Ontario is preparing to open out-of-hospital assessment centres to quickly screen and test people who may have COVID-19 and may offer drive-thru options so people can be screened for the novel coronavirus in their cars.
The dedicated assessment centres will help keep people away from already busy emergency departments as the province prepares for a potential surge in people seeking testing for COVID-19. The strategy will relieve pressure on hospitals and protect hospital patients, staff and visitors from being exposed to the virus.
Michael Garron Hospital in Toronto plans to open its COVID-19 Community Assessment Centre by mid- to late March. The centre will have a separate entrance from the hospital and will be designed to include a drive-thru component that will allow health-care workers to quickly assess people from their cars.
Drive-thru assessments will only be implemented should there be an increased need for testing, and would likely only be available by appointment, said Mark Dan, vice president of clinical programs at Michael Garron Hospital (formerly Toronto East General Hospital). Several regions around the world, including South Korea, where COVID-19 is spreading in the community, are using the drive-thru assessment model with success, he said.
“It really is a drive thru; you get a quick (nasal) swab that will be sent for testing, answer a few screening questions and then are able to drive back home,” Dan said. “It keeps people in their own cars, it’s a quick process and they can receive their lab results virtually. That’s an example we’ve seen around the world that we are implementing here.”
Ontario has yet to formally announce detailed plans for dedicated COVID-19 assessment centres, though it’s clear they are in the works.
During this delay, some community physicians are creating their own policies for how to manage the fast-moving situation with COVID-19 in the province.
Dr. Dina Kulik, a pediatrician and founder and director of Kidcrew in Toronto, said her patient population, including newborns and children with compromised immune systems, is among the most vulnerable to health complications from viruses, including COVID-19.
Because of these risks, Kulik is now telling patients who have travelled anywhere outside Canada, or who have been in contact with people who have travelled outside the country, and who have illness, such as respiratory symptoms and fever, to seek medical attention at their local emergency department. After two weeks, these patients can return to her clinic if they have no symptoms of COVID-19.
“If I can minimize potential exposure, I believe I’m providing the best care to my patients and the community as a whole,” said Kulik, who also works as an emergency medicine physician at The Hospital for Sick Children. “The only way to test and minimize exposure to other people is to do proper screening and testing in a hospital setting.”
In a statement to the Star, a spokesperson for the Ministry of Health said the province is “actively working with specific hospitals” and has “requested that they submit applications to establish dedicated assessment centres.” Plans for the centres will be “in place this coming week,” the spokesperson said.
The Star was able to confirm several Toronto area hospitals, including University Health Network, Unity Health Toronto and Mackenzie Health, are working on plans for assessment centres.
On Tuesday, Ontario health officials announced one new COVID-19 case — a patient who recently travelled to Switzerland and is now in self-isolation — bringing the number of cases in the province to 36. Canada had at least 93 cases of the respiratory illness as of midday Tuesday, including 39 in British Columbia, 14 in Alberta and four in Quebec. One person, a man in his 80s, died of the illness on Monday in Vancouver.
At Queen’s Park, Health Minister Christine Elliott came under fire from opposition parties Tuesday for not revealing more details about the assessment centres and the province’s broader plan to deal with potentially wider spread of the new coronavirus.
“We are currently assessing the appropriate sites for assessment centres,” she told reporters. “Not every hospital is going to be an appropriate place for testing. We are setting that up right now so that should the situation escalate then we will have the place for them to be assessed.”
Elliott would not reveal how many locations will be established or where they will be.
“That hasn’t been finally determined as yet because we need to make sure we have appropriate geographic distribution. That is being discussed right now and we should have a plan in place very shortly.”
Dr. Jerome Leis, Medical Director of Infection Prevention and Control at Toronto’s Sunnybrook Health Sciences Centre, said the province knows it needs to act soon to curb a potential surge in COVID-19 patients from overwhelming the health system.
“We can’t get these assessment centres up and running fast enough,” he said, adding the province and its health partners want to ensure they are “thoughtfully implemented” with clear communications to the public on how they work.
The centres will only be for people who have been screened, either by telephone or a virtual assessment, and may require an appointment, Leis said.
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“They are not for people who just want to get tested,” he said. “There will be clear criteria for people who should or shouldn’t visit the centres.”
A recent report in the Canadian Medical Association Journal analyzed data on COVID-19 testing in Toronto emergency departments. The study — a snapshot of early cases in a one-month period — showed the number of people being assessed for COVID-19 in hospitals is increasing, an indication the province will continue to see more cases of the coronavirus.
Leis, a co-author of the study, said it also showed the majority of patients undergoing testing “are not acutely unwell,” which means many do not need to be treated or even assessed in a hospital. The findings are further evidence creating additional assessment and testing options outside the hospital is needed, he said.
“With that kind of model, we can hopefully limit the number of potential exposures of COVID-19 to emergency departments. That (increase in patients) can be unsafe, and it can also amplify the epidemic and block access to the most acutely ill patients.”
NDP Leader Andrea Horwath said the province’s health minister should be more forthcoming on details of measures being contemplated to show the people of Ontario the government “has a handle on these things” with public health officials already warning person-to-person spread in the community is imminent.
Horwath also called on the Ford government to release a comprehensive COVID-19 emergency response plan for Ontario that would outline specific strategies to help hospitals, businesses and people cope with the impacts of the new virus.
On Tuesday, the Nova Scotia Health Authority opened eight dedicated COVID-19 assessment centres even though the province currently has no confirmed cases.
At Toronto’s Michael Garron Hospital, staff are working with community partners to pinpoint the best location for its dedicated assessment centre. The hospital had proposed opening an assessment clinic in an area with other medical offices and a senior centre, but Dan said other locations are now on the table to lessen concerns from the community.
Currently, the hospital is seeing between five and 10 people a day come to its emergency department for COVID-19 screening, though staff know the numbers will likely increase, Dan said. So far, no confirmed cases have been identified at the hospital, he said.
No matter its location, the assessment centre will be near the emergency department so that very sick patients can be treated immediately. It will also include a virtual component to help keep people who may have symptoms of COVID-19 at home, Dan said.
Given that most patients who develop COVID-19 have mild symptoms and can recover at home in self-isolation, the assessment centres will be key in efforts to “keep people out of hospitals that don’t need to be in hospitals,” said Dr. Isaac Bogoch, an infectious disease expert at Toronto’s University Health Network.
“The real question is, is that going to be sufficient? The answer is maybe,” Bogoch added in nod to other countries like Italy, Iran and South Korea that have seen their hospital systems swamped by the new coronavirus after its devastating spread through China.
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