Date: March 16, 2020

An Update from Dr. Michael Hanna from the Emergency Room

I am currently working in the ER through the COVID-19 pandemic and receiving an hourly update on the screening and preventative measures placed by the government and public health.

As of yesterday, March 15, 2020, public health changed the screening criteria for COVID-19. Given the government concerns over community transmission, travel is no longer a required criterion. The following guidelines are currently used in all the hospitals for COVID-19 testing:

Patients who present with mild symptoms of an URTI/Influenza-Like Illness and ANY of the following are eligible for COVID-19 testing:

1. Fever equal or above 38 degrees (tympanic)
2. Underlying immunocompromise (eg. Patients on chemotherapy, HIV/AIDS)
3. Age >60
4. Referred by a local public health unit for investigation due to contact with a confirmed or probably case of COVID-19
5. Health care workers in any acute care or long-term care facility (with priority)
6. Pregnant women

Anyone with an URTI/Influenza-Like Illness and ALL of the following does not qualify for COVID-19 testing and recommend to self-isolate:

1. No fever (T<38)
2. No underlying conditions of concern
3. Age <60
4. Able to rapidly access hospital if symptoms worsen

The government asked all hospitals to set-up COVID-19 Assessment Centers to avoid increasing pressure on hospitals. Currently, there are 17 centres in Ontario.

Public health announced on March 13, 2020, a downgrade of COVID-19 transmission from airborne to droplet and contact precautions. Simply put, no evidence of transmission via airborne route. N95 masks are no longer required and health care professionals’ Personal Protective Equipment (PPE) are as follows:

1. Surgical Mask
2. Gown
3. Gloves
4. Eye protection

With the new testing criteria, I expect an increase of confirmed cases given public health removing the travel and contact with COVID-19 probable or confirmed case as criteria for testing.

The current recommendations for the health care professionals’ PPE and self-isolation, social distancing and droplet precautions are challenging in the setting of in-person assessments. I take the safety of the clients, assessors and claimants seriously. Transportation and interpretation remain to be a challenge. As such, we are taking the following steps:

1. We will be postponing the in-person assessments with the exception of urgently needed assessments. For those that need to be urgently completed, we have added an extensive screening process for the claimants and assessors as well as our staff. Screening questionnaires will be implemented to both assessors and claimants. Confirmation from the assessor and the claimant will be in place.
2. We are currently looking into other options for completing assessments using our online capabilities technology such as skype and telemedicine.
3. We are rescheduling OT in-home assessments and situational assessments. There is an ongoing discussion about the feasibility of completing an assessment through skype.

At CMAC, we take the health and welfare of our people, our clients, and our community seriously. With the progression of the COVID-19 pandemic, we are making every effort to provide quality service with as little disruption as possible as we continue to monitor and adapt.

We have taken precautionary measures and have enacted our business continuity plan to continue operation as events unfold. At this time, our office remains open.
I am in constant consultation with the Hospital and following up on the recent updates from government agencies; Health Canada, Ontario Health Agency, and Toronto Public Health to ensure we are taking appropriate action.

Our efforts:

1. We have invested in technology to ensure our staff can operate remotely from any location.
2. We are asking everyone, including our employees, that they not visit us in person if they are feeling unwell. Instead, meet with us by phone or virtually, which we can arrange.We also encourage that as much communication as possible be through e-mail or telephone. 3. We have asked our staff to work from home if they or any of their family members are not feeling well or if they become aware that they have been exposed to anyone who has contracted COVID-19.
4. Client meetings and events are being limited, replaced with teleconference, or rescheduled, as appropriate.
5. We have implemented enhanced cleaning and disinfecting protocols in our offices.
6. We have implemented and are regularly updating policies and procedures as information becomes available.

Should an office closure be necessary, we want to assure you that all of us at CMAC are committed to being fully accessible and responsive to our clients, assessors and business needs.

We wish everyone the best during this challenging time and greatly value our relationships with you. If you have any questions or concerns, feel free to contact us.
We will update you from the ER. Stay well.

Dr. Michael Hanna | MBBCh, CCFP, DCAPM, CIME, CFE, MHM, LL.M(c)
Medical Director of Canadian Medical Assessment Centre
Staff Emergency Physician – William Osler Health System
Certified Fraud Examiner – Healthcare and Insurance
Master of Health Law (c) – Osgoode Hall Law School
Master of Health Management – School of Rehabilitation Science/DeGroote School of Business
Assistant Clinical Professor (Adjunct) – Family Medicine – McMaster University
Clinical Instructor – Department of Emergency Medicine – William Osler Health System
Clinical Instructor – Department of Family and Community Medicine – University of Toronto

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