​​​ ↑​ SPORT MED NORTH 

EXPERT SPORT MEDICINE CARE


Appendix B

How to Self-Monitor / Self-isolate – Stream 1

You have NOT been tested for COVID-19 due to low risk.

Continue to Monitor for Symptoms as outlined below

If you are ALREADY on self-isolation continue to self-isolate as outlined below.

Please contact York Region Public Health with any questions at: 1-877-464-9675

What does self-monitor symptoms entail?
Monitor for the following symptoms for 14 days after exposure

·       Fever

·       Chills and sweats

·       Cough

·       Difficulty breathing

·       Muscle aches or tiredness

·       Sore throat

Limit contact with others

·       Avoid crowded public spaces and places where you cannot easily separate yourself from others if you become ill.

·       Avoid large gatherings.

·       Avoid contact with vulnerable persons, especially older persons with chronic medical conditions

·       Avoid contact with people who live in health care facilities/congregate living settings (e.g., long-term care homes, retirement homes, shelters, hospitals, jails).

Clean your hands

·       Clean your hands often with soap and water for at least 15 seconds. Dry your hands with a paper towel, or with your own cloth towel that no one else shares.

·       Use alcohol-based hand sanitizer if your hands are not visibly dirty.

·       Avoid touching your eyes, nose, and mouth with unclean hands.

If you develop any of the following symptoms self-isolate as outlined below

·       Fever, cough, shortness of breath, sore throat, muscle aches, runny nose, chills and sweats

·       Self-Isolate immediately and contact Telehealth at 1-866-797-0000 or your health care provider

What does self-isolation entail?
Stay home

·       Do not use public transportation, taxis or rideshares.

·       Do not go to work, school or other public places.

Limit the number of visitors in your home

·       Only have visitors who you must see and keep the visits short.

·       Keep away from seniors and people with chronic medical conditions (e.g., diabetes, lung problems, immune deficiency).

Avoid contact with others

·       Stay in a separate room away from other people in your home as much as possible and use a separate bathroom if you have one.

·       Make sure that shared rooms have good airflow (e.g. open windows).

·       Avoid sharing with others any personal items that can come into contact with saliva, such as toothbrushes, eating utensils, cups/bottles, towels, and bedding

Keep distance

·       If you are in a room with other people, keep a distance of at least two metres and wear a mask that covers your nose and mouth.

·       If you cannot wear a mask, people should wear a mask when they are in the same room as you.

Cover your coughs and sneezes

·       Cover your mouth and nose with a tissue when you cough or sneeze.

·       Cough or sneeze into your upper sleeve or elbow, not your hand.

·       Throw used tissues in a lined wastebasket, and wash your hands. Lining the wastebasket with a plastic bag makes waste disposal easier and safer.

·       After emptying the wastebasket wash your hands.

Wash your hands

·       Wash your hands often with soap and water. Be thorough: wash for at least 15 seconds and include between your fingers, under your fingernails and wrists.

·       Dry your hands with a paper towel, or with your own cloth towel that no one else shares.

·       Use an alcohol-based hand sanitizer if soap and water are not available.

Wear a mask over your nose and mouth

·       Wear a mask if you must leave your house to see a health care provider.

·       Wear a mask when you are within two metres of other people.

·       If the mask becomes wet or dirty with secretions, change the mask immediately

·       Wash your hands after removing the dirty mask and before putting on the clean mask

Visit York.ca/covid19 or Ontario.ca/coronavirus for more information.

 ================================================================


Appendix C

How to Self-isolate – Stream 2

You have NOT been tested for COVID-19 due to low risk.

You are required to self-isolate due to your respiratory illness for 7-days minimum and 48 hours of full symptom resolution

Please contact York Region Public Health with any questions at: 1-877-464-9675

What does self-isolation entail?
Stay home

·      Do not use public transportation, taxis or rideshares.

·      Do not go to work, school or other public places.

Limit the number of visitors in your home

·      Only have visitors who you must see and keep the visits short.

