Sunday House Call, #734, April 12, 2020: The Other Curve to Flatten. The Deluge Will Come.

The Other Unblunted Curve (published on bourque.com)
Other medical illnesses cast aside by the pandemic are set to become the next deluge on our health care system.

By Dr. Barry Dworkin

Now, Canadian family medicine centers’ infection control measures and protocols have limited your physician’s ability to see you in person. The lack of availability of rapid SARS-CoV2 testing at the point of entry makes it difficult to ensure the health and safety of all who work in the centre and that of their families. There is no way to know with certainty who may be carrying the virus. It is a similar issue for radiology/imaging and blood testing centers.

Many patients are being directed to the emergency room especially if they have respiratory or cold-like symptoms. Family doctors’ offices are curtailing or limiting services because of the infection control measures noted above.

Some family doctors and specialists are unable to work because they practice as fee-for-service physicians. Without being able to evaluate patients in person, they cannot bill the service fees. They are increasingly unable to cover office expenses. Staff are laid off. Patients are not seen, and care is compromised.

There is also the matter of the increasing pressure on practices from all the other medical conditions that require evaluation: heart disease, cancer, chronic obstructive lung disease, osteoarthritis, osteoporosis, diabetes, high blood pressure, kidney disease, mental illness, in-office surgical procedures, vaccinations, allergy shots, minor injuries, connective tissue disease, psoriasis, eczema and other skin disorders, respiratory infections, women’s health, rheumatoid arthritis, well-baby exams, periodic health exams, contraceptive counseling, Pap tests, thyroid disease, chest, abdominal and pelvic pain, stress urinary incontinence, … the list can continue for the next few pages.

All these issues requiring follow-up are presently delayed. The longer this continues, the more complicated each issue can become; the more deleterious it is to our patients’ health.

Many of the medical conditions listed above require regular follow-up visits, ongoing monitoring blood tests, and/or imaging (e.g. x-ray, ultrasound, MRI, CT scan) studies. The concern is that there will be a significant surge in demand for these services once Public Health policy changes and movement and contact restrictions are lifted; The deluge is coming.

Up to now, the focus has been on testing symptomatic essential workers to determine whether they need to self-isolate or can continue to work. Everyone else is on the sidelines.

We need point-of-care rapid testing now to mitigate what is sure to come. Just as we have tried to blunt the curve so our hospital health care demands would not exceed capacity, a similar argument can be made to blunt the surge in demand for the “regular” stuff that must be done.

Point-of-care testing would allow health care providers to have in-person contact with their patients who test negative for the virus. It would ease the stress on staff who must treat everyone who comes in as a possible source of infection. It would also allow us to do what we were trained to do. There are definite limitations to telemedicine and an urgent need for resumption of in-office assessment.

Although there is a point-of-care device, the Spartan Cube, that is coming to market in the next week or two having being approved by Health Canada this weekend, it is being snapped up by larger Canadian organizations and the Quebec, Ontario and Alberta government health agencies. There are none available to individual family medicine or specialist centres. This is verified because I enquired about procuring the device for our office that provides care to 20,000 patients. I was told that Spartan Bioscience is overwhelmed by Federal and Provincial orders and that it will some time before they can be deployed to sites like ours.

The emphasis on prevention of illness is of great importance. The antithesis is now upon us because of the pandemic. This is one of likely many solutions that can control the flood gates before it overflows. It provides the opportunity to return to the standard of care that people deserve.

The Law of Unintended Consequences is looming.

This was the first time I sent a complaint about a tweet because it advocated self-harm. This is quackery at its worst. A great way to destroy your lungs.

Your calls about:

• Can mosquitoes carry SARS-CoV2? No they cannot. Although they can carry other viruses like Zika and Dengue, the same cannot be said for SARS-CoV2.
• Still limited and conflicting evidence for hydroxychloroquine and azuthromycin for treament of Covid-19. Need more robust evidence from properly conducted randomized placebo controlled trials before any conclusions can be drawn.
• Ventilators
• Small bowel poblems
• 27 year-old woman with nausea, vomiting, diarrhea and mild fever. Indications when to seek assistance at the ER reviewed.