ArtMed’s Response to COVID-19
ArtMed’s Response to COVID-19: Dr. Peirson Explains Phases & Stages Of Reopening
Well it’s been some time since I put pen to paper (or key to keyboard) to write a COVID-19 update. The last time I wrote was more than 6 weeks ago and much has changed in Ontario since then.
As I’ve mentioned in previous blogs, I receive a constant stream of COVID-19 updates from professional medical bodies, government agencies, research bodies and the like. The information overload can be dizzying! But I’ll endeavour to share some updates related to COVID-19 in the past 6 to 8 weeks.
In my previous blog I discussed the confusion around Directive #2 versus the phased re-opening of the province and how these different information sources can be confusing. This hasn’t changed!! The government of Ontario published ‘A Framework for Re-opening our Province’ back in May. This three-phased response to COVID-19 involves the following:
Phase 1 – Protect and support – shutdown, closures, and income support programs
Phase 2 – Restart – a stage-by-stage loosening of emergency shutdown measures and reopening of the economy
NOTE: Phase 2 has 3 stages: Stage 1 – select reopening of essential workplaces; small gatherings
Stage 2 – open more workplaces and outdoor spaces; larger gatherings
Stage 3 – open all workplaces and further relax restrictions on gatherings
Phase 3 – Recover –ensuring continued health and safety and support of the economy
As I said, it’s confusing language around many different processes and requirements.
Where are we now?
We’re in Phase 2, Stage 3. But only in parts of the province. Some places like Toronto are still in Phase 2, Stage 2. ArtMed was able to open during Phase 2, Stage 2 (technically, for our medical patients we were able to open in Stage 1 under Directive#2 but that’s another story). When we opened in Phase 2, Stage 2 we were only able to open for procedures delivered by regulated health professionals (doctors, nurses) and for procedures performed by non-regulated health professionals (laser technicians and medical aestheticians) on the body only. In Phase 2, Stage 3 (which Guelph entered on July 17) we can offer all of ArtMed’s services including facial services with non-regulated health professionals.
Clear as mud, right?
Trust me, this was all very confusing. So confusing in fact that we were on the phone with Public Health, with the College of Physicians and Surgeons, with the Province of Ontario and others. When we sought advice and direction even these agencies and regulatory bodies were not entirely sure what we could offer and when. Are we medical? Or are we a personal service business? We are in fact a medical office because close to 70% of our services are provided by regulated health professionals (thus we fall under Directive#2 – please see my previous COVID-19 blog).
Most of this confusion stems from the fact that laser services are unregulated in Ontario, as is aesthetics in general. Many of you know that I find this an unacceptable situation, so much so that I’ve written a blog previously about this very subject (you can visit that blog through this link Blog Post: We Need To Regulate Laser Treatment For Safety’s Sake.
Leaving all that confusion aside, let’s celebrate the fact that we’re fully reopened and back to regular services!
But for how long?
Almost every day patients ask me whether I think there will be a second wave of COVID-19. Historically, there has never been a pandemic that doesn’t have a second wave. Typically, a second wave occurs when we head indoors for the cold weather months. It makes sense – closer quarters mean it’s easier to spread viruses around. Thus, we should expect another wave; but hopefully we’ve learned enough in the first wave to avoid the kind of measures that were necessary then to control spread.
In a second wave it will be critical to identify cases early, test often and widely, undertake contact tracing swiftly and quarantine cases and contacts immediately and appropriately to prevent further spread. Doesn’t sound easy because it isn’t easy. Ontario is still on a learning curve with respect to this, and it remains to be seen if we’ll be ready.
In an ideal world we want to prevent people from acquiring COVID-19 in the first place. While a vaccine is still some ways away, one way that we can prevent COVID-19 is by paying close attention to what we’ve learned thus far. (Remember what they say: those who do not learn from history are doomed to repeat it).
This is some of what we know:
Covid-19 is less likely to be spread from contact with contaminated surfaces, and more likely to be spread via droplets when speaking, coughing, laughing in close quarters with another person or group of people.
