Canada is seeing what experts call a ‘summer surge.’ Although COVID-19 and other respiratory illnesses are often associated with colder months, COVID-19 cases have risen in recent weeks due to decreasing immunity among the general public.

Wastewater surveillance from the Public Health Agency of Canada suggests rising cases across the country. The current viral activity level for COVID-19 in Canada is deemed ‘moderate,’ with cases highest in Toronto, Winnipeg, Vancouver and large parts of Nova Scotia.

“This summer, we have seen some severe cases of COVID-19 among older adults and those with compromised immune systems”, says Dr. Jerome Leis, medical director of Infection Prevention and Control at Sunnybrook. “This is similar to past summers, but one difference is that these severe cases are occurring in higher frequency among individuals who may have been vaccinated at the beginning of the pandemic but have not kept up with seasonal COVID vaccines.”

What is behind the surge in cases?

The increase in COVID-19 cases is mainly due to decreasing immunity in the general population. While most cases remain non-severe, an increase in hospitalizations may be related to gradual loss of immunity against newer strains of COVID-19 and the need for updated seasonal vaccine to increase protection.

How do summer activities impact COVID-19 cases?

Like some other respiratory illnesses, COVID-19 circulates year-round. Cases of COVID-19 are heightened by common summer activities like increased social gatherings, travel, and spending more time inside during extreme heat events. All of these situations have the potential to spread COVID-19 to those with decreased immunity.

What can you do to protect yourself and others against COVID-19?

Getting the updated COVID-19 vaccine his fall is the best way to increase protection throughout the year.  While it’s too late to get the vaccine to combat the summer surge, this year’s updated COVID-19 vaccine should be available by early fall. Masks can also be worn to prevent transmission to high-risk individuals.

What should you do if you suspect you may have COVID-19?

If you have cold symptoms or think you may have COVID-19, you should avoid gatherings where you can spread germs to those who may have more severe outcomes from COVID, until you are fully recovered.

By following public health guidelines and staying up to date with COVID-19 vaccinations, we can all do our part to stay protected.

The post Not just a cold: What to know about Canada’s summer surge of COVID-19 appeared first on Your Health Matters.

“It’s a full-time job caring for your kids and juggling everything else,” says Dr. Ali Appelton, a family physician with Sunnybrook’s Department of Family and Community Medicine who has three young sons. “Many parents are scared.”

Dr. Appelton says it’s more important than ever to have reliable medical information to help guide you. Together with Dr. Claire Murphy, also a family physician at Sunnybrook, and Jo Arbus, a pharmacist in the hospital’s neonatal intensive care unit, they provide their tips and recommendations for parents. To view a webinar on the same topic, please visit our YouTube channel.

Three things to do as soon as you can

Review your child’s immunization records: Many children are behind in school-based vaccines and it’s important to get kids caught up. You can see the listing here. And don’t forget the flu vaccine and COVID-19 vaccine, both are safe and approved for kids aged six months and older.

Embrace prevention: You and your entire family should wash your hands frequently, wear proper masks in crowded indoor settings, cough into your sleeve, get vaccinated and stay home from school or work if sick.

Invest in a good thermometer: Digital is best. If your child is under two years of age, the armpit or rectum provide the most accurate measurement. When they’re older, taking their temperature by mouth or ear is the best way.

Assemble a list of both virtual and in-person after-hours clinics: You don’t want to scramble if and when your child does become sick. Good virtual resources include Toronto Virtual Emergency Department and Sick Kids Virtual Urgent Care, and there are many in-person after-hours clinics throughout the province.

If your child gets sick

When your child has a fever:

• If your child’s temperature is raised (38 degrees Celcius or higher) but their energy is okay and they’re drinking: It can be scary seeing a higher temperature, but treat your child, not the temperature. If they’re relatively energetic and drinking water, juice/diluted juice or Pedialyte or eating popsicles, you don’t necessarily need to treat the fever with medication. The same goes for those infants who are breastfed or on formula – if they’re drinking that’s great as keeping hydrated is the most important thing.
• If your child has a high fever AND they’re lethargic: Your child should be treated to bring the fever down. Dose the medication given based on weight not age.

For COVID-19:

• Know how to test with a rapid antigen test (RAT): swab in between the lower teeth and gums and turn the swab three times. Then swab the back of the throat, followed by each nostril. Do this every couple of days. If the test continues to be negative, it’s likely not COVID.
• If the test is positive, check out a resource created by the Department of Family and Community Medicine, University of Toronto and the Ontario College of Family Physicians.

Medication do’s and don’ts

Medication for fever:

• Under six months of age: no medication at all unless prescribed by a doctor
• Over six months of age: only ibuprofen or acetaminophen, and dose the medication based on weight, not age

Cough and decongestant medication: There is no evidence these over-the-counter medications work so they are not recommended. Coughing can be very helpful as it helps the body get rid of mucous. Medications that stop this normal response to cough can also actually be harmful as they may contain codeine (this cannot be taken by children 12 and under). Decongestants can act as stimulants and lead to insomnia in children. For a very stuffy nose, saline drops or sprays can soften the nasal mucous and offer relief, and nasal aspirators can remove the mucous.

Natural health products: These are not always safe for children. Please speak with your health care provider before taking any labeled as ‘natural’ or ‘homeopathic.’

When do I take my child to the doctor?

