Facts and Myths About the COVID Vaccine

Disclaimer: As always, the information I present here is meant to be an overall summary of what we know, and not specific medical advice for one person. If you have questions, please talk to your doctor.

As I write this blog, almost 52 million doses of the new COVID vaccines have been delivered to people around the world. Our knowledge about COVID (and the vaccines) continues to increase almost exponentially, and while we don’t know everything yet, here’s what we’ve learned so far.

Time to put the whole “Guinea Pig” argument to rest.

Many people have told me they don’t want to be a human “guinea pig” to test the vaccine on. The clinical trials on the vaccines (while quick) were thorough. More people have gotten their first dose of the vaccine than the entire population of Canada. If you get it now, you won’t be first. In fact you’ll be after this guy:

What if I have an allergic reaction?

After Britain warned against giving the Pfizer vaccine to people with a history of severe allergies, some people were concerned. However, now that we have given so many of these vaccines, we know that the rate of a severe allergic reaction (anaphylaxis) with the Pfizer vaccine is one in 90,090. Your odds of being struck by lightning in your lifetime are 1 in 15,030. Remember, all the vaccine sites have Epipen.

The Moderna Vaccine is Better/Has Less Side Effects

Some people are waiting for the Moderna vaccine. However, both the Pfizer and Moderna vaccines are equally effective. I had suggested that if your allergies were so bad that you needed an epipen, you might want to wait for the Moderna vaccine. But Canada’s federal government has done a poor job of ordering the vaccines. With Canada having deferred purchase of more of the Moderna vaccine (!), you probably should just get the first one you are offered.

I’m Worried About a Sore Arm and Other Symptoms After

Sore arm, fever, and muscle aches are all symptoms people can get after any vaccine. However, what’s important to note is that these are not side effects. A vaccine works by stimulating your immune system. If you get a cold, your immune system activates to fight the virus, and as part of that, will often give you a fever, and muscle aches. You may feel crummy, but your immune system is doing its job.

If this happens to you after a vaccine, it may be miserable to experience but at least you can take it as a sign your immune system is working, and you are getting a response to the vaccine.

It’s off label but I ensured that all of the resident of Bay Haven Nursing home got 1,000 mg of Acetaminophen three times a day the day before, the day of and the day after the vaccine. We have had no reports of flu like illnesses after the vaccine. I intend to take this myself before my second shot, and you may want to consider this as well.

I Am Pregnant or Trying to Get Pregnant

There were women of child bearing age in both the Moderna and Pfizer studies (although no pregnant women). The vaccine did not appear to cause issues. We routinely give other vaccines (like the flu shot) to pregnant women and it is felt to be safe.

When I study the science around it, there is no reason that the COVID vaccine should affect pregnancy. The Society of Obstetricians and Gynecologists of Canada has stated that: “Women who are pregnant or breastfeeding should be offered vaccination at anytime if they are eligible and no contraindications exist”. Please talk to your doctor about this.

But I Still Have to Wear a Mask/Get Swabbed/Get Screened!

Alas, yes you do. I share the frustration on this one. Health Canada only approves what it knows. The evidence from the studies on the vaccines was very strong that they would reduce your chance of getting COVID. However, to study whether the vaccine will reduce the risk of transmission is much more complicated. It requires a high level contact tracing which we don’t have in Canada.

However, every other successful vaccine in the past has reduced the ability to transmit whatever disease we were protecting against. That’s why we no longer have small pox, and until the rise of the renowned neurobiologist/brain surgeon Jenny McCarthy, had almost eliminated measles. I’m hoping that Health Canada will lift the requirement to wear masks for people vaccinated in the near future.

This should at least show you how much confidence they have in the Covid vaccines. I mean if an organization that historically takes it’s time to approve things moved so quickly when they saw the evidence for the Covid vaccines.

Are You Sure These Vaccines Were Tested Properly? They Were Approved Awfully Fast.

There was good reason to be approved quickly. As I mentioned in a previous blog, there was a significant reduction in bureaucracy. Everybody (drug companies/regulatory bodies/politicians) agreed we needed a vaccine as soon as possible, so the five years (!) of red tape was cut.

The second thing to keep in mind is that to test a vaccine, you have to expose people who had the vaccine to the illness. For a condition like shingles, you often times have to wait for years to see if the virus is effective, because as painful and awful as it is, Shingles is still relatively rare. It takes a LOT of time to accumulate the data needed to see if enough people benefited.

For COVID, one perverse benefit of the fact that the United States has one of, if not the worst responses to the pandemic in the world is that the virus is, well everywhere. That means the over 70,000 people in the studies could be exposed to the virus very quickly, and we could see very quickly if the vaccine worked.

Moreover, it’s a myth that all the drug companies who developed a vaccine were approved. There are 14 vaccines for COVID that were being developed. But if flawed, the trials were halted (like CSL in Australia or Sanofi-Glen‘s vaccine).

