Guest Column by Dr. Diane Duff RN PhD

Virtual health care has been around for a couple of decades in Canada, but we have struggled to make virtual visits a mainstream part of primary health care delivery (family doctor and nurse practitioner visits).

Privacy concerns, lack of digital expertise or connectivity by both patients and clinicians, and lack of approved “fee for service” funding have all delayed implementation of virtual health services.

In a recent study by the Canadian Medical Association, it was noted that less than two visits in every one thousand (1.5/1000) were done using virtual technology. This means the vast majority of visits to the doctor or nurse practitioner were conducted as face-to-face office visits or less commonly via home visits.

Virtual health care is an umbrella term that encompasses phone visits, videoconferencing visits, and email or text/chat visits that can be done synchronously (at the same time, using two-way communication); or asynchronously (at different times; more like writing and replying to an email or letter and then responding back and forth over a period of time).

So, what is wrong with just continuing face-to-face primary care office visits? Office visits require patients and practitioners to travel and coordinate times. For children and frail, elderly patients, this usually requires the support of one or more family members. Even without the COVID-19 pandemic, having sick people travel and congregate in a doctor’s office is not ideal.

Even if people were to be able to physically distance to two metres (six feet) in waiting rooms, surfaces and people may still be contaminated through touching, sneezing, and coughing.

Primary care face-to-face visits in doctor and nurse practitioner offices should be reserved for vulnerable people who must be seen and physically examined, such as babies, people who lack technology, or individuals that require hands on examination or care.

During the COVID-19 outbreak, office visits may facilitate transmission of this highly contagious virus before, during, and after overt symptoms are present and will lead to greater community spread.

Fortunately, most primary care practitioners in our counties have greatly increased the number of virtual visits they are offering and the Ministry of Health has fee-for-service codes to support virtual care.

COVID-19 may be the catalyst that helps us finally close the gap between consumer demand for virtual services and primary care provision of these services. It may also help non-attached or non-rostered people (people without access to a family doctor or other primary care clinician) have access to basic health care without having to use the Emergency Department (ED) or walk-in clinics to receive care.

While ED and walk-in care can fill an immediate need, these are expensive ways of delivering primary care and many people, especially older patients, need continuity of care in order to self-manage their ongoing or chronic illnesses.

In our counties, almost 50 per cent of people are non-rostered with a primary care provider in our community.

Kudos need to be sent to the Haliburton Highlands Family Health Team. They have not only offered their services to do COVID-19 assessment and testing but have also extended their services to many unrostered individuals in our community during the pandemic so that they do not have to visit the Emergency Department.

Other virtual primary health practices and services in Ontario have also reached out to offer virtual primary and specialist services, should we need their support.

As an unrostered patient myself, I recently decided to try out one of the virtual online options. I signed on to the virtual care site and 15 minutes later I was registered, had finished an asynchronous chat visit, and a prescription had been sent to the local pharmacy of my choice. The service was quick, efficient, and free. While virtual visits may not be for everyone, most of us at least have a phone, and they may reduce the pressure on our existing primary care services.

For more information about virtual health care, check out https://access2022.ca/ (Diane Duff is a nurse based in Haliburton County)

By Jack Brezina

Some thoughts and musings as the selfisolation grinds on:

• I have found that it is best to limit the amount of pandemic “news” one consumes. Initially, it was hard not to hang on every word, every pronouncement, every piece of so-called breaking news as the gathering storm unfolded. Newspapers, radio, television, and of course the internet, were tapped for the latest updates. Drawn like a moth to a flame, I sought out every bit of advice and speculation. But like that hapless moth, I learned that the flame can burn as well as illuminate. I started to forego the daily briefings from Ottawa, Toronto, and especially Washington, relying on the aggregators to give me the highlights once or twice a day. I found a calming effect was the result of limiting my exposure to the sources I trusted and leaving the rest for others to fret about.

• Hats off to the staff in our grocery stores, who soldier on under very trying conditions. Thank goodness they are there to keep the shelves stocked, calculate our purchases and deliver orders to those who can’t or shouldn’t get out to shop. It must be intimidating to work, every day, in a situation surrounded by shoppers with masks and some without, those struggling hard to maintain the six feet of separation and those unaware how breaking that rule must make others feel. There are many frontline workers who deserve our admiration and thanks, but we often overlook or take for granted those who help to keep us fed. Thank you.