When your child has had a fever for more than three days, so day four of a fever, you should call your doctor. Many viruses circulating now are causing prolonged fevers, so it’s good to check in with your family doctor, pediatrician or nurse practitioner. A fever that goes away and comes back may be a sign of a bacterial infection.

If your child has shortness of breath that has them flaring their nostrils, with the skin around their ribs sucking in like an accordion, also call your doctor to rule out a chest infection.

Take your child to the closest Emergency Department if they are:

• Younger than three months of age and have a fever
• Dehydrated, which means no urine in 8 to 12 hours and no tears. You can monitor urine output in their diapers – put some toilet paper in their diaper so it will be easier to check
• Severely short of breath to the point they are unable to feed to sleep
• Extremely lethargic, and cannot even muster a cry, or only moan and groan

The post Navigating the ‘tridemic’ of flu, RSV and COVID-19 appeared first on Your Health Matters.

A new study, published this week, from Sunnybrook senior scientist Dr. Donald Redelmeier explores how an available simple diagnosis can skew complex medical decision making.

“Occam’s razor is the traditional idea that simple explanations should be preferred over more convoluted theories,” says Dr. Redelmeier, who is also a Sunnybrook staff physician and Canada Research Chair in Medical Decision Making. “Yet this idea has rarely been subjected to experimental testing for evidence-based medicine.”

Dr. Redelmeier and his co-author Dr. Eldar Shafir from Princeton University were interested in testing the concept in the context of the COVID-19 pandemic. “We hypothesized that an available alternative explanation might lead individuals to underestimate the likelihood of a COVID-19 diagnosis,” says Dr. Redelmeier.

The study asked community members and health-care professionals to judge the chances of COVID-19 in a hypothetical patient through a set of different surveys. Each survey provided a succinct description of a hypothetical patient scenario, suggestive of COVID-19. Each scenario was formulated in two versions randomized to participants, differing only in whether an alternative diagnosis was present or absent.

“Through scenarios involving a spectrum of risk, we found that respondents judged the probability of COVID to be much lower in the presence of another diagnosis, such as influenza or strep throat, compared with when an alternative diagnosis was absent,” says Dr. Redelmeier. This contradicts available microbiological evidence.

“The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. In turn, underestimating the risk of COVID infection might reduce a patient’s willingness to seek care and a clinician’s willingness to investigate a medical diagnosis.”

Dr. Redelmeier adds that the results suggest an available simple diagnosis can lead to premature closure and a failure to fully consider additional serious diseases.

“This bias occurs because risk factors such as crowded living spaces, lapses in hand hygiene, and poverty are risk factors for COVID infection, as well as for other diseases such tuberculosis. After diagnosing a patient with COVID, for example, a clinician might pause and check — is that really everything?”

He adds that as patients are living longer with multiple diagnoses occurring together, an over-reliance on Occam’s razor can contribute to misplaced complacency and discourages the search for additional contributing factors.

“The bias may be important to recognize for the COVID-19 pandemic, other diseases, and for the next disease outbreak.”

The post Can an easy excuse lead people to underestimate a COVID-19 diagnosis? appeared first on Your Health Matters.

“The beginning of the pandemic saw a decrease in sexual activity amongst young singles because the normal places where people would meet up disappeared,” says Dr. Sharon Domb, a staff physician in the Department of Family and Community Medicine at Sunnybrook. “And people were afraid to pick up COVID, so there was certainly more anxiety and stress about meeting new people.”

But with fears easing, restrictions lifting, and most activities back on, Dr. Domb says she suspects singles will return to “normal” behaviours in terms of sexual activity — which can have benefits and risks. She shares helpful insight that people should be aware of if they hope to engage in more sexual activity.

Many people, especially singles, experienced a dry spell in terms of their sexual activity throughout this pandemic. But now with things opening up again, it looks like that could be changing. Can you talk about why this is a good thing?

Sex in the right context for most people usually is a positive thing. From a psychological perspective, from a physical perspective, all of those things.

Young singles certainly suffered a lot in terms of the isolation and the change in their social behaviours and normal social interactions; it was very challenging for the demographic. So, it’s great that they can rekindle social relationships, to be able to get back to sort of normal behaviour, to interact with friends and meet people and hang out.

There’s a huge mental health benefit, not just with sex, but also with the relationships that lead to that.

As we know, the pandemic isn’t over. So, for those who are trying to get out and date and meet new people, how worried should they about COVID-19?

I think everybody sort of needs to take stake of their personal situation.

Are they living with somebody who’s immunocompromised or with an elderly relative? Is it going to be catastrophic if they get COVID? Are they immunocompromised or unwell themselves? If yes, then I think they have to be extra cautious, understanding the ramifications if they get COVID.

If they’re not particularly at risk, they’re vaccinated, and if they live by themselves or they’re not putting anybody they live with in danger, then the risk is probably not huge. I think they should take reasonable precautions, but I wouldn’t say to a 20-something, “Stay at home and never go out.”

At the end of the day, everyone needs to find a point of some moderation.

Aside from COVID, what else should singles keep in mind as they start getting out there again?

By and large, it’s going to be the same issues that demographic dealt with before: you should take precautions, both for pregnancy and for sexually transmitted infections (STIs).

STIs are fairly common. Have a conversation with whomever you’re going to be with and understand their history and what your risk is. Condoms are always a good idea, but they don’t protect from everything. Often, people use condoms for intercourse, but they don’t use condoms for oral sex — and you can certainly get an STI through oral sex.