·      Keep away from seniors and people with chronic medical conditions (e.g., diabetes, lung problems, immune deficiency).

Avoid contact with others

·      Stay in a separate room away from other people in your home as much as possible and use a separate bathroom if you have one.

·      Make sure that shared rooms have good airflow (e.g. open windows).

·      Avoid sharing with others any personal items that can come into contact with saliva, such as toothbrushes, eating utensils, cups/bottles, towels, and bedding

Keep distance

·      If you are in a room with other people, keep a distance of at least two metres and wear a mask that covers your nose and mouth.

·      If you cannot wear a mask, people should wear a mask when they are in the same room as you.

Cover your coughs and sneezes

·      Cover your mouth and nose with a tissue when you cough or sneeze.

·      Cough or sneeze into your upper sleeve or elbow, not your hand.

·      Throw used tissues in a lined wastebasket, and wash your hands. Lining the wastebasket with a plastic bag makes waste disposal easier and safer.

·      After emptying the wastebasket wash your hands.

Wash your hands

·      Wash your hands often with soap and water. Be thorough: wash for at least 15 seconds and include between your fingers, under your fingernails and wrists.

·      Dry your hands with a paper towel, or with your own cloth towel that no one else shares.

·      Use an alcohol-based hand sanitizer if soap and water are not available.

Wear a mask over your nose and mouth

·      Wear a mask if you must leave your house to see a health care provider.

·      Wear a mask when you are within two metres of other people.

·      If the mask becomes wet or dirty with secretions, change the mask immediately

·      Wash your hands after removing the dirty mask and before putting on the clean mask

Visit York.ca/covid19 or Ontario.ca/coronavirus for more information.

 

March 25, 2020 Dr. Carson's COVID-19 Update #3

Dear patients,

As the Covid-19 virus continues to present a serious health threat to all of us, and especially to our vulnerable populations, it is my priority to make sure that you are kept well-informed with the most reliable and up-to-date information. This info is not necessarily easy to access on the news or social media. We are trying hard to keep this email brief and include only new items not featured in our previous 2 emails. We also are posting these on sportmednorth.com

We realize that only 70% of our patients have opened our email updates #1 & #2. If you have a family member or friend who is also our patient, please ask them if they have received our emails recently. If they did not, please ask them to check their email TRASH or junk mail. Let us know if you want your email address updated in our records.


Since last week... What Has Not Changed?

1.    The urgency to "Flatten the Curve", thereby reducing the number of people who will get sick. Not doing this will overwhelm our hospital’s ability to look after those who are ill.

2.    The importance of Social Distancing, and staying home

3.    Proper and frequent hand-washing

4.    Self-Monitoring & Self-Isolation (see below)

5.    Reminder to remain calm, prudent and cautious.  We will get through this difficult time.


Since last week... What Has Changed?

1.    We have started locking our office front door. We have so few patients and others visiting now, so we want to ensure that any visitor gets adequately screened for illness before entering. If our staff is away from the reception desk, we do not want someone just walking in, not having been screened. So if you do come to the office be sure to call first just prior to arrival.

2.    The virus spread is no longer simply related to travel from outside Canada. It is now spreading in our communities from personal contact with others who are infected. Some of my video conferences with patients have revealed that there are COVID-19 cases that just resulted from acting irresponsibly.

3.    Covid-19 Assessment Centre testing criteria changed last Friday. (see below)

4.    Local Markham and area doctors’ virtual town hall Tuesday evening has led to a better understanding of recent changes in public health COVID-19 screening policies.

5.    Local hospital outpatient clinics have cancelled non-essential visits. If your clinic appointment has been cancelled and you feel worse, then contact the clinic and if you cannot get through, call our office.

6.    In normal times, most people wait 3 months until they can be covered by OHIP. The new OHIP waiting period waiver covers all uninsured people.