The Vaccine Is Genetic and Will Affect My DNA

Simply not true. The mRNA used in the vaccine will not affect your DNA. DNA is the stuff that makes you, well you. I can’t explain it any better than Dr. Abdurrahman:

I Don’t Trust Big Pharma/Bill Gates is Injecting Nanochips Into My Body/It’s an Illuminati Conspiracy

………. I got nothing. If you really believe this there’s nothing I can do to convince you otherwise.

Should I Get The Vaccine (Whichever one) When It’s My Turn?

YES! The lockdowns and economic harm caused by this pandemic are having a terrible toll on us. The social isolation, job loss, economic harm, mental illness and much, much more is devastating society.

If we want to visit our friends, if we want to go to a restaurant, if we want to go to Church/Mosque/Synagogue/Temple, if we want to travel, if we want to……..simply live a normal life again, we need to get everyone possible immunized. Without this, the pain we all suffer from this pandemic will continue.

Community doctors key to successful vaccination rollout

The following blog was co-written by Dr. Samantha Hill (current OMA President) and Dr. Adam Kassam (OMA President-Elect). It first appeared in the online version of the Toronto Star on January 11, 2021 and is reproduced here with the permission of the authours.

Images of elated physicians and other health care workers being immunized has been an emotional experience for our community. Our professional stoicism has given way to more fundamental and broadly shared human feelings: joy and optimism. 

For close to a year now, we have had to work at the very tip of the spear against the pandemic. This dangerous, exhausting and unpredictable work has taken its toll. That is why the vaccine represents a literal infusion of hope for us, our patients, families and communities.

We are thoroughly delighted for every colleague, long-term care resident and vulnerable person who is now a little bit safer. However, collectively, we are still a long way from defeating this disease. As we encounter record highs of cases, hospitalizations and — sadly — deaths, only a fraction of Ontario’s physicians have received a first dose of the vaccine. 

For understandable logistical reasons — which include the need for special cold storage — most of the first vaccines were administered in tertiary hospital centres, which have admirably risen to the immense challenge of organizing the safe and efficient deployment of the vaccines. 

Getting everyone vaccinated successfully relies on two key factors: the federal government’s continuous and predictable procurement and delivery of the vaccines to Ontario, and the provincial government’s ability to distribute and administer the vaccine to Ontarians.

To that end, as approvals for other vaccines occur nationally and vaccine supplies ramp up across the country, we will need to move beyond hospitals to build capacity to be provincially successful in rapidly immunizing our population. These centres are already stretched thin, simultaneously treating a growing number of sick COVID-19 patients and the usual hospital health care needs of Ontario.

Which is precisely why, the next leg in this crucial vaccine race requires a co-ordinated community effort to vaccinate front-line health-care workers and the vulnerable patients both within and outside of congregate care settings.

Approximately 60 per cent of physician services occur outside of the hospitals. Many of these community doctors — both primary care and specialists — have direct knowledge of their vulnerable patients. They have developed relationships, credibility and bonds of trust through their continuity of care, all of which are crucial for success of any province-wide vaccination program. Grassroots, community doctors will also be essential to co-ordinating the necessary two-dose schedule.

Community doctors must have clarity on access to vaccines, not only for their own well being, but also for planning purposes for their patients. They have been caring for their communities for years, and these doctors are an invaluable resource with experience, expertise and capacity that must be leveraged. Even now, in this next stage, Ontarians deserve a trusted medical professional — many of whom come from, live and work in diverse communities — upon whom to rely.

This pandemic has challenged every facet of our society. In Ontario, thousands of people have contracted and died from this terrible disease. Our already-precarious health care system has been buckling under this added pressure. Disruption to businesses, communities and families has been widespread.

We all desperately want this devastation to stop. Our path out of this is with these vaccines. Doctors are, unfailingly, at our posts and prepared to help. While this pandemic has been a marathon, we need to now think of the vaccine rollout as a sprint. Because in this race, lives and livelihoods are at stake.

Message from OMA President: STAY HOME

Dr. Samantha Hill

The following blog was written by Dr. Samantha Hill, a Cardiovascular Surgeon, owner of a Masters in Biostatistics and Epidemiology AND another Masters in Health Practioner Teacher Education. In her spare time she is the current President of the Ontario Medical Association, which represents 44,000 physicians, medical students and residents.

It’s time for some serious advice from your doctors to ensure that everyone has the safest and happiest holiday season.  

The recently announced lockdown is effective Boxing Day, but Ontarians do not have to wait.  All of us can, and should, take action now, including cancelling plans to visit family and friends on Christmas.

COVID-19 is serious.  The numbers of Ontarians confirmed positive for COVID, hospitalized, admitted to the ICU, and ventilated continue to rise dramatically.  Hospitals are again reducing non-emergent care and preparing for surge capacity.  LTCs are overwhelmed and calling out for help, as their patients, our elderly, suffer.

Clearly, we need to do better.

This spring, we demonstrated severe lockdowns save lives from COVID.  But, we failed our most vulnerable, saw high health costs (late presentations of other illnesses, marked increase in mental health challenges, and a staggering pandemic deficit of health) and severe economic consequences.