On top of using condoms, I encourage people to ensure they’re vaccinated. HPV vaccines weren’t offered in schools until quite recently. Females in grade 8 were offered them in Ontario in 2007, and males in grade 8 weren’t offered HPV vaccines until 2016. So, unless people were on the ball and retroactively went to their doctors to get it, most people aren’t vaccinated for HPV.

Another important thing to know about STIs is that we can do a screen, but it doesn’t mean it’s a 100 per cent clear bill of health. Standard screens don’t include every STI, and some STIs can be easily missed if symptoms aren’t active.

So again, it’s important to take all the precautions you can, and have a conversation with whomever you’re going to be with.

Any final messages for those who are hoping to become more sexually active?

Go have fun, just do it responsibly.

The post Dating and sex during COVID-19: Q&A with Dr. Sharon Domb appeared first on Your Health Matters.

Pre-pregnancy / Trying to conceive

Will the vaccine impact my fertility?

Dr. Dixon: The information we know is very reassuring. There is no evidence that any of the vaccines affect fertility. I encourage everyone to get their COVID-19 vaccine when they’re eligible. This includes if you’re actively trying to have a baby or even just thinking about having a baby in the future.

I am 39 and am trying to conceive. Will the vaccination decrease my chances?

Dr. Dixon: I’ve been assuring my patients, regardless of their age, that there’s no evidence the vaccine leads to loss of fertility. While fertility was not specifically studied in the clinical trials of the vaccine, no loss of fertility has been reported among trial participants who have received the vaccines since their rollout.

Is it safe to conceive while awaiting the second dose?

Dr. Dixon: It is safe if you become pregnant at any point around your vaccine doses: immediately before or after your first dose, between your first and second doses, or immediately after your second dose. I advise my patients to get vaccinated as soon as they are eligible to ensure they do not become seriously ill from COVID-19.

Timing of vaccination during pregnancy

Is there an ideal time during pregnancy to get vaccinated? First or second or third trimester?

Dr. Ladhani: The best time to get vaccinated is when you become eligible. We know that COVID-19 in pregnancy can increase your risk of being hospitalized and also cause an increased risk of preterm delivery. Statistics suggest between eight and 11 per cent of people who are pregnant who contract COVID-19 will be admitted to hospital, and between two and four per cent will need intensive care. That’s compared to about eight per cent of all COVID-19 patients who have needed hospitalization and about 1.5 per cent who needed intensive care, so pregnancy puts you at higher risk than the general population. A recent study in the American Journal of Obstetrics and Gynecology found those who were pregnant had a strong immune response after vaccination, suggesting strong protection. The study also showed that COVID-19 antibodies were transferred to babies, and we are going to see the effects of this soon. 

I’m in my third trimester. Should I get the vaccine while pregnant or when the baby is born?

Dr. Ladhani: I would advise receiving the vaccine as soon as you can. You’ll be protecting yourself, as well as your baby, once your immune response begins to kick in (usually two weeks after vaccination). Please be sure to receive your second dose at the scheduled time. The antibodies you produce will be passed on to your baby through the umbilical cord and in the breast milk.

Pregnant and patiently waiting. Is it ever too close to the due date to get the vaccine?

Dr. Ladhani: Close to your due date is absolutely fine. You’ll be protecting two people – yourself and your baby – it’s a win-win situation.

Pregnancy & the COVID-19 vaccine

Can antibodies be passed to baby if vaccinated during pregnancy?

Dr. Ladhani: A recent study showed there was immunity transferred to babies via placenta and breast milk. This evidence points to the strength of vaccination, at any stage of pregnancy, and also for those who have delivered their baby and are breastfeeding.

What effects will the vaccine have on my baby?

Dr. Ladhani: The COVID-19 vaccines available for people who are pregnant don’t contain any live virus and do not put you at increased risk for pregnancy loss or harm to your baby. They will not give you or the baby COVID-19, and will not interact with yours or the baby’s DNA. You may develop a fever after you get the vaccine, but this will not harm the baby.

Does vaccination during pregnancy mount less of an immune response compared to non-pregnant?

Dr. Ladhani: In a recent study, COVID-19 mRNA vaccines generated strong immunity in pregnant and breastfeeding people. The immune response was the same as that observed in non-pregnant individuals. Immune responses from being vaccinated were significantly greater than if you had been infected with COVID-19.

Could post-vaccine symptoms be heightened due to pregnancy?

Dr. Ladhani: There’s no indication that if you’re pregnant you will have more severe post-vaccine symptoms. The vaccine can cause fever in some people (around 16 per cent of those vaccinated) and usually takes places following the second dose. The evidence shows there is minimal risk to your or your baby. A few hours after receiving the vaccine, if you have a fever, you can treat it with acetaminophen/Tylenol.

How do we know the vaccine is safe during pregnancy if trials have just started for that group?

Dr. Ladhani: Early clinical trials for the COVID-19 deliberately did not include people who were pregnant. It’s common practice for clinical trials to exclude those who are pregnant, with concerns about fetal development cited. However, we do know that some vaccine study participants became pregnant and to date there have been no adverse effects reported during pregnancy or related to the health of babies. The COVID-19 mRNA vaccines studied in people who were pregnant, breastfeeding and trying to conceive have been found to be safe.

