Communicable diseases “way down” in Nunavut due to COVID-19 containment
Less medical travel, routine procedures deferred, virtual checkups, all consequences of COVID-19
Rates of communicable diseases in Nunavut have dropped “significantly” since the territory went into lockdown against COVID-19, says the Department of Health’s chief of staff.
“Bronchiolitis is down, pneumonia is down, the flu pretty much wasn’t a thing this year,” said Dr. François de Wet.
These diseases are generally present in high rates in the winter and early spring, de Wet said. But social distancing measures taken to guard against the pandemic seem to have also stopped their spread, he said.
People are working from home, and bars, restaurants, gyms, libraries, schools and daycares are all closed.
“That’s an unintended consequence,” de Wet said, “but it’s a good consequence.”
As a result, there are fewer people seeking treatment in health centres across the territory. “We don’t see the 20 flus a day looking for sick notes,” he said, and medevac transfers are down by “almost 40 per cent.”
Part of that is likely because people with chronic obstructive pulmonary disease, or COPD, and pneumonia aren’t being transferred for treatment, de Wet said.
Health centres, clinics and emergency rooms in Nunavut have cut down in-person assessment as much as possible.
Triage is initiated when someone calls to make an appointment, de Wet said. If they are filling a prescription, they can do that over the phone with a doctor.
Some treatments are being deferred, such as fixing a stable hernia when “it’s not stuck and it’s not giving you pain,” or removing the gallbladder of someone who is getting gallstones, said de Wet.
Routine pap tests and “wellness exams” are also being postponed.
But routine visits for new babies are continuing because “some of those things, you can’t put off,” de Wet said.
Less medical travel south, more interregional travel
There are fewer medical travellers leaving the territory due to COVID-19. This was achieved, in part, by asking specialists which patients could wait to be seen, and which were more urgent.
De Wet said he has heard of some people who didn’t want to travel for treatment, because they didn’t want to risk getting infected with COVID-19 while out of the territory, or they didn’t want to wait for 14 days in the isolation hubs before returning home. That’s fine in some cases, he said, but others had to be told they couldn’t wait for treatment.
There are more people travelling among the three regions than ever before for treatment because of COVID-19, de Wet said, especially from the Kivalliq to the Qikiqtani. To avoid flying to Winnipeg and having to go through isolation, they are instead coming to the Qikiqtani General Hospital in Iqaluit.
“If a patient is sick enough to not stay in the community, but not sick enough to be sent down south, we have accepted transfers from the Kivalliq to QGH,” de Wet said.
Patients have also been transferred to QGH for surgery and ultrasounds to avoid the 14 days of isolation.
A similar approach may continue after COVID-19 is contained, de Wet said, but it would move in the opposite direction, sending doctors from QGH to the Kivalliq for surgery and pediatric services.
“Sending someone to the Kivalliq to see 20 people in a community is cheaper than sending 20 people to Winnipeg for service,” de Wet said.
Despite the fact that routine care is being deferred, de Wet said if someone calls and wants to see a doctor, but doesn’t want to say why, they will be able to make an appointment. He said there is no way to know how many people may be in need of treatment but are staying away from health centres because they’re afraid of COVID-19.
“There’s nobody that should stay away just because it’s not the right time for you,” de Wet said. “We are still here, operating at the same level.”
But there are some obvious changes in the QGH. For example, hospital staff sit at a table at the entrance to the emergency room to screen people coming in and direct them to where they need to go.
There is a separate waiting room for people who come in with a fever or cough. These patients get a mask, and staff try to eliminate contact between them and other patients as much as possible, de Wet said.
The cafeteria is closed, and doors are locked between different areas of the hospital.
After the ransomware attack in November 2019 that ground the government to a halt, de Wet said the Department of Health began working to set up software so physicians could remotely assess patients or hold clinics virtually.
The pandemic accelerated this work.
The Department of Health is now conducting video calls using Microsoft Teams.
“It still doesn’t replace a living person where you can lay your hands on the patient,” de Wet said, but it has its place, like diagnosing rashes, giving mental health treatments, or allowing doctors in the children’s hospital in Ottawa to assess patients virtually.
Patients can come into health centres or hospitals to use the platform to see a physician remotely, or attend a virtual clinic, de Wet said. Video calls are being done in health facilities partly because many residents don’t have reliable internet connections or devices at home, and partly for security reasons, he said.
Before Microsoft Teams, de Wet said, “We were full force going ahead to using Zoom as our patient provider platform.”
But these video calls soon became disrupted by “Zoom bombing,” with people intruding into private video chats to interrupt them.
“Literally a couple of days before we were going to buy licences … it broke down and people were Zoom bombing, so that went out the window.”
Microsoft Teams is as secure as it can be, de Wet said, “as of now. Tomorrow might be different.”
COVID-19 has turned the idea of patient interaction on its head, de Wet said. Before, it meant when a doctor sees a patient. Now, it can mean a phone call to fill a prescription, or a video call check-in.
“It’s kind of an exciting time because everyone’s wondering, what is medicine going to look like after COVID-19?”