Mental Health Resources

Many of us have become stressed, anxious and fearful about what the future holds. Many people may find their resilience waning because we are watching too many scary TV reports. Thus it is excellent that we now have increased availability for free online mental health & wellness resources. Here are some very valuable online tools to help you through this challenging time.

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.
http://www.anxietycanada.ca

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
http://www.balanceapp.com

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
Here is their free resource page...
https://www.calm.com/blog/take-a-deep-breath?utm_source=lifecycle&utm_medium=email&utm_campaign=difficult_times_subs_031720

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



MORE...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.

https://boldly.joulecma.ca/home/how-to-talk-to-your-kids-about-covid-19?utm_source=member-comm-240320&utm_medium=email&utm_campaign=covid19&utm_content=boldy-talking-to-kids-en

CAMH has a resource for coping with stress and anxiety during COVID-19 outbreak
http://www.camh.ca/covid19?fbclid=IwAR2yWpPt8FDcaLyrtrLe5p3OQ18-xfzZmP3p2je6ZNRVLDhLh8ZJNQ3LPhs

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.
https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety
News reports about COVID-19 are making some people anxious. Here are some tips to help you manage your anxiety, put news reports in perspective and maintain a positive outlook.
https://www.apa.org/helpcenter/pandemics

MORE...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


COVID-19 Assessment Centres –      Updated screening criteria


People who have symptoms that are deemed to be severe (increased shortness of breath, lethargy, drowsy, weak, dizzy, chest pain) should go directly to Emergency. The assessment centres are NOT for anyone suffering those severe symptoms.  If your symptoms remain mild to moderate you are recommended to ISOLATE yourself at home for 14 days.

The criteria for testing changed last Friday. (for graphic, see Appendix A below) Assessment centres will now only test for the COVID-19 virus on people with mild to moderate symptoms who work or reside in places where there are sick or vulnerable populations. Only go to the centre for testing if you have mild to moderate symptoms and you work at:

·      Complex Care/Rehab

·      Long-term care

·      Acute Care Hospital

·      Paramedics

·      Dialysis Centre

·      Retirement home

·      School or childcare center

·      Prison

·      Shelter/group home

·      Other congregate setting

·      Other vulnerable sector population

·      Or sent there by either Public health or the Emergency Department.

Who should not seek COVID-19 testing?

·      People who do not have symptoms, or have mild to moderate symptoms (and do not work or reside at one of the list above), or have traveled outside of Canada within the last 14 days, and thus have been told to self-isolate, should remain at home and self-monitor for worsening symptoms. To get info in other languages or to make use of the Ontario government's COVID-19 self-assessment tool, use this link:

·      https://www.ontario.ca/page/2019-novel-coronavirus



COVID-19 Facts & Updates
The information that has been released to medical professionals and health care workers has changed, as top health experts learn more about this novel virus.  We now know that this virus starts like any mild cold in the upper airways and throat.

This website was designed by the OMA (Ontario Medical Association) to counter much of the misinformation about COVID-19 online.
 www.virusfacts.ca


Self-Monitoring and Self-Isolating...see Appendix B & C below

Public Health Ontario has excellent resources which are frequently updated...
 https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources

Here is the latest from the local Public Health Department.
https://www.york.ca/COVID-19

Social Distancing
It is understandable for the public to wonder what to do. Thankfully, anyone can help fight the spread simply by Social Distancing, and avoid becoming ill, or transmitting the virus. If you're not sure how to properly social distance or why it's so important, visit the website below:
 https://www.virusfacts.ca/#social-distancing

and if that’s not enough…

The website getpocket.com has curated the best guides to managing life amid the disruptions, from coping with isolation and shopping for groceries to convincing skeptical friends to stay home and caring for sick loved ones.
https://blog.getpocket.com/2020/03/life-during-a-pandemic-adjusting-to-a-new-normal/?utm_source=pocket-newtab


I hope the above information and resources help all our patients during these uncertain times.  If you require further information or advice, please call our office at 905-477-0027, or e-mail drjamescarson@gmail.com.


APPENDIX A