I received the Tdap (Tetanus, Diphtheria, Pertussis) vaccine and Rhogam today. Do I have to wait two weeks to get the COVID vaccine?

Dr. Ladhani: There is no need to wait between vaccines. You can get both vaccines on the same day or within two weeks of each other.

Will the vaccine cause birth defects, miscarriages, or any other fertility or pregnancy complications?

Dr. Ladhani: From the data we have, there is no increased risk for miscarriage, stillbirth or congenital anomalies with the COVID-19 vaccines. I assure patients that there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications. This is based on the millions who have received the vaccines to date and were trying to conceive or were pregnant.

What happens if I get COVID-19 while pregnant?

Dr. Ladhani: If you begin to feel unwell with symptoms of COVID-19, please contact your obstetrician. Most people who are pregnant will have mild-to-moderate illness if they contract COVID-19. Your obstetrician will provide you with support and resources for managing COVID-19.

High-risk pregnancy & the COVID-19 vaccine

Is the vaccine right for me if I have an autoimmune disorder, asthma and recurrent losses?

Dr. Ladhani: Yes, we would recommend that you get the COVID-19 vaccine. Being pregnant and having asthma are both risk factors for moderate to severe illness with COVID-19. People with autoimmune disorders weren’t included in the vaccine trials, and so the effectiveness and safety profiles aren’t known, but NACI and the Canadian Rheumatology Association are recommending that people with autoimmune disorders are offered the vaccine. Given your risk profile, the vaccine may protect you from the severe forms of COVID-19. It may be worth discussing this more with your health-care practitioner.

I’m having a high risk pregnancy. Should I get the vaccine?

Dr. Ladhani: Yes, in most cases people who are pregnant with high or low-risk pregnancies will benefit from receiving the COVID-19 vaccine and being protected from the disease. Please speak with your high-risk obstetrician about the specific details surrounding your pregnancy to determine if you will benefit from the vaccine.

I’m expecting twins. Is it safe to get the vaccine?

Dr. Ladhani: Yes! You’ll protect yourself and potentially protect both of your babies!

I am pregnant after experiencing a pregnancy loss. Should I get the vaccine?

Dr. Ladhani: A pregnancy loss can be devastating, and it’s understandable you may feel anxious being pregnant again. I would recommend receiving the vaccine for additional peace of mind during your pregnancy, especially as contracting COVID-19 during pregnancy can put you at higher risk of hospitalization and preterm delivery. Please remember there is always support available for pregnancy and infant loss through Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network.

Are there complications with heart arrhythmias?

Dr. Ladhani: COVID-19 can be dangerous for those who have an underlying heart condition. Both of the COVID-19 mRNA vaccines were tested in people with heart problems and found to be safe and effective.There is no evidence that the vaccine has worse side effects for people with underlying heart conditions, and having COVID-19 is much riskier than getting the vaccine, so we would recommend you get the vaccine.

Breastfeeding & the COVID-19 vaccine

Is the vaccine safe for both me and my baby while breastfeeding?

Dr. Ladhani: The vaccine is safe for your and for the baby. There is new data showing antibodies for COVID-19 in breast milk after vaccination. So you’re not only protecting yourself against COVID-19 with the vaccine, but also possibly passing along some immunity to your little one. A huge win!

Fertility treatments & the COVID-19 vaccine

Is the vaccine safe when undergoing fertility treatment, like IVF?

Dr. Dixon: I suggest speaking with your fertility specialist who knows your history and care plan, and can answer your questions to help you make an informed decision. Undergoing IVF can be a stressful time and your fertility team is a wonderful resource to help guide you. Your specialist may suggest waiting a few days between some treatment procedures (for example, egg collection in IVF) and vaccination, so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure. 

Is it safe to get the vaccine if you have a planned intrauterine insemination (IUI) or embryo transfer?

Dr. Dixon: We may consider postponing the start of assisted reproductive treatments – like IUI, ovarian stimulation and embryo transfer after your first or second vaccination. This allows time for the immune response from the COVID-19 vaccine to settle down – this recommendation is purely to help patients cope with potential side effects IF they occur. Please talk to your fertility specialist if you have any concerns about the timing of your vaccine with upcoming fertility treatments.

I did IVF and I’m still in my first trimester. How long should I wait to get the vaccine?

Dr. Dixon: You should take the vaccine as soon as it is made available to you. Please speak with your provider about the specifics of your case. This is consistent with the most recent fertility practice guidelines.

I got pregnant after my second IVF cycle, I’m on my fifth week. Is it safe to receive the vaccine?

Dr. Dixon: It is safe to receive the vaccine in your first trimester. The data from those women who became pregnant immediately after receiving both of the COVID-19 mRNA vaccines showed no adverse outcomes in the pregnancy and the vaccines have thus been deemed both safe and effective. Further, there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications.

Read more: Got your COVID-19 vaccine? What you need to know about infection prevention after getting vaccinated

The post Pregnancy, fertility and the COVID-19 vaccine: Sunnybrook experts answer your questions appeared first on Your Health Matters.

Harlan Kirshenbaum says that engaging in virtual treatment for his OCD from his home has been beneficial.

COVID-19 presented a vast challenge for medical and administrative staff at Sunnybrook: How could they deliver the programs and services their patients relied on, yet still keep everyone as safe as possible? Here are just a few examples of virtual care initiatives developed at Sunnybrook through the pandemic.