In September, we moved indoors again. Despite most people following public health guidelines, labs and contact tracers are again overwhelmed.  Lockdowns are present and imminent.

Let me be clear, that means we are failing. 

Lockdowns are a last resort, imposed when we fail to live safely within tenuous new normals and escalating precautions are not enough to protect us. There is no space for blame.  We are all in this together, and we all have a role to play.

I find myself needing to remind you, that during lockdowns, essential workers still go to work: your doctors, all front-line health-care providers, teachers, but also “invisible” essential workers who stock grocery store aisles, work the cash register, service the TTC, support LTCs and hospitals, etc. Many ride the TTC to do so.

Doctors know that being deemed essential does not equate with being safe from COVID-19.  A grocery store is no safer than a clothing store.  Lunch in the work breakroom is no safer than lunch with others anywhere else.   An hour on public transit is no safer than a one-hour flight. Over the past nine months, we have seen outbreaks, illness and deaths stemming from essential services.  These services stay open because we need them.

Essential workers are exposed to increased risks for the well-being of others.  We decided we can’t live without them. So we have an obligation to protect them, not just bang pots.  Their lives, literally, depend on our choices.

So how do we keep people safe? You already know: Mask up, wash your hands, maintain social distancing.  Always choose the safer activity, skip the social event or stay home.  When we get it right, we decrease the spread of COVID in our communities, avoid lockdowns, protect our most vulnerable, our essential workers and everyone else, without sacrificing everything else.

A COVID vaccine is on the way for all of us – we can finally see the light at the end of the tunnel.  But we are still squarely in the tunnel, and will be until the majority of Ontarians have been vaccinated (and the timeline for this is the end of 2021).  Worse though, one-third  of Ontarians are planning to ignore the public health recommendations to not socialize over the holidays.   Worst-case modelling projections predict nearly 10,000 cases daily by January.  Our choices today determine that.

So, this doctor’s advice? 

  1. Assess the risk and benefit of each action, job, trip or interaction, particularly during the holidays.  Is it worth the risk not just to you, but to all of Ontario? For those scanning: ALMOST EVERYONE SHOULD STAY HOME FOR THE HOLIDAYS.
  2. When worth the risk,
    • wear your mask and distance yourself from those who will not 
    • wash or sanitize your hands frequently
    • stay two metres apart
    • minimize the time you spend in close quarters with others, the number of people involved, how often you interact with others.
  1. Don’t grow complacent.  Small actions matter:  start a line when a store is full; redirect friends to gather outdoors or skip eating; keep your kid with a runny nose home; no one can tell if it’s just a cold.
  2. Keep getting tested for COVID-19.  We need to know where it is to eradicate it.

2020 has been a long, dark, year but the vaccines are arriving, bringing renewed hope.  Let’s all do our part and ensure that as many of us as possible make it into the daylight 2021 promises.

Letter to the Staff of My Nursing Home

Note: The following is a letter I sent to all the staff of Bay Haven Seniors, a joint Retirement and Nursing Home. There has been rather a lot of variable information about the new Covid vaccines out there, and I wanted to address that up front. Some of this information may help you as well, so I’m copying it here.

To:  All Staff at Bay HavenFrom: Dr. M. S. Gandhi, Medical Director
Re: New Vaccines for COVID19


As I think all of you are now aware, Bay Haven has been fortunate to have our staff given the opportunity to immunize early with the new vaccines for COVID19.  There has been much written about the vaccines in print and on Social Media (unfortunately!!) .  I wanted to let you know about some information on the development of the vaccine, and why I do strongly encourage people to get the vaccine.


In “normal” times (remember those?), when a drug company thinks about whether it’s a good idea to develop a vaccine for a certain disease, there is a bit of convoluted process that has to happen first.  Some officious bureaucrat at the drug company does a cost analysis on how much it will cost to make the vaccine and how much profit could be made from it.  Then it goes to a regulatory body in the host country where some other pointy headed bureaucrat looks at how widespread the disease is and whether it’s worth while to approve a trial.  Then it goes back to the company where some lawyer reviews the cost/benefit ratio, whence it goes back to the officious bureaucrat and then back to the pointy headed one.  Amazingly enough (and I’m not kidding here) this process can take 2,3, even 5 years before a trial even begins.


This time, every body agreed right off the bat that it was good idea to have a vaccine for COVID19, and so the up to five years of paperwork was eliminated. Seriously, that bureaucratic bafflegab can take that long.


The next step after the paper work is done is for a vaccine to undergo three phases of trials.  It’s important to know that both the Pfizer and Moderna vaccines DID undergo all three phases of trials.  Given the catastrophic situation around COVID, the trials were done quickly, but they were fully completed.  The Pfizer trials had about 42,000 people (by the way about 35% were people of colour ).  The Moderna vaccine had over 30,000 people (also with 35% people of colour).  The trials were extremely successful (94-95% effectiveness).  

