COVID-19 Update

 Please Note: Our knowledge about best practices for COVID19 is changing all the time as new information becomes available. Please refer to our most recent update for the most up to date information.

Dear Patients,
Here is another Covid19 update for you. Some key information at the beginning, especially for those age 20-50. I’m putting a summary first, read on below that for all the details.
 
Summary:

1. Please continue very diligent social distancing. This means, you can interact / do activities with the people who live in your home, but that’s it. No one else. 
2. Many adults between the ages of 20-50 are having severe Covid19 and being admitted to the ICU. Many are even dying. Just because Covid19 is somewhat less dangerous in this age group, does NOT mean it’s ‘safe’. You are NOT “safe” from this. Social distancing applies to you too! When the media refers to ‘mild’ Covid19, that’s actually pretty severe already. It includes people at home who struggle to walk to the bathroom. Moderate is usually in hospital on oxygen, severe is in the ICU, critical is intubated in the ICU.
3. The government currently recommends 14 days isolation after you think you were exposed, and a further 10 days if you have any sort of infectious symptom. Please think of this as the bare minimum. Information on this is still evolving.
4. There were reports of a possible effective treatment with the drugs hydroxychloroquine and azithromycin. This got badly misunderstood on social media, and some politicians. It is NOT yet known if this is effective. There are serious risks, especially with hydroxychloroquine. It will NOT be used as a general treatment at this time. NO ONE should self-treat with any medications for this (other than Tylenol for those with no liver disease).
5. The MedVoice app has been made free for the next few months. This will help you communicate with me, and keep us efficient during the pandemic. Please try to use it for all your appointments, even video and phone appointments.

So first, a reminder that while children between the ages of 2-10 are only very rarely having severe Covid19, everyone else…again everyone else…can end up in the ICU. Far too many young adults between the ages of 20-50 are ignoring doctor’s instructions and going out and mingling. Not surprisingly, they are starting to represent a larger and larger portion of those in the ICU and dying. As I previously informed you, this is not “just a bad flu”…it's substantially more risky than the flu, which itself is already dangerous. In any case, even if you don’t get very sick, you may spread the disease to others who won’t be so lucky. It may be a family member. We have to do our job as a community. Stay home.
 
The current recommendation is for everyone to stay home as much as possible. Go out for things you *need*. If it can wait, then it should wait. Get your groceries, get your medications. That’s mostly it. You can go out (preferably close to home) with people who live in the same home with you (for a walk /exercise), but STAY AWAY from other people. Give them a wide berth. If you have to talk to them, you need to be a couple of car lengths away. Will it feel weird? Yes. Do it anyways.

About 97% of my patient encounters over the past 2 weeks were done by phone or video.
 
I do have some comments on the reports of a possible effective treatment with the drugs hydroxychloroquine and azithromycin. This is based on a study from France involving a SMALL number of patients. The study had some huge problems with it (like, a few of the patients in the control group got more sick and were excluded from the study for unclear reasons – the is highly unusual and unscientific). Despite that, it has generated a lot of excitement, because the
results (even taking those irregularities into account) were dramatic. Numerous additional research groups around the world have pounced on this, and started their own (hopefully better designed) studies to look at this further. Hopefully it won’t take too long to get results. Immense resources are being thrown at this, with large teams working around the clock to get the results asap. It’s pretty stunning actually how much is being done so quickly. This has never occurred before in history. 
 
Although this will be extremely good news if it pans out, it is NOT clear yet whether this works. Hydroxychloroquine can have SERIOUS side effects. Two people in Nigeria died, and now one in Arizona, attempting to self-medicate with
these sorts of compounds. Therefore, these medications will NOT be prescribed by us at this time, so please do not ask. We MUST wait for further data. Even if it does work, the question then becomes, ‘who exactly will benefit from it’? Do mild cases really need it? Does it only work if we give it early enough? Can we safely reserve it for those in hospital? We just don’t know yet. Unfortunately, others have not been so responsible in their communications, and there is already a massive shortage of the drug worldwide. This is now a new problem, as both drugs are used for other health conditions. Hydroxychloroquine in particular is used for people with rheumatologic conditions. Without it, their condition may flare, and they end up in hospital…exactly the LAST place we want them right now. The drug companies that make these medications have ramped up production, and hydroxychlroquine is cheap and large amounts can be made in a few weeks, so the shortage shouldn’t last too long. But this underscores why it’s important to report on these developments responsibly, and plan ahead. 
 
Please remember, even if this drug-combo doesn’t work, our situation remains solvable. Information continues to be gathered from other locations where this has been controlled. The original outbreak was in Wuhan, a city of 11 million, in the province of Hubei in China. Hubei has had zero new cases for 4 days in a row now. They have a date posted to end their ‘lockdown’ soon and resume life (in a couple more weeks). Cases in South Korea continue to dwindle. Hong
Kong, Taiwan, and Singapore have maintained a low case count from the beginning, even with kids still going to school, and businesses open. We do need get our surge clearly under control before relaxing anything. But it proves this can be done. We need to learn, and we need to act on it.
 
Lastly, I previously mentioned the MedVoice app to you. This is a program that helps collect information from you in advance of a visit (not just an in-person one, but in advance of video or even phone consults as well). It gathers key details from you, and makes that available to me. It should always be used in association with a visit, NOT on it’s own. You can create a patient account at www.medvoice.ca, and/or download the iPhone or Android app. It will ask you
for my “Doctor ID code”, which is (please call the office for this). I hope most of you will start using it for your video/phone visits with me for the next while as it will greatly improve my understanding of how you are doing, and improve our efficiency quite a bit. It will be free to use during the pandemic. Best time to use it is the day before, or at least 1 hour before we have our video/phone visit.
 
I will continue to update you... Keep well!