Virtual OCD treatment: A better fit for some

Harlan Kirshenbaum has battled obsessive-compulsive disorder (OCD), a chronic psychiatric illness, for most of his life. Over the years, his OCD has led to the repetition of various actions, called compulsions, which have had a dramatic impact on his life.

“At one point, I couldn’t get dressed without looking at the labels on my clothes,” Harlan explains. “In recent years, I couldn’t touch my kids or my wife because I would get bad thoughts, like I would give them cancer.”

When the COVID-19 pandemic hit, Harlan’s OCD worsened. He reached out to Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre for support through the Intensive Residential OCD Program, which had recently shifted from in-house treatment to virtual care amid the pandemic.

The six-week program includes exposure and response prevention sessions guided by a therapist through video conferencing, as well as group sessions for mindfulness and cognitive-behavioural therapy. It was an intense experience, but Harlan says that virtual treatment for his OCD was even more beneficial because he was being treated while in his home, where the majority of his triggers are.

“It’s where my OCD attacks me the hardest, and the virtual program was amazing – the most effective treatment I’ve ever had,” he says.

Dr. Peggy Richter, head of the Frederick W. Thompson Anxiety Disorders Centre and director of the Clinic for OCD and Related Disorders at Sunnybrook, says that coaching people in their home environment has, for many, been advantageous over typical live treatment on-site.

The success of the virtual program has prompted Dr. Richter and her colleagues to plan for a hybrid model of care in the future, based on the positive experience of patients like Harlan. Patients would have shorter residential stays, then migrate to a virtual environment to take advantage of coaching in their home environment.

“We see all the advantages in terms of access, what can be done and how much easier it is for patients to attend our program,” Dr. Richter says. “We don’t want to lose those wonderful improvements.”

COVIDEO: A lifeline for patients

For infectious disease physician Dr. Nisha Andany, developing a virtual care model for COVID-19 was an important part of keeping patients informed about a new and unknown disease.

“Early on, it became clear that most people with COVID-19 would not need to be admitted to hospital and could be managed at home,” Dr. Andany says. “But they might be feeling alone or uncertain in terms of what to expect, what they should do or when they should seek medical attention.”

Alongside members of the infectious diseases team at Sunnybrook, Dr. Andany developed the COVIDEO program to conduct phone and video assessments of outpatients with COVID-19.

“We [also] give patients our email address and pager number and inform them there’s a doctor on call 24 hours a day for any emergencies,” she adds. “We’re often able to reassure most patients that they can stay home and guide them in managing their symptoms.”

As the COVIDEO program was rolling out, the team also began to send out blood oxygen monitors to higher-risk patients. That way, the COVIDEO team could obtain a more objective assessment of someone’s condition from home.

“Now, patients will call us and say ‘my oxygen level is at a certain level’,” Dr. Andany says. “It allows us to more reliably determine how sick someone is. If a patient has a normal oxygen level, we will typically reassure and advise them to remain home and keep monitoring. However, for those with low oxygen levels, even if they say they feel okay, we know they actually need to come into the hospital for treatment.”

Virtual post-operative physiotherapy

For patients recovering from hip or knee replacement surgery, virtual post-operative physiotherapy offered by the Holland Centre has given patients all over the province greater choice, says Amy Wainwright, manager of the Holland Bone and Joint Program.

“For some patients, the possibility of virtual care removes some barriers to receiving care at the hospital such as arranging transportation, long travel times, paying for parking, as well as family members to accompany them,” Wainwright says.

Throughout the pandemic, physiotherapists have been hosting rehab sessions by video to safely guide patients in their post-surgical recovery.

Going forward, the Holland Bone and Joint Program will continue to offer virtual care for outpatient physiotherapy, as well as virtual options in other areas of the program such as pre-admission and post-operative follow-up clinics. Wainwright says the expansion of virtual care has been something of a silver lining among the challenges caused by COVID-19.

“We now have a virtual care model that would have taken years to get to and may have been challenging to implement if it wasn’t for the pandemic pushing us all into a new arena,” she says.

Bringing the ED to the community

When Sunnybrook physician Dr. Justin Hall saw patients avoiding the Emergency Department (ED) due to fears around contracting COVID-19, he saw the need to provide another option.

“People delayed their care and were more unwell when they eventually came in,” Dr. Hall explains. “In some cases, there was permanent or irreversible damage because of this delay.”

Along with members of ED leadership, Dr. Hall developed Sunnybrook’s Virtual ED. Focused on addressing acute but non-life-threatening issues, it launched thanks to provincial funding as a six-month pilot in December 2020, and it has since been extended with ongoing provincial and hospital support. Patients can book a same-day appointment to see a physician through video conferencing app Zoom if they’re unable to visit their regular family doctor.

“It’s not a replacement for the in-person ED,” Dr. Hall notes, as emergency departments are still open and are safe to visit. People experiencing life-threatening issues like a heart attack or stroke should still go to the hospital. But issues such as skin conditions, some mental health concerns or sprains and strains can now be assessed through a video appointment.

As with many departments at Sunnybrook, there are plans to incorporate a hybrid model of virtual and in-person care in the ED post-pandemic, says Dr. Hall, making it easier for patients to access treatment in an integrated manner.

“We estimate that 30 per cent of in-person visits could be seen virtually,” he says. “There’s an increasing recognition of the value of virtual care and that patients like it and are willing to use it.”