The main side effects are the same as you would get from just about every other vaccine (pain at the injection site, fatigue, muscle pain, joint pain, fever).  These side effects are rare and and if they occur, go away in a couple of days.


There has also been a lot of talk about the fact that these are the first vaccines to be developed using “mRNA” technology.  I appreciate that when people talk about genetics, it can cause many people to have second thoughts.  But, mRNA technology has been studied for something like 30 years now in the oncology field.  Additionally, mRNA cannot and will not affect your genes.  It’s your genes that make mRNA in your body.  Your mRNA can’t go backwards and affect your genes.  


In short mRNA vaccines are an efficient, safe process.  They actually herald a new era of vaccine development that promises rapid and effective prevention for new pandemics in the future.  This is a good thing.


I also want to address some concerns about side effects circulating on social media.  The first is with respect to Bell’s Palsy.  There were four people in the Pfizer trials who developed Bell’s Palsy (now recovered) after getting a dose of the vaccine.  This translates to a side effect rate of .01%.  However, the “background rate” for Bell’s Palsy is .03%.  Put another way, if we were to simply pick 40,000 people at random, and watch them for a year, we would expect 12 people to get Bell’s Palsy.  This is why health professionals don’t feel that Bell’s Palsy is related to the vaccines.


Second, there is some talk about anaphylactic reactions (which can happen with any vaccines).  With the Pfizer vaccine the concern is polyethylene glycol.  Moderna has this in their vaccine too, but it seems in a different manner.  There may be some concern about this for patients who have severe allergies (to the point that you carry an epi-pen).  The best recommendation I could give is that if, and only if, you allergies are so bad that you need an epi-pen, it would be reasonable to wait for the Moderna vaccine (which just got approved today).  We expect this vaccine to be available for distribution in February.  If you do not need an epi-pen, then you should get the Pfizer one as it is out already.


If you want additional material, there is a nice thread from one of Ontario’s leading infectious disease specialists here:
https://threader.app/thread/1338610832884854784


There’s also a great interview with one of Ontario’s leading allergists/immunologists here:
https://twitter.com/jkwan_md/status/1339344606555746305


Finally, I would like to thank all of you for all the hard work you have done this year.  2020 is a year that we will never forget, and I suspect a year that we are all anxious to give the boot too.  Yet despite the hardship, the challenges and the seemingly unending (bad) surprises, you have continued to keep the residents safe, clean and comfortable.  Providing this at the latter stages of peoples lives is the absolute minimum sign of respect we can show, and the staff have done that in spades this year.


Thank you again, and allow me to wish all of you a Merry Christmas and a Happy New Year!


Dr. M. S. Gandhi

Medical Director, Bay Haven

A Physician Speaks Out About Long Term Care and COVID19

Dr. Silvy Mathew

The following blog was written by Dr. Silvy Mathew, who is by far one of the smartest people I know, and a dedicated and compassionate family physician to boot. It originally appeared as a Twitter Thread after she chipped in to lend a hand at a Long Term Care facility in crisis. It is being reproduced here with permission.

Tonight is 3rd night of no sleep since I went into a Long Term Care home (nursing home) in Ontario with over a hundred COVID19 positive residents, and almost no staff. So far, my other nursing homes have avoided outbreaks, but what I witnessed yesterday is needing words I don’t have. My brain can’t rest, and I think I’m in shock.

I’m not even tearful. I’m not afraid for myself (although yes the conditions were not good and Christmas with elderly parents is cancelled for sure now). I am just … hyper-vigilant.

I woke up after a couple hrs of sleep, having “dreamt” of another catastrophe. What I think my brain is ruminating on is how many levels have gone wrong here. This isn’t an individual’s fault, this is just so damn systemic. And with the right resources and people in charge, given some power to leverage things, we could probably stop some deaths.

But the system doesn’t allow for that. And asking individuals to do more…and more…and more… While we are all trying to maintain their other responsibilities… This is why things are crashing and burning now. It is traumatizing to say the least.

The worst is that only those of us who share these experiences and work in the same environment, can empathize. Empathy is lacking as a whole in our society, but even among colleagues because it feels (and is) like a war environment. And that itself is shocking nine months in.

At this point, it’s too late to stop events or focus on who’s responsible. Mitigation is key, but requires leadership, ground knowledge, and support.

I can say that the “boots on the ground” were women. All colours, various ages. And yes, a few men. Physicians, nurses, PSWs. Those whose pay is less were more likely to be BIPOC and female. The ones without sleep or breaks? Female.

I wish I took the contact of the RPN I worked with. She was one day new and a superstar. A hero. Maybe I’ll cry at some point but right now, I wish I could sleep.

Open Letter to all Residents of the Georgian Bay Region

The following letter was sent to local media outlets by the Medical Staff of the Collingwood General and Marine Hospital. It has been re-produced here with permission.

