Discussion: Still skiing!

That's awesome - I'm jealous! We had great late season snow but the clubs were forced to close around March 18.

Yes - the Sites and Trails closure of the nordic trails got lifted now that the official season would be over anyway. Still lots of snow and despite no grooming quite smooth. Snow is pretty dirty in spots and variable conditions depending on the temperature, overnight refreeze and how sunny it is. We are not going to be mountain biking or trail running at Macpherson for a while so might as well still ski. A potential May ski is a certainty this year. Milo can come on all the trails now which is nice.

That's great! Are things continuing to stay manageable at your hospital?

No new COVID cases in town for over a month and no admissions. I am sure we have several COVID cases grumbling along but we have not been able to test mild cases. Our testing criteria have just broadened so we can start trying to get a better sense of community burden. BC is doing much better than Ontario/Quebec. I think a lot of this is based on luck and circumstance. We likely had way less community spread when shut downs went into effect. With exponential growth every day makes a big difference. Our later spring break likely helped limit people bringing cases back from holidays.

ED volumes have increased a little as people realize that they still have medical issues that need to be addressed but overall still low volume. We are in the lull where the initial adrenaline and excitement of preparation is wearing off and settling into the new routine. Clinic is 98% telephone or telehealth visits. Our fee codes got adjusted very quickly so we are still getting paid (unlike Ontario where there seems to be a delay getting telelheath payments up and running). Should be able to access the wage subsidy to cover some of the income shortfall.

That sounds about as civilized as one could hope for. I hope things stay quiet! How has telehealth been working for you? It must be tough when you can't even take blood pressure, let alone all the other things you would do differently when the patient is physically present.

'Bent hasn't billed anything since mid-March. He has mostly talked to patients on the phone and he's treated four quick emergencies in the office. Because he's not allowed to use aerosol-generating procedures (like a high-speed dental drill) without hospital-level PPE, he's not able to do a proper job most of the time, even if the patient's emergency meets the narrow criteria to be "essential", as determined by the Royal College. These days, dentistry mostly consists of figuring out ways to keep paying employees. For variety, we sometimes imagine what things will be like in future, e.g. 15-minute COVID test for each patient at the start of their appointment and for staff on a regular basis. Also N95 masks and gowns, renovations to the office to prevent air flow between operatories, etc. Ugh.

Most of my visits so far are by phone. I prefer video as I can get more clinical information from seeing the patient. It is surprising how much of an exam you can manage to do virtually. Overall for the majority of our visits things are exactly the same. Most of our physical exam in family practice actually has poor evidence for usefullness. Office BP readings are known to be the least helpful way to diagnose or follow hypertension. I'd say that the majority of family practice visits are counselling and reassurance which does not require a face to face visit. Our ED and walk in visits have dropped by around 1/3 to 1/2 but we haven't seen that same amount of patients showing up later in worse shape. Again an indicator that even for more acute care we are not usually offering a treatment that changes the course of the problem.

This pandemic will change how medicine is provided in the future with a fast forward to more virtual care. I can see 20-40% of my family practice becoming virtual. Historically payment was an issue but this was changing even before this event. I've talked with patients while they are still at work or at home. It is way more convenient with less productivity loss and less travel to/from the office. My colleague in Salmon Arm has patients who live all over the northern Okanagan who don't need to drive up to an hour to see him.

Dentistry is going to be tough in the short term but there will be scenarios eventually to provide the service while limiting the risk. There will be big changes though and I empathize with the difficult position you guys are in. I'm curious if dental staff generally have higher rates of other respiratory infections?

Excellent question. I did a little looking tonight. The first thing that popped up was a cluster of dental workers with idiopathic pulmonary fibrosis, possibly related to occupational exposure. Not the same thing but not entirely unrelated.
https://www.ada.org/en/publications/ada-news/2018-...

This 20-year-old Canadian paper was the most directly related:
Risk of Transmission of Viruses in the Dental Office
"...Seroprevalence studies have shown a higher prevalence of antibodies to influenza A and B viruses, respiratory syncytial virus and adenovirus among dentists compared with controls."
http://www.cda-adc.ca/jcda/vol-66/issue-10/554.htm...

Most of what I found discussed infection risk in dental offices from multiple perspectives: patient->dentist, dentist->patient and patient->next patient in the same room. Not surprisingly, there is more concern about the patients staying healthy than their health care providers! This is an example.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC33751...

Btw it's fascinating to get your perspective on how telemedicine is working out, how much patient visits have dropped without increased negative outcomes, and how/why medicine will change post-pandemic. These changes sound very positive.

I'm also thrilled to hear that office BP readings are unhelpful since I seem to get white coat syndrome occasionally, even when I think I'm relaxed. I never see those numbers at home or at the pharmacy. My doc is unconcerned so I guess she believes me!