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.

Long COVID and Sunnybrook’s COVIDEO

COVIDEO, funded in part by Ontario Health, is a program at Sunnybrook that has helped patients with mild to moderate cases of COVID recover at home with consultations over video or phone. Dr. Daneman is the co-lead of COVIDEO, along with Drs. Philip Lam, Nisha Andany and Adrienne Chan.

The doctors have now seen 9,000 patients through COVIDEO, and they are beginning to analyze some of the data. Patients diagnosed with COVID-19 at Sunnybrook are offered a 90-day in-person follow-up visit. Of the first 995 patients, 506 didn’t respond to the invitation, 266 responded and declined, saying they were back to health, and there were 206 patients who came in for the 90-day follow up. From that data, Dr. Daneman says they have been able to look at which symptoms are most persistent and how common they are.

He did caution these numbers are likely overestimates, and also says these are symptoms seen in individuals who were not hospitalized with COVID-19; hospitalized and critically ill patients would have a different recovery than people who had a mild to moderate case of the virus.

“Generally, if you read about long COVID in the news, people are going to be worried that everyone is left with terrible after effects, but the vast majority of people are back to normal health way before the three-month mark.”

Most common “long COVID” symptoms

Dr. Daneman says the most common symptoms seen in COVIDEO patients are similar to what is being seen elsewhere.

“Fatigue, number one,” he says. “Some kind of anxiety, depression, insomnia [is] pretty common. Headache.”

He also says some patients still experience loss of smell at 90 days and temporary hair loss, known as telogen effluvium, was common, although it’s a condition known to happen sometimes after an acute illness.

Some patients still had a cough or some muscle and joint aches. 

Recovery from long COVID

For people still battling COVID-19 symptoms months after their initial infection, they may understandably wonder when they will feel well again, and what they can do to help the process.

“One of the biggest things is time,” says Dr. Daneman. “We see this after almost any type of infection. That some people, a minority of people, can end up with some residual symptoms.”

He gives the example of a chronic cough following influenza or chronic fatigue after a bout of mono. And he says while it may be tempting to hunt for an “active, ongoing infection,” most often there is no infection remaining; the body simply needs time to recover.

“The trigger’s already gone and the body just hasn’t turned off the light switch that’s been turned on,” Dr. Daneman says.

Adopt healthy coping strategies

While Dr. Daneman is not a rehabilitation specialist, he says it’s important for people to find ways of coping and to find a “happy medium where they’re getting energizing activity, but not overdoing it.”

The COVIDEO program has some multi-disciplinary collaborations with the physiatry and rehabilitation departments to provide rehabilitation for Sunnybrook patients who are experiencing long COVID symptoms.

It might be difficult, but Dr. Daneman also recommends people don’t withdraw from their family, friends, work or hobbies because that could make mood or anxiety symptoms, or even physical symptoms, worse.

“It’s important to try as best as possible to find coping strategies and work toward the recovery because it will come with time,” he says.

The post When COVID-19 lingers: symptoms and recovery tips for COVID long haulers appeared first on Your Health Matters.