Learn more about the Virtual ED »

Staff members of the Virtual Emergency Department Team (from left): Toni Alevantis, patient administrative associate; Steffanye Michaelson, patient care manager; Dr. Aikta Verma, chief of emergency medicine; Dr. Justin Hall, emergency room physician and virtual emergency department lead.

The post Ushering in a new era in medicine: Sunnybrook creates virtual care programs in response to COVID-19 appeared first on Your Health Matters.

“Since the onset of the COVID-19 pandemic, Sunnybrook researchers have been quick to rise to the challenge, initiating more than 100 research studies related to COVID-19 that seek to make a substantive impact in better understanding the virus or proposing solutions to the many questions posed by the pandemic,” says Dr. Kullervo Hynynen, PhD, vice-president of research and innovation at Sunnybrook.

These studies were launched thanks in large part to donor support. Close to 11,500 donors from the community stepped up to help Sunnybrook’s COVID-19 response, contributing more than $7-million.

While insights into the virus are still evolving, it appears that although COVID-19 is best known as a respiratory disease, it also has repercussions elsewhere in the body. Here is a look at some of the research projects ongoing at Sunnybrook:

What impact does COVID-19 have on mental health?

Having seen the effects of the pandemic on mental health firsthand, Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program and medical director of the Family Navigation Project (FNP), was spurred to lead a formal study into its wide-ranging impact, with the FNP team.

“I do not think we yet fully understand the tremendous negative, and even positive, impact of the pandemic on the mental health of our society,” Dr. Levitt says. “Our study is designed to explore this and the specific effects of having contracted COVID on mental illness and addiction.”

At the end of the project, around 7,500 Ontarians will have been surveyed over a period of a year and a half. Early findings have revealed that people who have contracted COVID-19 are at a greater risk of having depression, anxiety and substance misuse, compared to those who have not. As well, the data shows that several factors are associated with higher risk of suicidal ideation during the pandemic, including younger age, COVID-19 exposure and reduced socio-economic status.

The study has revealed that greater long-term social support is potentially protective of people experiencing these kinds of challenges, says Dr. Levitt. He hopes the study’s results will assist the province in creating better supports for people experiencing mental health challenges not only from the COVID-19 pandemic, but also for future pandemics.

What is the impact of COVID-19 on the brain?

Neuroscientist Dr. Simon Graham, PhD, is leading a team looking at the longer-term cognitive effects of infection. “The brain effects of COVID-19 are somewhat under-appreciated, and we don’t know the full extent to which they’re occurring,” he says.

Using magnetic resonance imaging (MRI) and behavioural assessments, Dr. Graham’s study has already shown some patients who were on a ventilator before recovering suffered from brain micro-bleeds or mini-hemorrhagic strokes. Some recovered patients have also been found to have evidence of inflammation in the brain.

These discoveries are particularly important given the growing number of “long haulers,” patients who experience lingering problems from the virus like brain fog and poor memory, Dr. Graham adds.

“Even if their persistent symptoms have to do with shortness of breath or abnormal heart rate, those things are actually controlled by the brain, so it could be COVID-19’s impact on the brain is causing those problems, too.”

What is the relationship between COVID-19 and the heart?

Cardiologist Dr. Idan Roifman in the Schulich Heart Research Program at Sunnybrook is leading research examining how COVID-19 may lead to inflammation of the heart muscle or cause damage to the heart similar to a heart attack.

The study is building on considerable research globally showing COVID-19 increases the risk of blood clots.

Using magnetic resonance imaging (MRI), Dr. Roifman’s work seeks to find evidence of heart damage in patients who have recovered from COVID-19 and determine the type of damage that has occurred. The study is also investigating how risk factors like diabetes and high blood pressure may elevate the risk of developing cardiac complications like heart failure.

Already, the research has revealed heart function abnormalities in some patients in recovery. “That alerted us to follow them closely and led to a potential change in their long-term management,” Dr. Roifman says.

Why do COVID-19 symptoms persist in some people?

Sunnybrook’s Dr. Hubert Tsui, head of hematopathology, and clinical microbiologist Dr. Robert Kozak, PhD, are poring over blood tests and nasal swabs from patients with COVID-19 to understand why some individuals become so-called long haulers. “The research literature states as much as 50 per cent of people could have some long-term COVID symptoms,” says Dr. Tsui.

The researchers have been looking at early diagnostics from patients who became long haulers, while comparing them with other patients who have fully recovered to see if they have a different initial immune system response. “Some of our preliminary data is indeed showing that something very early on, even at the diagnostic point, is different – providing a clue in terms of risk to developing long COVID,” he adds.

Understanding the basic science regarding immune response to COVID-19 could lead to identifying patients who are likely to experience long-term problems early on, Dr. Kozak notes. Research could even lead to therapeutics to prevent and treat long-hauler symptoms.

“The more we can help people now, the more they will benefit down the road,” he says.

The post Sunnybrook community steps up to support critical COVID-19 research appeared first on Your Health Matters.

Can I get the flu shot and COVID-19 vaccine at the same time, or do I have to wait for a few weeks in between? 

Yes, you can get both at same time and this does not reduce the protection received.  Even the RSV vaccine that is in its second season, can now be received at the same time as Flu and COVID vaccine for those who are eligible – primarily older adults.

Do I still need to get a COVID vaccine if I was previously vaccinated during the pandemic? 