Translation: Wear a mask. Especially when indoors. Wash your hands often.
Spending extended periods of time in the same room and especially in close contact, where droplets in the air can be inhaled, is the dominant route of transmission.
Translation: Wear a mask. Physical distancing is also key to prevent disease transmission. Stay 6 feet apart from individuals who are not part of your ‘bubble’ at all times.
The highest risk of transmission is around the time of symptom onset.
Translation: people are most infectious in the day or two before and after they first develop symptoms.
Reproduction number is important. Reproduction number is the expected number of cases of an infection that can be generated by one case in a population where all individuals are susceptible to that infection. When one person only infects one other person (before recovering themselves) the number of cases in the community will stay level. If one person infects 3 other people, and those 3 people infect 3 other people you can see that an infection will grow exponentially. When one person infects one person only the Reproduction Number = 1. When one person in infects 3 people, the R=3. So we strive for an R=1 or less during a pandemic. The R rate in Ontario in the past couple weeks has been about 1.2 (pretty goodJ). Ontario publishes its R rate twice weekly.
Translation: If R=1 or less we’re doing a good job. If R=>1 we need to worry a bit. A quickly rising R rate suggests a second wave.
The highest rates of infection are presently being seen in people between the ages of 20 to 40 years old. This is not surprising because community transmission is the most common mode of transmission of COVID-19 right now. Younger people are often asymptomatic, low symptoms, or unusual symptoms which makes them harder to identify as COVID-19 cases and therefore vectors for spread. Younger people generally have less severe illness so they may feel a bit more invincible in terms of COVID-19. It’s also summer in Ontario and people want to socialize.
Translation: Encourage young people in your life to take care. If there is any suspicion they may be sick or have been in contact with a potential COVID-19 case – they must get tested.
It is believed that 80% of individuals who contract COVID-19 are asymptomatic or low symptomatic (including children). Less than 20% of people will have significant illness and much less than that in children. Additionally, it has been found that asymptomatic and low symptomatic people are about 50% less contagious than older individuals with typical symptoms of COVID-19.
All good, right?
Not quite. Asymptomatic and low symptomatic cases are the source of 80% of further infections because there are more of them and they are more likely to be out and about. And if you are among the 1 in 5 who have a more serious illness, a good 20% of those individuals will suffer a long recovery with significant lingering symptoms (often referred to as ‘long-haulers’).
Translation: under 40 years old? Likely (but not guaranteed) mild illness, less infectious BUT RESPONSIBLE FOR MOST OF THE SPREAD.
For the younger crowd who’d like their social lives to normalize, for their job prospects to stabilize and for things to just generally get back to normal: it will be on your shoulders to wear a mask, avoid crowds, socially distance and wash your hands all the time. In the past few weeks Ontario has seen about 65% of its new cases of COVID-19 to be in those under age 40.
When children return to school there will be another level of complexity and children in particular are often asymptomatic. If you’re the parent of school-age children and you get sick, but your child is not, do not assume it’s nothing, or that you got it somewhere else. Get tested.
In the meantime, let’s enjoy our low COVID-19 summer!
As the saying goes, make hay while the sun shines! Visit friends and family, patronize local businesses and restaurants. But don’t fall into bad habits around COVID-19 prevention and preparedness. Don’t let your guard down. Autumn is just around the corner and we’ll need to be pandemic-fightin’ ready.
ArtMed’s Response to COVID-19: Reopening
ArtMed’s Response to COVID-19: Update
ArtMed’s Response to COVID-19: Update
This is an acronym you’ll want to know.
It stands for Infection Prevention And Control. Hospitals have entire departments responsible for IPAC. Every institution should have IPAC policies and procedures in place including every health care office and facility, every community business or agency that offers personal care services (manicures, mass age, tattoo etc) and every organization or business that treats water or supplies food (grocery stores, restaurants etc).
Prior to COVID-19, preventing the spread of infection was always important to keep people healthy and to prevent unnecessary risk of illness. But as we look to reopening our economy during a pandemic we’ll be entering a higher level of IPAC readiness. To borrow from military parlance, we’re entering into defcon 1 for IPAC level (‘defcon’ = defense condition). We’ve never been at this level of IPAC requirement for businesses in modern history.
