TORONTO — Is it a cold? The flu? Or is it COVID-19? Canadian doctors may have no choice but to test everyone with respiratory symptoms this coming fall as students and parents anxiously gear up to go back to school in a few short weeks.
Doctors across the country, worried about the daunting unknowns in the weeks and months ahead, are asking for guidance from public health officials as their offices prepare for the potential onslaught of cold and flu season during what is expected to be another wave of coronavirus infections. Part of the concern is over protocol and process, but also access to care for patients should family practices and clinics need to close because of an outbreak.
“We are not going to be able to tell the difference between what influenza is, potentially what a common cold is, and what COVID is,” said Dr. Iris Gorfinkel, a family physician in Toronto, with PrimeHealth Clinical Research.
“For that reason all patients with any flu-like symptoms will have to get screened for COVID-19.”
Doctors with the Canadian Medical Association (CMA) say they are hearing a lot of concerned physicians asking questions about how to tackle the next few months and believe a plan is necessary.
“Reopening up our schools is an experiment in real life,” said CMA President Dr. Sandy Buchman.
“We really don’t know yet how it’s going to turn out. So in this experiment I feel we have to be very proactive in ensuring we have the capacity to test, trace, and isolate quickly.”
Doctors’ questions include: should patients exhibiting respiratory symptoms be sent straight to COVID testing centres? Should they be triaged differently? What about headaches, diarrhea, unexplained chest pains or shortness of breath? And what should doctors do if they or their own children get sick?
These concerns are top of mind for many doctors like Gorfinkel, who says these symptoms make up a large portion of the patients she sees as a family doctor. Meanwhile, she is also a parent herself with three children the youngest of whom is in high school* .
“She is now going into grade 10. Am I worried? Am I concerned? Absolutely,” Gorfinkel said of her youngest daughter, who worries about her potential to become a super spreader.
“If she were asymptomatic and transmitted it to me, I may not have any idea that I’m potentially infectious to others.”
And what if it was a classmate that tested positive? All these scenarios raise questions about whether Gorfinkel should be regularly tested, and if so, how often.
Hospital staff are generally expected to get tested every week, but there are currently no guidelines on how often asymptomatic health-care workers should be tested, she said.
And if a doctor does test positive, they have to close their practice and go into quarantine for two weeks. Patients who were in direct contact with the doctor in the prior two weeks need to be notified and tested as well.
“If I were feeling fine and asymptomatic, I would carry on virtual care from home, but that would put an end to the in-person visits for the next two weeks.”
The incoming CMA president has also been fielding similar concerns.
“Do I stay away from the office? From the hospital? Concern is really around care for our patients being able to not have too much of a disruption,” said Fredericton-based Dr. Ann Collins, the CMA’s president-elect.
“What about the surgeon whose little girl is sent home from daycare with symptoms? Does she cancel her OR list? There are all kinds of care-related concerns.”
Collins, a family doctor for more than 30 years, says there is confusion and “lack of clarity early on about who to turn to, to find out about these pragmatic, day to day concerns.”
Meanwhile, some doctors say masks, gloves, and gowns are still in short supply.
“It varies by jurisdiction, but we are still hearing from doctors that they don’t yet have a full supply or they’re still having to purchase it themselves,” said CMA’s Buchman.
At the same time, emergency room doctors say they already get easily overwhelmed during normal cold and flu seasons. What will happen to hospital ERs if family doctors choose not to see patients with respiratory symptoms, or if they close clinics because of COVID-19 outbreaks?
Dr. Alan Drummond from the Canadian Association of Emergency Physicians calls it a “double edged sword” if there’s both a flu and COVID outbreak.
“We have survived the first part of the pandemic,” said Drummond.
“Now’s the time to say OK, we don’t know if a second wave is coming or if this surge is going to increase suddenly, but we now have the wherewithal to plan. So let’s start planning.”