Niagara Medical Group

If you have been following the news lately, you know that our health care system in Ontario is in crisis.  Emergency rooms are overflowing with patients and wait times are very long.  The situation is particularly bad in the pediatric sector, where both McMaster Children’s Hospital in Hamilton and Sick Kids in Toronto are struggling to cope, and sadly, being forced to look at ways to ration services, even to the point of cancelling planned surgeries for children.  Here in Niagara, we are also struggling to cope.  In our Family Health Team, after-hours urgent care clinics are swamped, and we are having to turn people away because we simply cannot cope with the numbers.  We need your help to get through this.

Why is this happening?  The main issue seems to be a massive amount of respiratory illness.  Based on wastewater analysis, a lot of it is Covid-19 (the pandemic is NOT over!).  About 1 in every 18 people in Ontario has active Covid-19 right now.  We are also seeing a surge in influenza and RSV (respiratory syncytial virus), and again, a lot of it is in children.  It probably reflects a couple of things:  First, we (and our children) have been wearing masks for about two years, and have had very few respiratory illnesses like colds and flu.  Now the masks are off and the viruses are making up for lost time!  Secondly, there is emerging evidence that infection with Covid-19 causes an immune system deficiency that lasts for quite a long time after the main part of the illness is over.  This may be making us and our children even more susceptible to the other viruses that are circulating.

What can you do to help us weather this storm? 

 PREVENTION and TREATMENT

Prevention:

1. Masks –  I know that nobody wants to hear this, but you can prevent Covid-19 and other respiratory illnesses by wearing a mask.  Please consider wearing a mask in indoor settings, especially crowded ones, and on public transit.  The smaller the space and the more people in it, the greater the risk.  And not just any mask, either.  Cloth masks should not be used.  They are just not good enough.  Those pleated medical/surgical earloop masks are not really good enough either.  What you need is an N95 or KN95 mask.  The closer it fits, the better.  Outdoors, you probably don’t need to bother, but indoors in public places, please go back to wearing one.
2. Ventilation – Open windows.  Exchange the air in the space as much as possible.  Install HEPA filters to filter the air if you can.  There are lots of different models at various prices.
3. Vaccines and boosters–  Please get a flu shot as soon as possible and a Covid-19 booster as soon as you are eligible and make sure your children do too.  They can be given at the same time or at any interval, it doesn’t matter.  Our rates of immunization and boosters in people under 18 in Canada are dismal and that is making things worse.

Vaccines and boosters DO reduce the likelihood of infection (especially after a recent booster) and DO reduce transmission, even though they are not 100% effective at either of those things.  Where vaccines and boosters are really helpful is reducing serious illness, hospitalization and death.  This applies to flu as well as to Covid.  Don’t fall into the trap of thinking that influenza is a mild illness, or that Covid in children isn’t very serious.  The truth is, sometimes it is and sometimes it isn’t, and if you guess wrong, then you may be one of the people in the waiting line to get health care.  With respect to Covid, there is good evidence that the older you are and the fewer boosters you have had, the higher your risk of dying.  For instance if you are over 80, have had less than 2 doses of vaccine, and get Covid, your risk of dying is about 1 in 7.  If you have had 4 doses and the latest was less than 3 months ago, it is 1 in 66.  This kind of difference is seen in all age groups.

4. If you are ill, stay at home and isolate yourself.   No matter what you have, don’t go out and spread it around to others.  If you have tested positive for Covid, the “rules” in Ontario now say you can stop isolating when you begin to feel better.  Unfortunately, this recommendation is not supported by science.  According to one study in Japan, the highest amounts of virus are in your system on days 3 through 6, and aren’t really low until day 10.  So please bear that in mind and consider self-isolating for a longer period than what is currently recommended.

Treatment:

Antibiotics DON’T WORK.  These are viruses, and antibiotics are only useful for bacterial infections, and even then, we are trying to avoid using them as much as possible.  If you have a runny nose and a cough, no matter how annoying or how long you have had it, you have a virus.  There is no need to seek medical assistance unless you are having trouble breathing or severe weakness.  A lot of people think they may have strep throat.  Strep is actually not that common compared to viruses, and the symptoms are usually sore throat and fever and nothing else.  If you have other symptoms like cough or runny nose, it’s likely NOT strep.  If you or your child has an earache and are not feeling TOO ill, and don’t have a really high fever (over 39C), wait 48 hours before calling.  Most ear infections clear on their own so we try not to prescribe antibiotics right away.  Nasal congestion does not mean you have sinusitis, and even if you do have a sinus infection, we are avoiding antibiotics because the vast majority of these are caused by viruses also.

If you have symptoms of a virus, do a rapid test to detect Covid.  Do the test on about the 3^rd day of symptoms for the best detection rate.  The recommended procedure now is to use a single swab to swab the back of the throat (or your cheek next to the back teeth), and then use the same swab to do both nostrils, as deep as you are comfortable going.  This also increases the detection rate.  If you have Covid and are relatively young and otherwise healthy, and you aren’t too ill, there is no treatment needed other than isolation and fever control with acetaminophen or ibuprofen.  Stay at home and isolate, as discussed above.

There is a treatment for Covid-19 called Paxlovid.  It consists of two antiviral drugs given together.  It has to be started within 5 days of symptom onset, but it is only prescribed for people at high risk of severe illness or death.  You are at high risk if you are:

1. Immunocompromised because of medications or certain illnesses
2. Are over 70
3. Are over 60 but have fewer than 3 vaccine doses
4. Are over 18 with fewer than 3 vaccine doses and one of a number of underlying conditions.  You can do a self-screen here, to see if you qualify before seeking medical attention:

https://www.ontario.ca/covid-treatment-screener

I know that this has been a rather long bulletin, and I appreciate you reading it all.  We in the health care sector really need your assistance to get through this crisis and hopefully soon return to some degree of normalcy.  If you do need to call us for help, please bear with us and realize that we are doing our best to keep you and your family safe and healthy through a very trying time.

Cheers,

* Please note masks are still to be worn during this time.*