As many of you know, I worked in Public Health for over 20 years. I am extremely well versed in IPAC and a real stickler about safety. When we renovated our new office at 381 Woolwich Street, IPAC was foremost in my mind. Consequently, ArtMed is already well placed to provide the highest level of IPAC due to our clinic infrastructure. Nonetheless, in addition to our usual protections, we’ll be taking it to another level when we reopen.
Some of you who may have attended medical appointments during the COVID lockdown. You may be familiar with the process involved when visiting a medical office during a pandemic. There is advanced screening of patients – if they are symptomatic with potential COVID symptoms they will not be attending the clinic in person but assessed through virtual care. Appointments are widely spaced to allow for disinfection of treatment rooms between appointments. Patients must wait in their cars on arrival and staff will call them in when ready. There are no waiting rooms full of people. Visiting a clinic means wearing a mask for both patients and medical staff. Medical staff are in medical clothing – no street clothes. Full face shields are worn if staff are getting closer to patients. Hand-washing is required when entering and leaving the facility. Acrylic barriers have been put up at reception areas. And the list goes on.
ArtMed has been working diligently in the past month and continues to work daily toward implementing the IPAC processes we’ll need to safely reopen during the pandemic. In the coming weeks we will let you know what visiting ArtMed will look like and what you can expect. Each day I receive dozens of emails with pertinent information from medical experts around the world. This information informs our decisions with respect to IPAC. There are a lot of things we don’t know about COVID-19 and so our IPAC processes need to adapt continually according to new information when becomes available. Fortunately, in North America we’re weeks behind Europe. They’ll be reopening ahead of us and so we’ll benefit from their experiences in the coming weeks.
As with most businesses, ArtMed will undertake a graduated opening. What does this mean? It means that we will offer the safest services first to the highest need clients first and at a lower volume of appointments than usual. It means we can’t go from fully closed to fully open all at once. We will bring things back in a graduated way and monitor our processes every day to be sure we’ve optimized safety for our clients and staff. We will offer more options around virtual visits for consults, and also chat function on our website so that clients can communicate with us in real time.
As you may be aware this new way of doing things may persist for some time, possibly 12 to 18 months. We cannot go back to our pre-COVID processes until there is a viable treatment for COVID or a vaccine to prevent it.
In Ontario we look forward to restarting our economy and partially relaxing the lock down in the coming weeks to months. In healthcare, medically necessary or urgent care will come online first – this will be the first tier and the first to reopen. First tier includes the backlog of surgeries that were postponed, cancer care, cardiac care etc. Second tier medical will come next which includes elective, non-urgent care and this is where ArtMed fits in.
We have been told that by the end of this week or the beginning of next week the government of Ontario will provide more detailed tier 1 and tier 2 opening dates. Armed with that information we hope to project an actual reopening date for ArtMed very soon.
As most of you know, Ontario is taking a more cautious approach to reopening the economy than Quebec. I believe Ontario is making the right choice. We need to be sure we’re ready to lift the stay-at-home orders. We need to be sure we have the infrastructure in place to monitor for coronavirus once the general public has more freedom to move about in the community. We need to be able to identify new COVID cases quickly and complete contact tracing within 24 hrs. We need to avoid a surge in hospitalizations. When restrictions are lifted it’s inevitable we’ll see further
spread of COVID-19. Monitoring and controlling that spread is essential if we want to avoid another shutdown.
Measure twice, cut once.
ArtMed has the measuring tape in hand. We have our clients’ health and welfare in hand. And when we get the green light from the government of Onbtario we’ll be ready to provide care at a defcon 1 level of IPAC readiness. We look forward to seeing you then.
ArtMed’s Response to COVID-19: Update
As our society-wide isolation continues, one of the most common questions I’m asked is how long will we need to practice social distancing? The short answer is – we don’t know. New infections and diagnosis of COVID-19 is still rising in Ontario and in Canada. Until we see significant plateauing of infections the only effective measure we have to fight the pandemic is social distancing. There is also the wildcard of what is happening in the United States which may influence decisions made by our own government.
