Jan 6, 2022

Chair's Column: Navigating this COVID-19 Chaos Together

Gillian Hawker

Navigating this COVID-19 Chaos Together

I am generally an optimist. I really didn’t believe that we would still be in the midst of the COVID-19 pandemic two years on. Then came OMICRON. To find ourselves here in January 2022 is truly frustrating and disheartening.

The next few weeks are going to be profoundly tough. Adding to the incredible stresses and strains of managing life in a pandemic, we are facing a new crisis – a critical shortage of health care workers. And the shortage is affecting all clinical services indiscriminately. It will take all of us working together to sustain high quality patient care as we go forward. With such rapid and pervasive community spread of OMICRON, some of you will find yourselves in isolation, frustratingly unable to help. Others, particularly early and young faculty with school aged children, will be challenged to be in two places at once as schools move to online learning yet again. 

But we will get through this. As I’ve said before and have witnessed repeatedly these past two years, this department is inspiring in how it comes together in times like this. WE have an amazing community at the U of T DOM.  Together, we are strong.

First, I want to remind you of the many resources available to support your mental health and wellbeing. These can be found at https://deptmedicine.utoronto.ca/covid-19-wellness-resources-faculty-and-trainees. Please do not hesitate to reach out to me personally, or to our DoM Wellness Lead, Simron Singh, anytime you need. We are here for you.

Second, some of you are preparing your documents for Continuing Faculty Appointment Review which are due to the Department of Medicine on February 22, 2022. As before, we will be as flexible as we need to be to enable you to focus on the issues at hand right now – we don’t know how long this will last, but if we need to, we will extend the deadline.

Third, I want to assure you that our incredible IPAC leads across TAHSN and our clinical sites – Jennie Johnstone (Sinai), Susy Hota (UHN), Matthew Muller (Unity) and Jerome Leis (Sunnybrook) – and the hospital Occupational Health folks are totally aligned, including their approach to managing healthcare worker shortages. As healthcare workers become more and more scarce, we have to all face the hard truth that the rules around the approach to a physician with an OMICRON exposure will change. Further, redeployment of both faculty and learners will need to be approached differently – much more rapidly, e.g., to fill daily holes in the system – than before. Yes, the limits of our ability to be flexible and patient with these changes will again be tested.

Finally we will be putting a hold on ALL non urgent meetings for the next four weeks. We know there will be increasing challenges both clinically but also personally.  It is essential you pay attention to your own well-being now and so all non-essential meetings will be delayed until we have more capacity.

So, how do we go about supporting you in this fourth, and hopefully last, COVID-19 wave? Here is what our IPAC colleagues had to say to help guide us through:

General Principles:

They strongly recommended that we reiterate that DOM members do the following:

PLEASE KNOW that the TAHSN sites are aligned on how they manage COVID-19 and high-risk exposures, but there may be differences in their recommendations regarding how fast people can return to work due to variability in staffing pressures, both within and across the sites.

PLEASE READ your site-specific daily communications so you are aware of the specific logistics at your site because the process varies across sites and over time for the reasons noted above.

PLEASE DO NOT email the Director or Medical Directors of Occupational Health and IPAC directly with questions until you have reviewed the instructions provided at your site and tried speaking to your PIC/Department lead - the volumes are simply too high and back and forth emails are inefficient and will only lead to delays and frustration for those looking for answers. The PICs/Department leads should be aware of the processes in place and able to direct their physicians, while our education leads can assist learners.

Responses to Frequently Asked Questions:

Q: With the newly released provincial guidance, when can I return to work if I test positive for COVID-19?

A: If you test positive for COVID-19, generally you will not be able to work for the 10 days after symptom onset (or positive test if you are asymptomatic). However, during this Omicron wave, if you are well, it is possible you will be returned to work sooner than 10 days. All TASHN sites are following the same guidance; decisions on returning before 10 days will depend on staffing pressures and patient surges. It is important that you notify your Occupational Health Department at your work as soon as you find out you have COVID-19, and they will be able to provide direction on when you can return to work.

Q: If someone tests positive for COVID-19 in my household, can I still go to work?

A: If someone tests positive for COVID-19 in your household, this will be managed as a high-risk exposure. You should first go get a PCR test (at your hospital or in the community, as available) to confirm if you are already positive, then notify the Occupational Health team.  If PCR negative, conventional guidance for healthcare workers with high-risk exposures due to COVID-19 in their home is to self-isolate for 10 days after the exposure ends, which means it will be longer than 10 days if there is ongoing exposure. All TASHN sites are following the same approach, but differences will exist in whether return to work occurs sooner based on local staffing pressures and patient surges.

Q: What do I do if I have a child with a new onset runny nose?

A: COVID-19 is the most common explanation for any viral respiratory syndrome currently, although there are other respiratory viruses circulating. However, a runny nose alone is insufficient to raise concern about COVID infection*. If your child is eligible for PCR testing, please get them tested for COVID-19. If you are unable to get them tested, you will have to assume they have COVID-19. There is an updated symptom list that can be reviewed on the Ontario.ca website (https://www.ontario.ca/page/covid-19-stop-spread#section-0)

Q: How do my child and I isolate in the same home?

A: It is very difficult to self-isolate from children in the home. The decision of whether you try to self-isolate in the same home will depend on several factors, including age of the child, additional supports available for childcare, structure of your home among other things. If you are unable to self-isolate from your children (as many can’t), it will be factored into the timing of your return to work.

Q: Who can we bubble with?

A: On January 3, 2022, the provincial government introduced public health measures to minimize contacts in an effort to protect our healthcare system. It is important that we minimize our contacts as much as is feasible right now. Current restrictions limit social gathering to five people indoors and 10 people outdoors. If you do choose to have social contacts right now, please do so sparingly and try and keep your social contacts consistent.

Q: I am confused by the constantly changing guidance. How can I best get answers about whether I can work?

A: Guidance continues to change and will continue to change through this Omicron wave. PLEASE READ the hospital-specific communications daily so you are aware of the specific logistics at your site because the process varies for the reasons noted above.

I know it is incredibly nerve-wracking to deal with such uncertainty and stress; I am feeling it right with you.  Remember: You, can only do your best; this means doing whatever we can to keep ourselves well and able to tend to those who need us - our patients and our own loved ones. Thanks again and again for everything you do day in and day out. Wishing you and your families a New Year that gets happier and healthier as the months progress.