Most of the focus during the COVID19 pandemic has been on frontline workers in hospitals, coping with the flood of patients exhibiting severe symptoms of novel coronavirus infection.
Family physicians and health teams are also facing challenges in the midst of the pandemic, and have an important message for their patients: “The rest of medicine continues.”
The Bradford West Gwillimbury Family Health Centre at 100 Holland Court is “definitely open,” says office manager Paula Big Canoe, although the doors are shut.
The Health Centre has worked out a new safety procedure to cope with the pandemic, that so far is “working well.”
Most medical consultations begin with a virtual assessment, online or by phone. “Anybody that does need to come in calls us,” Big Canoe said, making an appointment.
When the patient arrives in the parking lot, they are asked to stay in their car and call in, advising of their presence, then wait in the vehicle while their health care provider prepares.
The patient will then be told to go to the door – where he or she will be greeted by the care provider wearing personal protective equipment. Only one physician is on site at any one time, available for urgent cases; there is no contact with administrative staff or need to ‘swipe’ a health card.
The patient comes in, is examined, and is then escorted out by the provider.
“People are being taken care of,” Big Canoe said.
Dr. Susan Kuzmyk is one of a team of six physicians, one nurse practitioner, two nurses, a social worker providing phone support, a pharmacist and a dietitian who are working out the Family Health Centre. The important message, Dr. Kuzmyk said, is that “we are definitely able to see our patients. The rest of medicine continues.”
Dr. Kuzmyk has practiced family medicine for over 30 years. She was a physician during the SARS epidemic – but noted, “It was nothing like this. You knew who the SARS patients were. They were so sick.”
It made isolation, tracing the spread and curbing the virus relatively straight-forward.
SARS-CoV-2, the novel coronavirus that causes COVID-19, is a different story. A significant percentage of those infected with the virus will have no symptoms or very slight symptoms, but may still spread the disease.
Only wholesale testing can identify those individuals, and “there’s just no way of testing everyone,” Dr. Kuzmyk noted, since there are not enough tests, testing facilities, or labs to do the work.
Under the circumstances, she has a message for residents and patients alike: the best way to break the chain of transmission to “stay home as much as possible, wash your hands and adhere to physical distancing guidelines,” as issued by Canada’s Chief Public Health Officer.
“Everyone needs to assume they have it, and act accordingly,” said Dr. Kuzmyk. “Stay away from people, stay home, act like you have the virus… for the common good.”
And that includes staying out of parks and away from trails, where there’s just no way to guarantee safety.
“Let’s do the most conservative thing possible. It may be overcautious, but… the price of not being overcautious is far too great,” she said.
Dr. Kuzmyk took a cautious approach as soon as the potential scope of the pandemic became apparent. On the weekend of March 15, she put a sign on her office door that read: “We are open. We are here. It is business as usual. We are here for you,” but outlined the new procedure.
Those at home, were asked to call for a phone or video assessment before coming in. Those who showed up at the door were asked to return to their car, and call the office for further instructions.
For those with needs that could not be managed over the phone, or through an OTN (Ontario Telemedicine Network) teleconference, “we arrange for them to come into the office in a controlled way,” Dr. Kuzmyk explained.
“I am going to greet them at the door, decked out in appropriate PPE. If I need to lay hands on, the appropriate safety measures will be taken. The staff want to protect their patients as well as themselves,” she said. “Don’t be afraid to go to the doctor, don’t be afraid to go emergency.”
And she wanted to reassure patients, who may have hesitated to call because they feel their own medical issues are too small to be bothering a physician, during the COVID-19 crisis.
While their concern and selflessness are appreciated – “It just warms my heart,” said Dr. Kuzmyk – she wanted them to know that their medical condition is “not a small problem, it’s just a problem during COVID.”
She, and the other doctors in her team, are finding ways to carry out most assessments online, while ensuring “anyone who physically needs to be seen, is seen.”
Residents with non-COVID-19 health needs should continue to contact their primary health care provider during the pandemic. For those who lack a family physician, the options are more limited. Most of Bradford’s Walk-in Clinics have closed their doors, and are doing phone assessments only.
The exception, for the moment, is the Bradford Healthcare Centre, 26 Holland St. East (in the old RBC building). Currently, the clinic is staffed by a pharmacist, receptionist and doctor, from 9 a.m. to 7 p.m. daily; 9 a.m. to 2 p.m. on Tuesdays. Walk-in patients are pre-screened, before being seen, and social distancing is maintained in the reception area. Anyone with COVID-19 symptoms is asked to stay home and follow the recommended steps, taking an online self-assessment before seeking medical assistance. For information on Bradford Healthcare Centre, call 905-775-2025 or click here.