I have been getting a lot of questions about social distancing versus self isolation. I am also getting a lot of questions about COVID itself and what to do if a person believes they may have COVID. Also questions about testing etc. I’m going to try to summarize the key information in this blog and also provide links to useful instruction sheets and websites.
This past week the government enacted stricter measures for self-isolation after travel. If you have returned to Canada from outside the country you must enter into mandatory 14 days of isolation under the Quarantine Act. If you do not respect the quarantine you could face heavy fines or jail time. It doesn’t matter when you returned to Canada, your 14 day quarantine starts when you arrive.
When you are under quarantine you cannot leave your residence. If you need anything – groceries, medications, they must be brought to you. If you just arrived in Canada you cannot use public transport (buses, subways or trains) to get from the airport to your home. You must go via a private vehicle and if you do not have access to one you must contact Public Health and they will arrange transport. Returning travellers will not be able quarantine anywhere they can come in contact with vulnerable people; those who, for example, live with an elderly person or someone with a compromised immune system. Again, if the traveller doesn’t have a place to quarantine due to these restrictions they are to consult Public Health for residential arrangements.
The government is increasing restrictions in an effort to limit the spread as over 1,000,000 Canadians have returned from abroad in the past week and many travellers may have COVID-19 and be unaware that they are infected. Limiting the seeding of infections across the country is a priority for the government at this juncture. Social distancing alone is insufficient to prevent spread from returning travellers.
The Ontario Medical Association provides excellent information with respect to what’s involved in social distancing. A great deal of up to date information can be found at: https://www.virusfacts.ca/ Everyone in the province should practice social distancing and also monitor themselves for signs of illness. This link provides information on how to self monitor:
At this time the only people who can work out in the community are those deemed ‘essential’. Here is the link to a government list of essential workplaces: https://www.ontario.ca/page/list-essential-workplaces
Self-Isolating is the next step after social distancing. It means you must not leave your home for any reason. The only difference between quarantine and self-isolating is that quarantine is not voluntary, it is a legal requirement and will be enforced by the government. If you are sick you should self-isolate. If you are not sick but fall under quarantine (recent travellers or identified by Public Health as having to quarantine or suspect you have been exposed to COVID) then you are self isolating as well. Even if you are on the list of essential workplaces if you are sick you absolutely must self isolate.
How to self isolate or quarantine if you are not sick:
How to self isolate or quarantine if you are sick:
If you are a caregiver of someone who is sick, how to self-isolate and care for sick individual:
What are the symptoms of COVID? Symptoms can be very mild through to severe in rare cases. The majority of people develop symptoms around 5 days after exposure to COVID but it can take up to 14 days for a few people to become symptomatic. Most people are infectious for 2 days before they become symptomatic. Children tend to have very mild illness.
Symptoms of COVID:
• fever ~90% of people get this (80% typically have fever above 38 degrees)
• fatigue ~70% of people
• dry cough ~60% of people get this
• shortness of breath ~30% of people
• runny nose, headache, sore throat, nausea and diarrhea are much less common symptoms
Symptoms can range from mild (80%+ infections) to severe (less then 20%) to critical (less than 5%). If you are sick and you suspect you may have COVID then notify your primary care provider or if you cannot reach them then contact Public Health (this to make sure health care providers know where there may be cases of COVID). If you have mild symptoms and do not live or work in a high risk environment (nursing home, care home, medical facility) it is unlikely you will be tested for COVID. Follow the instructions for self-isolation and STAY HOME. If your symptoms become severe then you should go to your local Emergency Department.
If you think that you were exposed to a person with COVID then self-isolate for 14 days. If you are an essential service worker and you are sick but did not get tested for COVID you must not return to work until at least 3 days after your last symptoms and a minimum of 7 days after your first symptoms.
Who is being for tested for COVID in Ontario?
