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.