• Speaking of groceries, have you noticed how shopping has all of a sudden become a highlight of the week? And what is all this fuss about toilet paper? I admit I don’t want to run out either, but I am sure I won’t be needing a closet full of rolls in the next three or four weeks. While, at least it won’t spoil, toilet paper was far down my want list. I can think of many other things to consider stock-piling.

• Have you Zoomed lately? Zoom is not the first and only multiple participant communications platform, but it seems to have become the one everybody is talking about and using. I have birthday party Zoomed and read plays on Zoom and, well, attended meetings on Zoom or similar services. I have heard of church services and book clubs and online family gatherings congregating online. Tip: go to the bathroom before starting what you suspect will be a protracted online meeting.

• While I understand the concerns about straining the limited health and infrastructure resources we have here in the Highlands, I have sympathy for those city folk who decamped to the cottage for a couple of weeks or longer. If I was sheltering in place in the city, (especially with children), the open spaces and nostalgic draw of a cottage would be irresistible, particularly if “home” is in one of those apartment or condo towers. Confronted with the same options, most of us would choose to be here rather than in the city right now.

• It is the direct interpersonal contact I miss the most. On the occasional visits to the post office or the grocery store, there is an irresistible urge to talk with people, keeping the requisite six feet or more distancing, of course. The conversations for the most part aren’t deep or consequential to anything in particular, they are just interactions, basic human contact that has been stripped from our lives by the rules of the day. There is a hunger for that contact, however fleeting, that we instinctively sense is missing from our daily lives. Even a 30 second chat about the weather seems to provide a boost to the soul.

• Now, if you’ll excuse me, I’m sure it is time to wash my hands.

We’ve had some good news from the Ontario government – and locally – about the COVID-19 situation. Premier Doug Ford told us this week that health experts say the outbreak has likely peaked in Ontario. The modelling, released this past Monday, showed things such as staying home and physical distancing – along with the work of our frontline health care providers – is working to contain the spread of the virus and flatten the curve.

Here’s what we know. The wave of new community-spread cases appears to have peaked and Ontario is trending toward a best-case scenario rather than a worst-case scenario. We are in considerably better shape than the March modelling.

However, we also know several hundred new cases are identified daily in Ontario although the rate of growth day-over-day is declining. Hospitals have not been overwhelmed as a result of capacity planning and the public health measures currently in place.

Dr. Norm Bottum tells us in today’s Highlander that we’re somewhat lucky to have had only seven cases locally since we know people travelled during March break, have returned from wintering in Florida, and are coming to the cottage.

He attributes it to people following health protocols, and preventative measures at Haliburton Highlands Health Services.

But, he is worried about what will happen next month when cottagers traditionally return for the summer season to our County. Across the province, there also remains a real worry over outbreaks at long-term care homes and other facilities where large groups of people live.

So, rather than looking upon this week’s news as permission to ease up on handwashing, or going out to do some non-essential shopping, or over to the neighbour’s for that long overdue beer, view it as affirmation that you are on the right track.

All of us still need to stay home unless absolutely necessary for essential trips, such as accessing health care services, groceries, picking up prescriptions or supporting vulnerable community members with meeting essential needs.

If you must leave home, continue to go alone and stay at least two metres apart from others.

Yes, it’s going to get harder and harder as the temperatures warm up. And, yes, it’s going to become ever so more tempting for cottagers to return. However, we must all continue to stay the course so the good news keeps coming. The last thing we need is May modelling saying we have gone backwards, that a second peak is upon us and a worst-case scenario now looms. We’d hate to see a second wave that could ruin summer.

The public is further reminded that Ontario has made improvements to its COVID-19 self-assessment tool by expanding its symptom list, addressing the most high-risk individuals, and making it more accessible and responsive.

If you have any suspicion at all that you have been infected, get yourself tested.

Don’t be complacent at the first sign of good news. Continue to protect your health by washing your hands often with soap and water or alcohol-based hand sanitizer, sneeze and cough into your sleeves, avoid touching your eyes, nose or mouth and avoid contact with people who are sick. Stay home if you are sick.

After all, it will be slow and steady that wins this race not fast and reckless.