If you are an older adult or immune compromised, or if you are someone who cares for vulnerable populations – yes you should get vaccinated this season.  The virus that causes COVID is similar to the flu in that it is constantly changing which means that a seasonal vaccine is needed that is adapted to the current strain circulating.  Just like the flu vaccine is an annual seasonal vaccine, you should think of the COVID vaccine that way too.

Can I get the flu from the flu shot? I got sick after my shot last year.

No, the flu shot cannot cause infection. If you did get sick after getting the flu shot, there are a number of possible explanations:

• Maybe you had another virus (e.g., common cold) and this was not flu;
• You were in contact with the flu before vaccination (it takes 2 weeks to develop full immunity); or
• Because the flu shot doesn’t provide 100 per cent immunity, you can still get the flu if you get the flu shot, but your disease will be less severe on average than if you hadn’t received the vaccine. But the shot doesn’t give you the flu.

 If neither the flu or COVID shot can guarantee that I won’t get infected, why should I bother getting it?  

The greatest benefit of these vaccines is reducing risk of severe outcomes – like hospitalization or death.  This is why it’s so important to vaccine high-risk individuals to keep them safe during respiratory season.  While they do not always prevent infection – they do reduce the odds of getting infected which can make the difference between spreading it to others or not.  This is why it’s so important to make sure caregivers of vulnerable populations are vaccinated every season.

The flu doesn’t seem that bad. Why can’t I just take my chances and not get the shot?

You’re not only getting the flu shot for yourself, it’s offering protection to those around you. While the flu may not seem like a big deal, it can have deadly consequences for many people. Every season there are over 3000 deaths and well over 10,000 hospitalizations related to flu.  So even though less severe than COVID on average, it has devastating impact each year and results in major additional strain to our healthcare system.

What makes the flu so serious for some people?

The flu can be fatal in three major ways:

1. The flu can cause severe inflammation of vital organs, which is when the immune system attacks itself. This can lead to failure of vital organs and requires supportive treatment in the critical care unit.
2. The flu can progress into a secondary bacterial pneumonia or other respiratory conditions, which can be fatal.
3. Chronic diseases that are stable with medical treatment can become destabilized by the Flu.  An example is a person with limitations in mobility who can become weak and fall, or a person with known heart failure who can have difficulty breathing, or someone with heart disease can suffer a  heart attack, precipitated by the Flu.

 Is my immunity lowered after all these vaccines? Several years in a row, I got a cold right after the flu shot.

No, the flu and COVID shots do not lower your immune system – they boost it.  You likely became ill with something else, but due to the timing it is common for people to think it was caused by the vaccine.

Is it safe to get the flu and COVID shot while pregnant?

Yes, pregnant women should absolutely be getting both the flu and COVID shot. Being pregnant places you at risk of complication from either of these infections and these shots are strongly recommended for pregnant women at all stages of pregnancy, as well as those who are breastfeeding. The flu and COVID viruses, and not the vaccines we give to prevent these, can harm pregnant women seriously enough to land them in hospital and cause death.

Another reason for pregnant women to get vaccinated is that vaccines result in antibodies that get passed on to the developing fetus, providing protection to the newborn in the first months of life. A baby can also acquire antibodies through a vaccinated mother’s breast milk.

I live a healthy lifestyle (eat well, exercise, etc.) and consider myself to be a healthy person. I never get sick. Do I still need to get the flu shot?

Yes. You do. Public health agencies from around the world recommend everyone over the age of 6 months get the flu shot every year.  A flu shot not only protects you against the flu, it also helps protect your loved ones, colleagues, strangers on the street. By getting the shot, you are reducing your chance of spreading the illness. Even if you’re healthy, you should still get the flu shot.

Can flu be transmitted without symptoms like COVID?

While this is not as common, yes flu can be transmitted in absence of symptoms.  This re-enforces the benefit of getting vaccinated against the flu since it reduces the chance that you could unknowingly spread it to a vulnerable person that could become an issue of life or death for them.

Besides seasonal vaccines, what other measures (if any) are still recommended? 

Your best protection against circulating viruses is seasonal vaccination.  Beyond that, if you do develop cold-like symptoms it is very important to stay home and especially never to come to the healthcare facilities or other high-risk areas where vulnerable populations are present – until you are fully recovered.  Wearing a mask when you will be in close contact with high-risk individuals is another way of increasing their protection.  At the height of the respiratory season we require universal masking at Sunnybrook when visiting or providing care to patients.

The post Can I get vaccinated against the flu and COVID-19 at the same time? Answers to this and 10 other flu-related questions appeared first on Your Health Matters.

Dr. Peggy Richter, psychiatrist and head of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, talks about the pandemic’s impact on OCD and what we can do to help those who may be struggling.

How has the pandemic impacted people with OCD?

For people who already have OCD, the pandemic has had very mixed effects. There are some people who, of course, are made much more anxious by it. But there are also many who say the pandemic has made things easier.

For example, during COVID, recommended public health measures have included limiting contact with items, cleaning surfaces, using sanitizer and having more frequent hand washes. For people who would call themselves “germaphobes” or who have contamination as the focus of their OCD, these actions actually reduce their anxiety. Before COVID, these individuals might have found themselves feeling anxious going into supermarkets. Now, they know that in some stores, carts have been wiped off before every use, and if they’re concerned, they can take their own wipes with them, clean their cart, and nobody notices.