To All Residents of Georgian Bay:

A day that we had hoped would never come has sadly arrived.  A concerning rate of COVID19 has been demonstrated in our community and has been reflected in recent hospital admissions, as high as almost 10 per cent of all patients in Collingwood Hospital this past weekend.  The surge in patients hits us at a time when all of us would normally be planning Christmas dinners, trips with friends and family, and looking forward to well deserved vacation time.

As your physicians we have volunteered much of our time preparing for a day like this all the while hoping it wouldn’t come.  We have helped to set up our Covid Assessment Centre.  We have ensured that the hospital continues to have physician coverage and that Emergency care remains unchanged.  We have helped set up drive through flu shot clinics.  We have helped set up an Alternate Health Facility to offload the Collingwood Hospital.  We have attended many extra meetings outside of our normal clinical time.  We have kept local Family Physician offices and the After Hours Clinic open for both virtual and in-person visits. Our Hospital remains open for emergencies as well as routine, scheduled care. 

But now we need your help.

If all of us don’t take necessary precautions to protect our community our hospital is in danger of being overwhelmed, and we may not humanly be able to take care of a large influx of patients.

So we ask all of you:

– Please shop locally but wear a mask in stores, and at all public places

-Please maintain physical distancing of two metres (or one moose length)

-Please stay in your own social bubble of 10 people

-Please ask your friends and family not to come visit you this year

-Please stay home and do not travel to other areas

What we ask of you is difficult.  These asks come at a time of year when social events are the norm.  A time of year when many of us attend celebrations and a time of year when we normally enjoy fellowship with others.

But historically, it is also a time of year when our sense of community and our love for our fellow citizens, has always shone through.  This year, there is no better way of showing our commitment to our community by following the asks we have of you.  In this way, you will show that you care enough about our community to keep it safe and healthy.

We promise to continue to do our part to provide the best possible care to you.  We ask that you help us, help you and those you love.

Yours truly,

Gregg Bolton,

President, Collingwood General and Marine Hospital Medical Staff

COVID19 and Nursing Homes

For those of you who don’t know, I am the Medical Director of Bay Haven Care Community, a combined retirement and nursing home. Below is a letter that I sent to the family members of all the residents of the nursing home, updating them with information about COVID19. Reproduced here so it can be shared if others wish to copy it.

Dear Family Members of Residents of Bay Haven,

As the Medical Director of Bay Haven, I wanted to write to all of you to update you on some important new information about COVID19.

As you are likely aware, Ontario is now firmly in the second wave of the seemingly never-ending COVID19 pandemic.  As I write this, 99 out of 626 nursing homes in Ontario are in outbreak from COVID19.  Thankfully, Bay Haven is not one of them.  I hope and pray that it will stay that it will stay that way, and that the other nursing homes get out of outbreak as soon as possible.

Our knowledge of the COVID19 virus has increased significantly over the past few months.  We still don’t know everything about it, nor do we have a cure, but we can be better prepared than we were in the past.

We now know that the virus is largely spread by what’s called “aerosolized” means.  That’s to say that it is expelled by your mouth when you breath/talk/sing and floats in the air for a large period of time, thus spreading to others.  This is why wearing a mask is so important.  All of our staff and visitors have been required to wear masks for many months, in addition to all the other screening that we do.

With this knowledge, it is becoming more and more apparent for the need for high quality ventilation and air purifiers, particularly those with HEPA filters.  While the physical plant at Bay Haven is quite old, I am extremely grateful that the management of Bay Haven invested in HEPA air purifiers for all the large common areas, even before Health Canada updated their website to indicate the risk of airborne spread.  I applaud their commitment to keeping residents safe.

Additionally, there has been much speculation about the benefits of Magnesium, Zinc and Vitamin D in fighting viruses.  To be candid, the evidence for Magnesium is not that great.  Magnesium may kill viruses “in-vitro” – that’s to say, in a petri dish in a lab – but more study is needed to see how it works in a human body.  But at least it’s not harmful.

There is actually decent evidence that Zinc can help fight off viral infections.  Taking 25 mg of Zinc daily is not harmful and has benefits.

There’s been evidence that Vitamin D can help fight viral infections for some years now. Recently however, a large clinical trial showed that people with low vitamin D levels were more likely to get COVID19.  It’s a very large trial, and the first one I am aware of where the benefits vitamin D were proven for one specific virus.

What can you do?

First, of course we ask that you abide by our visitor polices, that have been mandated by the Public Health Departments.  These policies are sometimes frustrating to follow, but they have been implemented to keep our residents safe.  We ask that you please help us keep your loved ones safe.

Second, if you wish to provide additional protection, you could purchase a small room HEPA air purifier for your loved one.  These would stay next to the head of the bed in the room, and provide additional protection.  Currently they range in price from about $60 to $90 from Amazon. There are other models as well, of course, but they should be HEPA certified to be effective.  At that price, frankly these devices will only last 6-9 months before going bad, but hopefully by that time we will have a vaccine. (While a vaccine is expected shortly, there are many distribution problems with them, and I don’t expect them to be available for a few months).

