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

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…….