Contrarily, for individuals whose OCD focuses on illness anxiety, the pandemic has been very difficult because they are ordinarily preoccupied with potentially developing a medical illness or problem. This means they are highly vigilant around any risks in their environment and are very concerned that sensations that don’t necessarily mean COVID could be COVID. I am seeing individuals in that population struggle.

Another group that may be having a hard time are those who need orderliness and things precisely in position. If you’re in a home that’s gone from people coming in and out at the start of the day to now everybody spending more time in the home, working or doing school remotely, there is a lot more chaos, which can be very difficult.

OCD is an illness that affects individuals in different ways.

Has the pandemic caused more people to develop OCD?

Though I haven’t seen the data to back it up, anecdotally, mental health colleagues in the community feel they are seeing a lot more OCD. My colleagues in child and adolescent mental health, especially, have expressed they are seeing more cases of new-onset OCD compared to past years.

OCD does very much seem to occur on a spectrum of severity, so the pandemic may also be leading to obsessions or compulsions for many that are milder than required to make a formal diagnosis, while nonetheless causing some degree of distress.

How will easing restrictions impact people with OCD or those who are experiencing symptoms?

In the case of anxiety disorders, avoidance can make symptoms worse. With the pandemic, that avoidance has been mandated, which may have felt better in the short-term, but will make re-entering the wider world that much harder.

In fact, one of our best first-line treatments for all anxiety disorders is a form of treatment called cognitive behavioural therapy (CBT), in which people are encouraged to systematically confront their fears by triggering them.

With OCD, many people have been avoiding a lot of the situations that normally would trigger them. For example, for someone whose OCD would ordinarily compel them to check the doors, lights and appliances when they leave the house, lockdown and working from home may have made things easier. However, going out to work and socialize will now trigger them like before, and may feel even harder as they have not had to challenge this fear for a while.

Returning to these triggers that have been avoided, it’s going to be hard.

When should someone seek help?

The simple answer, for any psychiatric or psychological problem, is for someone to seek help when it causes distress or when it begins to interfere with their ability to function. If it’s getting in the way of their relationships, causing problems in their work environment or in their functioning at home, that’s a clear indicator that maybe it’s worth talking to a professional.

The core features of OCD are the presence of obsessions or intrusive, recurrent anxiety-provoking thoughts and urges, as well as compulsions, which are repetitive acts the person does in response to obsessions. When these symptoms cause significant distress, impaired functioning or waste an hour or more of the day, it is considered severe enough to make the diagnosis. With that said and as mentioned before, OCD does very much seem to occur on a spectrum of severity. So, if someone is unsure if they meet the criteria for an OCD diagnosis but are still having a hard time, they shouldn’t hesitate to get help.

How can I help my loved one who’s struggling with OCD or OCD-like symptoms?

If someone you know is struggling, be supportive and non-judgemental. Just being there for someone and letting them know that you care is incredibly helpful for most people.

You can also encourage them to seek professional help. Seeing their family doctor is often a very good place to start, as they can help them find effective treatments for OCD, including drug therapy and CBT. In general, most people will greatly improve with treatment.

Also, one thing that’s happened because of the pandemic is a mushrooming of resources online, so it is much easier than in the past to find great online educational material, to find online therapy and to find support groups.

Further, help your loved ones have hope. This is a tough time, but they are not alone, help is available, and things can get better.

Resources for OCD:
OCD information and resources
OCD handbook
Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre

The post COVID-19 and its impact on obsessive-compulsive disorder appeared first on Your Health Matters.

Why did you look at this issue?

Dr. Wijeysundera: During the first wave of the COVID-19 pandemic, we kept hearing stories from patients and other doctors that there were delays in care for patients with heart disease. We decided to look deeper at the Ontario data that tracks waitlists and wait times for people living with heart disease who require a procedure or surgery.

What did you find?

Dr. Wijeysundera: The data was distressing – we learned that there was a significant decline in referrals and procedures in Ontario for common heart interventions after the pandemic started. Patients waiting for coronary bypass surgery or stenting were at a higher risk of dying while waiting for their procedure compared to before the pandemic. We found this to be consistent across patients with stable coronary artery disease, acute coronary syndrome and emergency referral.

Can you explain why this happened?

Dr. Wijeysundera: We are very interested in the “why” behind referrals decreasing so dramatically. We believe there are a number of reasons, some of which are patient factors such as fear of contracting COVID-19 in the hospital, or worries about missing work or family commitments. We suspect there are also system factors at play, such as delays in testing for heart conditions, as well as hospital bed and staffing pressures.

What is your advice for people who are noticing a change in their health?

Dr. Wijeysundera: Our biggest fear is that people are ignoring symptoms like chest tightness, or feeling lightheaded or short of breath, and not seeking care as they’re worried about placing burden on the health-care system. Or they may be afraid of contracting COVID-19 if they come to the hospital.

Hospitals are safe places to be – over a year and half into the pandemic, we have learned so much and know how to protect and care for you. Even if you feel like it’s not an emergency, please let us assess you. Yes, this may be virtually at first, but if we need to see you in person, we’ll make sure it’s done safely.

Where should patients start if they’re feeling new symptoms?

Dr. Wijeysundera: Your family doctor is always a good place, or your heart specialist if you’re already seeing one. Heart disease and stroke are time-sensitive conditions. We are committed to getting you the care you need, when you need it.

The post Noticing changes in your health? Don’t delay seeking care appeared first on Your Health Matters.