Finally, if you would like your loved ones to start Magnesium, Zinc and Vitamin D, please let me know by replying to this email, and I will ensure these are ordered. To be clear, this is “off label”- it’s not specifically an approved therapy, but it is at least very safe, and not harmful at standard doses.

None of these measures of course, is guaranteed to prevent a COVID infection, or an outbreak, but right now, represents the best possible protection we can provide.

I hope and pray you all continue to stay safe and well.

Your sincerely, 

Dr. M. S. Gandhi, MD, CCFP

Medical Director,

Bay Haven Seniors

Integrated Health Care: If Not Now, When?

As always, opinions in the following blog are mine, and not necessarily those of the Ontario Medical Association.

Recently, Canada Health Infoway, a non-profit organization funded by the federal government to develop digital health solutions, announced that their electronic prescription solution, PrescribeIT, was adopted by the Shoppers Drug Mart and Loblaw chain of pharmacies. This followed on the heels of PrescibeIT being accepted by the Rexall chain. PrescribeIT allows physicians to essentially send electronic prescriptions from their Electronic Medical Records (EMRs) to pharmacies directly, eliminating the need for paper prescriptions.

Reaction from many physician leaders was generally positive:

Other reports indicate how solutions like this have helped during the current COVID19 pandemic. In England for example, 85% of prescriptions are now electronic, thus helping with social distancing.

While I’m glad progress is (finally) being made, I’m forced to ask one question. Why did it take so bloody long?

As I’ve mentioned repeatedly to various health care bureaucrats over the years, my region (Georgian Bay) has had electronic prescriptions for ELEVEN YEARS now. We’ve regularly been emailing pharmacies and had them message us with either requests, or further information.

Our project additionally allows for pharmacists to become part of the health care team by allowing them limited access to a few important pieces of health information they need to do their job properly. For example, they are allowed access to the patients kidney function tests (knowing that many drugs are excreted by the kidney). In that way, I have gotten much advice about changing the dosage of medicine based on how someone’s kidneys are working.

Building on this project, our local area has also ensured that the our After Hours Clinic uses the local EMR, so if patients have to go there, the physician on call can easily access their charts. The local hospital allows us to house our server in their IT room (increases security because of all the firewalls). The advantage of this is that hospital physicians can access all the outpatient records if needed, and provide better care for patients. Even our local hospice has access to this so that patients can get the care they deserve during their last days.

We were even able, for a three years to have the nursing homes access and securely message our EMRs. The result was an over 50% reduction in admissions to hospital from the nursing homes. The cost of the project was $35,000 per year, but the government couldn’t find the right pocket of money to fund it (sigh – see here for how the bureaucracy works) and so the project died. If you need a cure for insomnia, my talk with more details of how the project worked is here (skip to 7:28):

This then is the real frustration that I, and many other physicians have with EMRs and other Health IT systems. Can you just imagine how much further we would be if all areas of the Province had what a few isolated regions (like mine) have?

For COVID19 for example, our Covid Assessment Centre is on our EMR which means that I get an automatic notification if someone goes for a test. And if that test is positive, it allows for quick notification of the family physician so we can begin the process of contact tracing. It also allows for easy transmission of information of people with febrile respiratory illnesses so that we can track important information like when the symptoms started and ended.

Dr. Irfan Dhalla wrote an exceptional piece in the Globe and Mail on preparing for the winter in times of COVID19. Unsurprisingly, he called for reducing “untraced spread” of COVID19 (50% of all cases have no known contact) and a large part of that solution is a technological one, namely the Canada COVID alert app (available at both the Apple App Store and the Google Play Store).

While he’s correct about that, the reality is that we have more illnesses that we have to deal with than just COVID19. We need to be able to manage cancer, other infectious disease, heart disease, diabetes, the frail elderly with multiple problems and much more. The better we manage those illnesses, the more we can keep those patients out of hospital, which is great anytime, but particularly when there is a risk of hospitals being overwhelmed by a pandemic.

Again, in our neck of the woods the Home Care case co-ordinators are on our system. I often get messages from them about how one of my patients is doing, and requests for information from them (so much easier than faxing). This allows me to remotely address concerns patients are having sooner, and for frail patients, getting treatments sooner can often prevent a rapid deterioration, which will of course, prevent a hospitalization.

So while I really am glad that many more physicians will have access to PrescibeIT, I reluctantly point out that in its current iteration it only does about 65% of what our solution does. I suppose that’s better than 0% which people had before, but it is a testament to the failure of a wide swath of health care bureaucrats over the years that this is the best we have.