At West Park Walk-In Clinic, 1-456 Holland St. West, all consultations are being done over the phone, 905-551-5500, between the hours of 9 a.m. and 1 p.m. The Clinic is accepting new patients – but again, only over the phone. “No patients are allowed in,” a spokesperson said. If a prescription is required, it will be faxed to the pharmacy of choice.
South Simcoe Medical Walk-in Clinic at 239 Holland St. West, is doing phone assessments only; 905-775-4863.
Bradford Central Walk-in Clinic, 107 Holland St. East, is doing phone consultations only, from 10 a.m. to 5 p.m. – but is accepting new patients. Dr. Amir Zeinaly is available on Mondays, Wednesdays and Saturdays, to connect with patients: “He’s set aside hours for OTN (Ontario Telemedicine Network) and phone consultations only.” For information, call 905-551-3040 or visit the website.
Bradford Medical Centre, 157 Holland St. East, is closed to walk-in traffic except for family practice patients, who are already registered with the clinic. Patients are asked to call and leave a detailed message at 905-551-8555 before coming in. The Centre is accepting new Addiction medicine patients. For more information, click here.
For others who lack a primary care provider, and have non-COVID-19 health issues and concerns, call Telehealth Ontario at 1-866-797-0000; in an emergency, residents should still call 911.
Dr. Larry Barcza has taken a different approach. While he is taking all precautions – sanitizing his office, donning personal protective equipment – he is still meeting face-to-face with his patients.
“I have been a doctor for 46 years and I can’t do my job on the phone,” Barcza said. “I am a mechanic. A phone assessment won’t fix your car. The mechanic has to be there to check the valves, tune the engine and everything else.
“I am a mechanic, period. A phone assessment won’t fix your car, period.”
Dr. Barcza has dealt with multiple health threats during his 46 years as a physician. “It’s more important for me to do my job properly, than to hide,” he said. “If I get sick, I’ll hopefully survive.”
He does pre-screen his patients. Have they recently returned from travel, or been in contact with someone who has travelled? Are they exhibiting any symptoms of COVID-19, such as persistent fever, cough, shortness of breath or any other flu-like symptom?
If the answer is yes, “I refer them to the COVID-19 clinic at the Newmarket hospital (Southlake) for proper assessment.” He has referred “three or four” people this past week alone.
Dr. Barcza is also paying close attention to those of his patients who are at high risk – not simply the elderly, or those with chronic medical conditions, but those who smoke, who are on any one of a number of immunosuppressant drugs for a range of common conditions, from psoriasis to arthritis to Crohn’s disease.
The risk of dying goes up significantly in people who are diabetic, who have high blood pressure, COPD and any cardiac or circulatory problems. There are articles in the New England Journal of Medicine, suggesting that those taking commonly-prescribed ACE inhibitors and angiotensin-receptor blockers (ARBs) may have poorer COVID-19 outcomes.
Dr. Barcza is critical of the misinformation that has been circulating on the internet regarding various potential treatments for COVID-19, although he notes that recent studies out of Quebec suggest Colchicine, a gout medication, may be helpful.
Colchicine is used to treat acute attacks of gout, and pericarditis - an inflammation of the tissue surrounding the heart, often caused by a virus. The drug is now being used in clinical trials to combat the lung inflammation that causes the most serious COVID-19 symptoms.
Dr. Barcza remains cautiously hopeful about ongoing scientific studies and work on a vaccine, and plans to continue to see his patients, providing hands-on care – despite the threat of infection.
“I will continue to treat my patients,” he said.
All physicians are encouraging the public to take the pandemic seriously. Practice social distancing. Wash hands frequently. Sanitize surfaces regularly. Avoid touching the eyes, nose or mouth. And above all, stay home as much as possible, to block the spread of the disease.
“Be more cautious. Be more patient. The payoff will be huge,” said Dr. Kuzmyk.
She is also encouraging people not to despair or feel overwhelmed by the pandemic, but to be “in the moment,” and grateful for what they have: access to food and medication, a health care system that has taken steps to cope with the virus, and every day of good health.
“It’s very important to say, let’s just hunker down for now,” she said. “We will come out on the other side.”
“It is human behaviour that determines the outcome of outbreaks.” – Dr. Melita Vujnovic, W.H.O.
Note: COVID-19 concerns? Please take the COVID-19 self-assessment tool before taking further steps.