At the time of writing the Ministry of Health is prioritizing testing in the following groups:
• symptomatic health care workers and staff who work in healthcare facilities
• symptomatic residents and staff in Long Term Care facilities and retirement homes
• hospitalized patients admitted with respiratory symptoms (new or worsening)
• symptomatic members of remote, isolated, rural and /or indigenous communities
• symptomatic travellers identified at a point of entry to Canada
Eventually the government may seek to do wider community testing. But at the moment given the number of days it takes to process tests and the availability of tests, testing is being limited to individuals who must be identified if they have
COVID because it impacts treatment decisions (eg. ER/hospitalized patients) or they could put vulnerable people at risk (residential situations like retirement/nursing homes/ prisons/ reserves) or they are health care workers.
That’s the update! I know that all this information is rather dense, but I’ve done my best to collate and organize it in a way that is easy to follow. I’m receiving updates all the time and it can be dizzying to keep track of all the information.
I hope this blog helps a little bit.
Stay well! Stay home.
ArtMed’s Response to COVID-19: Extended Clinic Closure
Due to the closure of all non-essential businesses as of yesterday for 14 days, as mandated by the provincial government, we have extended our closure to Tuesday April 14th. The current return date for businesses according to the official shut down for businesses is April 7th, however, we anticipate the closure to be extended to at least April 14th. Regardless, if the closure is not extended, we hope to be back in full swing to serve you on the Tuesday the 14th, right after Easter Weekend.
Stay home. Stay safe.
We will continue to update our closure and re-opening dates here. Please watch for follow-up posts. Thanks for your patience everyone!
From Jane and the whole ArtMed Team
ArtMed’s Response to COVID-19: Information
I’d like to pass on a few COVID related pieces of information. I have been receiving a constant stream of updates from government agencies, professional organizations, public health, hospitals and more. I’m happy to pass on key pieces of information and I hope you find it useful.
First and foremost, STAY HOME. Social distancing is the key to preventing the spread of COVID in Ontario. But what does that really mean? It means the people you live with should be the only people you are spending time with. If you absolutely must venture out into the public realm stay 6 ft away from others and don’t interact with them for more than a couple minutes. Do what you need to do, keep on the move, and then go home. If you are continuing to work outside the home carefully adhere to workplace policies related to social distancing and avoid socializing with co-workers.
No, you do not need a mask. It has been proven that masks are not useful to prevent spread among the general population. HAND WASHING is the key to preventing spread. Wash for at least 20 seconds with soap (any kind) and water. The virus has a fatty exterior coating which means that SOAP kills the virus by breaking down its outer coating. If you must go out your hands before you go anywhere and immediately on your return. Wash down door knobs, counters (especially plastic or stainless steel as the virus lives longer on these surfaces) light switches, toilets and faucets. Anything people touch is a source of infection. DO NOT TOUCH YOUR FACE, this is the most common way people acquire COVID. They touch a surface that is infected and touch their mouth, nose or eyes.
Absolutely avoid contact with people outside your residence who have travelled outside Canada in the past month. If you have travelled outside Canada in the past month yourself self-isolate. DO NOT GO OUT. If you need things have them delivered to you. If you’re going stir crazy get familiar with video technology to meet up with friends and family. Yes, you can go outside for a walk but don’t stop to chat at length with others. Yes, you can walk your dog. Going outside to get some exercise is fine for now.
Most people who are infected with COVID will not experience symptoms until at least 5 days after exposure to the virus. Research shows that individuals who have COVID are infectious to others 2 days before they show symptoms. Most community based infections occur during those 2 days when COVID infected asymptomatic individuals are interacting with others. But it can take up to 14 days for some people to show symptoms. This is why if you’ve travelled outside Canada in the past month, or have been in contact with someone who may have COVID you must SELF-ISOLATE FOR 14 days.
How long will this last? The jury is out. But the Prime Minister said our border will be closed for at least a month and it could be closed for months. So it could be a while, we just don’t know at this point. China is just starting to let Hubei province lift its restrictions and Wuhan itself has another 14 days of lock down. In total that means Wuhan will have had 70 days of lock down (and that’s assuming no new cases in the next 2 weeks). We will be able to see how things go in Europe which will also inform strategies for Canada.