Even our system is not perfect. I get miserable situations like some of my COVID19 results come in through OLIS (Ontario Lab Information System) and others through HRM (Hospital Report Manager) and yet others get faxed (!) to me. The auto-categorization in HRM is really a complete joke. I dictated a note on one of my hospital inpatients, and the system classified me as a combined General Surgeon, Anaesthetist and Paediatrician – and while I’m glad the system thought I was that smart, the reality is I now have to go through all this data and spend extra time categorizing it properly.

eHealth Ontario, Ontario MD, Health Quality Ontario, the Ministry of Health and its various digital health teams were all to work co-operatively to build a strong Health Information System. But the reality is that these individual systems do not share information in a way that benefits patients.  The shared vision for health IT in the province (integrated health systems IT) still only exist in pockets around the province. There are lessons to be learned here and steps that should be taken.  All of which would really be beneficial now as we head into a potential second wave of COVID19.

Which leads this old country doctor to wonder: If knowing that a potentially huge crisis is coming our way in health care, will no one step up with a vision to fix Health IT Systems and Integrate Health Care information once and for all? And if not now, WHEN?

ConquerCovid-19 a True Canadian Success Story

Not all heroes wear capes.” – It’s an expression often found on the internet.  It of course, refers to the fact that you don’t have to be Batwoman or Superman or whoever, to do some good in this world.  

During the Great Pandemic of 2020 of course, this phrase is often used to describe those of us who provide health care on the front lines. Cleary, the physicians, nurses, first responders, PSWs, support staff, environmental services staff and many others who provide front line care during this historically difficult time are heroes.  They inspired me during my term as President of the Ontario Medical Association (OMA), and they continue to inspire me now with their dedication and passion.

While there are many other heroes out there, I want to give a shout to one group that in many ways represents Canadians at their best, ConquerCovid-19.  

The full story of how ConquerCovid-19 came to be can be found here. The short version is that they started out in mid-March as the brainchild of Sulemaan Ahmed and his wife Khadija Cajee.  They heard their physician friends complain about the lack of Personal Protective Equipment (PPE) in their clinics, and wanted to help.

Neither one of them is a stranger to advocacy for social causes. They both are already heavily involved in fighting the ridiculous No Fly list in Canada that erroneously lists thousands of children and innocent people.

Sulemaan, Khadija and four of their friends formed ConquerCovid-19 and using their business connections ( Executive Training with ServoAnnex) asked companies who had PPE to donate them to health care providers.  Almost immediately, their friends and their friend’s children volunteered to help out (with apologies there are too many to list).  The organization grew steadily and quickly.

Then a medical student who also was worried about the shortage of PPE heard about their endeavours, and offered to help out.  As brilliant as medical students are, normally one extra student wouldn’t cause a wholesale change.  But said medical student also happens to be the greatest female hockey player of all time, Hayley Wickenheiser.  Next thing you know, she gets her friend Hannibal King….Green Lantern….. Deadpool… Ryan Reynolds involved and the star power catapulted the success of the organization.

A quick look at the their twitter feed shows that they have donated PPEs to organizations that deal with at risk youth, medical schools, support services for frail seniors, nursing homes, multiple child and youth services, shelters for new immigrants and refugees, rural and remote areas of the province and much more.

What’s more, they suddenly found people willing to donate supplies other than PPE. Instead of saying no, ConquerCovid-19 took on Hayley Wickenheiser’s mantra (Get Sh-t Done!) and took non-PPE supplies and found good homes for them. Have some extra computer tablets – send them to nursing homes so residents can communicate with families. Feminine hygiene products – send them to Women’s Shelters, and much more. There has also been a significant amount of cash raised from sales of what Reynolds calls “a boring shirt”. Ok he was more colourful than that, but check out #boringshirtchallenge.

All of this was in addition to the almost 500,000 units of PPE donated to medical clinics across the Province in co-ordination with the OMA. I was honoured to have been invited their April PPE drive where I saw the group in action.

That’s when I realized the best thing about ConquerCovid-19.  They exemplify what Canada is all about.

It’s no secret that we are so living in a time where there is a tremendous, un-precedented call for social justice.  The Black Lives Matter movement has forced us to confront and deal with inherent systemic racism against Black Canadians. In particular, Statistics Canada data shows that we are failing yet another generation of Black youths. Alas there are too many such stories in Canada.

Our record in dealing with our Indigenous population is disgraceful, with even the United Nations calling the housing conditions abhorrent.  We have systemically discriminated against them, and there are too many individual stories to mention. There has also been a rise in Islamophobia and anti-Semitism.

Many will see this and despair for Canada.  Make no mistake, all of us need to continue to be vigilant and work to improve our country.  But when I think of Canada, I will, instead, think of ConquerCovid-19, and how it exemplifies what Canada is all about.

You see, Sulemaan and Khadija are Muslims whose families immigrated to Canada.  The leadership group (whom I was fortunate to meet) includes Jews, Sikhs, Christians and those that are, let’s say, ill defined when it comes to religion.  They have people of all colours in their organization.  

ConquerCovid-19 is not just a snap shot of Canada in 2020, it’s a snapshot of the best of Canada.  While we struggle to deal with our failings as a nation, rather than look with despair on our country, we should look to the hope that organizations like ConquerCovid-19 provide.  To my mind, there is no other country on this planet where such a diverse group of people could come together, find a common cause that is rooted in charity and selflessness, and work co-operatively for the benefit of all.

