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LETTER: Our Bubble Will Burst if it Expands Too Quickly

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I’m exhausted. This pandemic is exhausting. I’m exhausted like everyone else from social distancing and not seeing my friends and family.

But I’m also exhausted from spending the past few months putting in 12- and 16-hour days (when not caring for my school-aged son) trying to ensure that when the time came, our clinic would be ready to start seeing the people who needed to be seen in person.

I am in a rather unique position in healthcare: I am a healthcare administrator and an epidemiologist. I manage a medical practice and I study the statistics of illness and health, so I not only see the day-to-day practicalities of administering healthcare in this province, but I also have a background in public health and statistics. I am also the child of a physician and run said physician’s practice, so I have a readily available source for most practical medical knowledge.

The fee code for remote care came out at 4:30pm on a Friday afternoon. The next day, a Saturday, I went into the office and sat down with the MCP preamble and the guidelines for the new fee code and created a virtual care worksheet for my father to use, to ensure that we would be collecting all the information required in order to document these visits properly. I also booked a “dry run” clinic for the Monday with the patients booked further apart then necessary in case we ran into any hiccups with medicine over the phone.

Over the next week, we figured out a rhythm and were able to reach the MCP cap of 40 calls a day and accommodate all of our follow-ups over the phone. We cancelled new patients and procedures for the time being. We began to start calling the follow up for several months down the road in order to make space for and to triage the urgent patients we would need to see in person once it was deemed safe. This is what we did for months, not booking anyone more then a day or two before their phone calls. We learned during those early weeks that without the physical act of leaving the house, people forgot that their doctor was calling them and would take naps, go for drives or out into the yard without their phones.

People don’t realize how exhausting virtual medicine is for physicians and staff. The physician has to sit in front a phone calling people all day, no usual change of scenery by going from one examination room to the next, no visual contact with the person you are used to examining in person. For the admin staff it involves significantly more work, as you are now double and triple checking phone numbers, collecting pharmacy information and have become defacto tech support for those who are unsure how to email a picture. It’s been an exhausting time, but it was well worth it, or so we thought.

In the last week or so, Newfoundlanders and Labradorians were hit with the surprise news that we were joining the Atlantic bubble, significantly sooner than expected, and then with the news that we would be opening up to the rest of Canada two weeks after that. People are understandably upset. I’m upset. Not only as a citizen, but as an epidemiologist and health administrator. Everything in my being both professionally and personally says this is the wrong move and is premature. I know what opening up to the rest of Canada means right now: it means we will end up in lock down again soon.

Like many in our province, I have been watching the statistics coming from our southern neighbours and they are to put it mildly: terrible.

We have seen what happens when others have opened things up before the curve is not only flattened but on a downward trajectory, people die. This is what will happen if we open up to the rest of Canada too soon, specifically Ontario, Quebec and Alberta. These provinces still have steadily rising numbers of cases. We have been told that the virus only moves when people move, so right now people need to stay put. The summer heat has not slowed the virus down as some theorized it would. However, this theory was always flawed all you had to do was look to Singapore where the weather is always a balmy 30 degrees year ‘round and the virus spread quickly. The difference between us and Singapore is that they acted quickly with contact tracing, testing and supervised quarantine. Another covid-containment success story is New Zealand and they also practice supervised quarantine. Supervision is a key element that Canada has been missing in their containment measures, as it ensures the careless do not spread the virus to others.

Back to healthcare in Newfoundland and Labrador. Over the past few weeks, we had begun to slowly bring in the most urgent new patients and follow-ups. Guidelines were strictly adhered to, doors locked and patients had to ring the bell to enter, temperatures were taken, screening questions asked, our waiting room was closed, one patient at a time, masks and PPE for all involved, all surfaces sanitized and so on. We looked forward to when we would be able to relax these protocols, unfortunately, we are still not there and will not be there anytime soon. We are still not booking patients more than a few days in advance because we don’t want to have to cancel everyone again.

We have a backlog, all healthcare facilities do, and it is unrealistic to expect us to be able to clear those backlogs in a reasonable amount of time, especially now. The health minister suggested that we would all be up to 85% capacity shortly. I don’t see that as possible, especially not with the current requirements for screening questionnaires, social distancing, and disinfecting. Someone asked me the other day why we don’t just relax some of those protocols. I responded that healthcare facilities must remain hypervigilant when others relax protocols as we are the at the forefront of detecting new cases and more importantly, we are places that vulnerable can’t and shouldn’t avoid. No physician’s waiting room should become the next Caul’s cluster, but I worry that one might be given the rush to open up.

Photo by Fusion Medical Animation on Unsplash.

Susanne Gulliver, MPH is Research and Operations Manager with Dr. Wayne Gulliver and NewLab Clinical Research Inc.

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