a sense of purpose, while helping people in need. By volunteering your time and effort you can strengthen ties to your community, learn new skills, meet other people, lessen the burden of work and stress on the people you’re helping, and improve your mindset by making the world an easier place to live in during these difficult times.  

Volunteer Ideas & Opportunities  

- Donate to food banks  

- Help family members and neighbours by offering to pick up groceries, medications and other essential items  

- Check in daily or often with family and neighbours who need assistance  

- Donate blood  

- Support health care workers with groceries, take out, offer to look after children, pets, or walk a dog, donate to health organizations and credible charities and funds  

- Support local businesses: restaurant take out, gift cards, on-line merchandise  

Do you have extra PPE? 

Until our health care facilities are assured of their supply of masks, gowns, goggles and face shields, you will have an opportunity to donate any extra supplies you may have... 



Health Workforce Matching Portal  

The Province of Ontario has developed the Health Workforce Matching Portal, which helps match individuals and organizations with experience in the healthcare sector, to various positions and great opportunities to help and/or increase work hours. People who are part-time, former or retired healthcare workers, or who have inactive status with their regulatory college are encouraged to apply on-line at: https://healthcloudtrialmaster-15a4d-17117fe91a8.force.com/matchingportal/s/?language=en_US


Dr. Carson sincerely thanks: 

All our patients, who entrust us with your health care, especially during this crisis 

All our staff, who have adjusted well to the changing needs and expectations 

Carolyn Smith - who you may have met in our office on a Thursday evening. Carolyn was largely responsible for putting this extensive email together. THANKS!