You have a fever, a cough and feel short of breath, but when you arrive at your family doctor’s office something doesn’t look quite right.
A sign on the door describing your symptoms sends you to another entrance and advises you to wear a surgical mask. The receptionist is wearing a mask and sitting behind a plexiglass shield. All the magazines and stuffy toys are gone.
The seats are covered with plastic sheets, but many of them have been removed altogether to create separation between people with flu-like symptoms and other patients. A sheet is hung from the ceiling to complete your isolation.
When you get to the exam room, it is stripped of all supplies and equipment save an exam table and the blood-pressure cuff that is bolted to the wall.
You’ve seen the images from China of empty streets and first responders wearing head-to-toe hazmat suits picking up the sick and the dead and wonder if it can happen here.
It can, and our health authorities are ready for it.
The changes to your doctor’s office are described in detail in B.C.’s Pandemic Influenza Response Plan, a collection of 14 documents that include instruction on everything from contagion surveillance to mass antiviral distribution.
Most if not all of the protocols and strategies prescribed by the influenza plan will be applied to fighting the COVID-19 coronavirus if a pandemic is declared.
“Since the severity of a virus can change throughout the course of a pandemic, and no one can say for certain how a pandemic will unfold, it is essential that planning and response measures be in place to mitigate its impact,” the plan notes.
A multi-ministry overhaul of the plan has been underway for a month, according to the ministry of health.
Novel viruses spread more quickly than recurring flu viruses, which are limited by some level of immunity in the population. COVID-19 is encountering little to no immunity.
“There is no inherent immunity, there’s no vaccine and there is no crossover protection from previous flus,” said family doctor Essam Hamza.
Pandemics have been recorded about every 10 to 40 years since the 1600s. The Spanish flu outbreak of 1918 killed 55,000 Canadians and 20 to 100 million people worldwide.
The most recent pandemic was the H1N1 influenza outbreak of 2009 that saw nearly 9,000 people hospitalized in Canada.
The mortality rate of COVID-19 — based on preliminary statistics from China — is around 2.3 per cent, ranging as high as 15 per cent for the very elderly. The typical mortality rate for influenza A is lower, between 0.1 to 0.4 per cent.
“One of the first lines of defence in a pandemic is protecting health care workers and a big part of that is telling people not to come in to the clinic,” said Hamza, who is CEO of Premier Health Group, which recently released the CloudMD app.
“Telemedicine is going to be a big part of that, especially for determining who should come in for treatment and who should just stay home,” he said.
Even if people do have coronavirus, doctors won’t necessarily want to see mild cases during a pandemic.
“For most people it will be a like a bad cold or the flu, but you have to reassure those people because they will be scared,” he said.
CloudMD and Telus Babylon video consultations are covered by the Medical Services Plan for British Columbians. CloudMD has about three million registered users and enables patients to see doctors, consult with pharmacists and get followup checks with nurses.
Both apps work on your smartphone, and CloudMD is also available via the web.
Videoconferencing is particularly useful for reviewing symptoms and lab results, refilling prescriptions and the 70 per cent of doctors’ work that doesn’t involve touching patients.
Bluetooth-based stethoscopes and otoscopes developed for use in remote First Nations communities by Premier Health’s Livecare can be used for a more hands-on-style remote exam.
“You can listen to the heart and lungs, or see an ear drum in high definition,” said Hamza.
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