The strength of Canada lies in it’s unique multi-cultural nature, where our differences are celebrated, not denigrated. Where our basic humanity, tolerance and kindness is the common thread that unites us all. That is what Canada is all about, and that is what ConquerCovid-19 exemplifies every day by their actions.

Thank you ConquerCovid-19, for reminding us of the promise that is Canada.

We Need to Learn to Live With COVID-19

“All of this has happened before, and will happen again.” – Lt. Kara Thrace, aka Starbuck, from the Battlestar Galactica (2004) TV show.

An advantage of being old is that whatever is happening, you have likely seen it, or something like it before. Every so often, society undergoes an upheaval and people have to change behaviours. For those of us who were around in the 1980s, there are some stark parallels to what happened then, and what society must do now in 2020.

The early 1980s were a different time not only for how we lived as a society, but for how medicine was practiced. This was particularly true with how we handled body fluids. As surprising as it may be to some younger readers, there was no such thing as universal body fluid precautions back them. If you had a known blood born illness like hepatitis, then sure, extra precautions were taken. But not for every body. When I was in medical school, there were multiple stories of a particularly nasty vascular surgeon who would squirt blood on trainees during surgery if they got an answer wrong to his questions. Needle prick injuries were routinely ignored. There was not a robust sharps disposal system. In short, it was very different.

A huge shift in society, and medicine, came when reports of a novel virus (sound familiar?) became publicized. This virus was new, deadly, and little was know about it. At first, this strange new illness seemed to only affect gay men. This led to all sorts of additional discrimination against the gay community, and even more ostracization then they were already experiencing. Mainstream media outlets routinely referred to it as “The Gay Plague” which clearly didn’t help matters. This also led to whack job conspiracy theories about its origins, some of which persist to this day.

This strange new illness was, of course, eventually named “Acquired Immune Deficiency Syndrome” or AIDS and the virus that causes it was identified (Human Immunodeficiency Virus or HIV). It was recognized that body fluid transmission could spread it and that it was not limited by sexual orientation. We learned it was possible to carry the virus and not have symptoms and you could get it from anyone.

And so, the age of universal blood and body fluid precautions began, and policies around this were implemented in hospitals and other health facilities between 1985-1988.

But there was also a shift in how society responded. Until then, most public service announcements around Sexually Transmitted Disease (like this painfully dated one from 1969) focused simply on encouraging people to get treatment after the fact. And accepting that it was possible for you (yes, sweet innocent you) to get an STD.

AIDS changed all that. Suddenly, an STD could be deadly. Suddenly there was no cure or vaccine. Suddenly, just getting treatment wasn’t an option, and education around prevention was mandatory.

With education, the public took precautions. “No glove, no love” was a popular catchphrase used to promote latex condom use as these were proven to significantly reduce the risk of transmission of STDs (including HIV). Public service announcements shifted to openly talking about prevention.

In short, people and society adapted, and changed behaviours to deal with this new virus.

Today of course, we are faced with a novel new virus, that is clearly deadly and is widely publicized. Little was know about it at the start, and we continue to learn about it. The virus seems to have originated out of China, and this has led to all sorts of anti-Asian racism (including from the President of the United States). There are whack job conspiracy theories about it. As we learn more about the virus, we know asymptomatic spread is possible, and that, yet again, anyone can get it. There is no vaccine (and despite Dr. Fauci’s optimism I’m not holding my breath) and no effective cure.

In response, hospitals and other health facilities are implementing new polices around Personal Protective Equipment (PPE). Hospitals are taking extra precautions around elective surgery as the risk of mortality in patients who get COVID19 infections peri-operatively is ridiculously high. In my office I now see patients wearing a mask, eye protection, and surgical scrubs that I immediately remove after my day is done.

And now too, society will be asked to change in response to this most awful virus. The simplest thing to do of course, is to wear masks when you are in an indoor public place, or better yet whenever you leave the house. As mentioned in an earlier blog, one only has to look at Japan where there was poor social distancing, packed public transit and no closure of their famous karaoke bars, but people wore masks, and the number of infections was extremely low. Wearing them also is key to restarting the economy so we can get on with our lives.

Next, we need to accept contact tracing. Aggressive contact tracing in South Korea was largely responsible for their low rates of infection. I was glad to hear that Ontario will be introducing an app to do this. I can already hear the cries of invasion of privacy, but if we are to control this virus, we are going to have to figure out a way to contact trace safely, and protect personal privacy at the same time.

The big difference between the AIDS epidemic of the 1980s and COVID19 now is, of course, the economic costs. The economy was never shut down then, and the kind of wholesale level of job loss we are experiencing now in (hopefully) once in a life time.

But if we are to get the economy running (and we must for a whole bunch of reasons, including the fact a good job improves overall health care), then society will need to adapt again. We did it forty years ago, and I believe we can do it again.

I am however, not looking forward to 2060…….