What about testing? Countries which have employed aggressive COVID testing have seen the best control of the virus. In those countries they are testing widely including asymptomatic health care workers and often asymptomatic residents too. At this time we do not have the resources in Canada to test in this way (not enough test kits, not enough lab capacity). At present, the only people being considered for testing are individuals who have COVID symptoms (high fever, cough, shortness of breath) and the symptoms are MODERATE to SEVERE. Mostly this means people who may need to be hospitalized.
So what to do? In summary, stay home unless required to work, don’t be tempted to socialize, self-isolate for 14 days if you’ve travelled outside Canada in the past 14 days or live with someone who travelled, self-isolate if you have symptoms of COVID, and wash your hands and surfaces regularly and don’t touch your face.
It’s a brave new world! On the upside, the environment is very happy. An extended break from human activity has really improved the earth’s atmosphere and coastal waters. Always look for the silver lining, and as the British say, keep calm and carry on.
Mary Peirson, M.D., C.C.F.P.
Medical Director, ArtMed
ArtMed’s Response to COVID-19: Clinic Closure
ArtMed’s Response to COVID-19 – Clinic Closure
As many of you know, I worked in Public Health for about 20 yrs. Communicable disease prevention and treatment has always been a concern and interest to me. As you know, the World Health Organization has declared COVID-19 to be a pandemic which means that we are seeing worldwide community-based spread of this severe respiratory illness. In the world of Public Health protecting the health and well-being of the entire community is paramount and this means that in unusual times we must take unusual measures.
Thus far Canada has been relatively unaffected by the severity of this epidemic. But it is becoming clear from what we are seeing around the world and especially in Italy that an abundance of caution and preventive measures are necessary to prevent spread. South Korea, for example, has taken a very strong pre-emptive stand against COVID-19 and they have managed to severely curtail the spread of this illness in their country despite an early outbreak. We should all learn from their example.
Consequently, ArtMed has chosen to close starting Monday March 16th. We will be closing for two weeks but will reassess the length of closure as events unfold. We are shutting down the clinic at 381 Woolwich in a bid to protect our clients and staff from possible unnecessary exposure. Procedures at ArtMed are elective, and it is my position at this time that elective medical appointments, like elective surgeries, conferences, public sporting matches etc. should be avoided in a bid to limit the community wide spread of this illness.
Like influenza, COVID-19 is particularly severe in the elderly. Mortality rates in those aged 70-80 are around 8% and in those 80 years and older closer to 15%. By comparison younger people often have mild symptoms and the mortality rate is much lower. Newly infected individuals can be incubating the virus for a week or more before developing symptoms. We have observed around the world that the unchecked spread among the young and healthy eventually leads to severe illness in the elderly and in those with pre-existing medical conditions.
It is impossible for us to know whether we have asymptomatic or minimally symptomatic COVID-19 cases in our community already. From a public health prevention perspective, and based on what we’ve learned worldwide, the best approach is to limit COVID-19 spread among the entire population before we see an outbreak in our own community in order to protect the most vulnerable. Therefore, closing now will be most effective.
In summary, it’s ArtMed’s position that preventing spread in the first place is the best way to limit the pandemic. Because we are an elective medical facility, we feel it is responsible to shut down before illness starts spreading in our region. As a physician well versed in public health, I strongly endorse that old adage – an ounce of prevention is worth a pound of cure.
ArtMed staff will be working remotely to answer emails and phone calls and will be available through our social media channels. We will update our website and social media regularly to keep you appraised of when we will reopen. If you have scheduled appointments in the coming weeks, we will be available to reschedule your appointments. At this time, we are recommending booking at least 1 month from your previous appointment.
We understand and recognize this may be inconvenient for some. We hope to be open again in the very near future. For updates regarding COVID-19 please find below links to two reliable sources of information.
Mary Peirson, M.D., C.C.F.P.
Medical Director, ArtMed