COVID-19: What You Need to Know Today

Special Episode
In this time of a rapidly evolving global health situation we asked our physician guest, Dr. Dedeshya Holowenko, to give us some perspective of what’s really going on with COVID-19 and how best to respond today.

About Dr. Dedeshya Holowenko
Dr. Holowenko is a family physician with a special interest in Women’s Health. She has worked in a specialty menopause clinic for over 10 years. She maintains her family practice, but also accepts referrals for contraception management including IUD’s, pelvic pain, irregular bleeding, menstrual issues, sexual health, hormonal health and weight management. She is the former board chair of the North Shore Division of Family Practice. She is the co-creator of Medvoice.ca, an app that assists in efficiency and communication during a doctor’s visit and is co-founder of FEMME.bc, the Federation for the Empowerment of Menopausal Women and Medical

Remember Dr. David Patrick? You can find him here on Facebook singing a song of how to handle yourself around COVID-19. 

Important links and resources regarding COVID-19:

The Public Health Agency of Canada

World Health Organization

BC Centre for Disease Control (recently revised):  

Ministry of Health

Call 8-1-1: for Healthlinks. Call if you suspect you have COVID-19 to get info for testing. 

Flattening the Curve

For specific information on how to perform Infection Prevention and Control go here. 

Find Gillian McCormick @physiogillian. 
Find Susannah Steers @themovingspirit. 

Transcript

SPEAKER_00 0:05

Health is wealth, and this is where we're going to talk about it. The Small Conversations for a Better World podcast with hosts Gillian McCormick and Susanna Steelers. The podcast represents the opinions of the hosts andor their guests for the show. The content is for informational purposes only and should not be taken as medical advice nor established legal standard of care.

SPEAKER_01 0:28

Hello and welcome to a special episode of the Small Conversations for a Better World podcast. I'm Gillian McCormick, and I'm Susanna Steers. In light of recent world events with regard to novel coronavirus, COVID-19, we thought we might take this opportunity to try to help shed some light on what we're seeing in the media and the community, what kind of response to the pandemic is necessary right now, why it is a changeable situation, and what is the goal versus expected outcome in the next weeks to months of 2020? We've been struck with how challenging a situation it is to interpret, to anticipate, and to be nimble enough as governments and individuals to respond responsibly. We are aware of a great many conflicting pressures, such as public and individual health, economic losses globally and locally as we shut borders, stop traveling, cancel sporting and music events. We grapple with what may be to come all business closures like in Italy, no ability to run restaurants or keep the doors of our own small businesses open as we desire to be responsible, but acknowledge that we don't know how to pay our staff or our rent if we don't work. With us to answer some of the questions about COVID-19 is general physician Dr. Tadesha Haloenko, former board chair of North Shore Division of Family Practice, uh, and expert on menopause. Family physicians are some of the boots on the ground front lines of this evolving situation. So we really appreciate that you've taken the time out of what must be a really busy time to come and talk to us on the pod. So welcome back, Dr.

SPEAKER_02 2:13

Top for inviting me.

SPEAKER_01 2:15

So we're actually in the studio recording this on Saturday, March 14th, and we just want to get this on the air as soon as we can, but acknowledge that some of the things that we discussed today may have actually changed by the time you listen.

SPEAKER_00 2:30

We've been hearing, well, for weeks now, that the novel coronavirus from Wuhan, China has been a fairly serious threat. We watched at the end of January as the Chinese built entire hospitals where there had been none before that were up and running for treatment of COVID-19 patients in a matter of weeks or so. A week or so. It was a week. But of course, that seemed really, really far away at the time. It's it was it was happening somewhere else. We've watched as during the past couple of weeks, the virus has come knocking on North America's door as well as Europe's door and South America and indeed almost everywhere. A lot of us have been hoping still that it might pass us by, but after events this past week concerning Canada's first COVID-19 patient death here, right here in North Vancouver, we're realizing that it's here. It's not a distant thought. And while we're in some ways resigned to this idea, some feel that perhaps there's not enough being done to limit people's exposure to each other. It's quite an atmosphere of apprehension and frustration and confusion. So, Dr. Haloenko, can you help us? What can you tell us about COVID-19?

SPEAKER_02 3:45

COVID-19 is a new virus on the world stage. It is different than many of the other viruses that have presented themselves with significant mortality because there is a vast array of presentations. Some people can be minimally symptomatic, some people can be moderately symptomatic, and others severely symptomatic. And because of the patients who have minimal symptoms, they tend to continue to move around in our community and spread the virus. Whereas remembering what SARS was like, I worked and lived through SARS, people got sick very quickly and they got acutely sick very quickly. So they sought out treatment and were identified quickly, and therefore the virus was contained in a very organized and quick manner. So COVID is something that often will be amongst our patient population, and it takes a great deal of effort and education and social responsibility to contain it. And we've learned that through the successes of China, and we've also learned that through some of the um less successful uh countries in how they've dealt with COVID.

SPEAKER_01 5:39

So what does getting COVID look like if you're an otherwise healthy child?

SPEAKER_02 5:47

So often uh children can be very mild in their symptoms. It looks like a common cold. Coronavirus is a cold virus. So runny nose, cough, fever.

SPEAKER_01 6:00

Got it. They're still probably pretty perky.

SPEAKER_02 6:03

Might be able to play. Yeah, in fact, um, according to the data, there have been no deaths in children under the age of nine.

SPEAKER_01 6:13

Okay. Wow. So if your kid has that perpetually snotty nose, right now, you have to suspect it's COVID.

SPEAKER_02 6:23

I think that because COVID is in our community and the social responsibility is to prevent the spread. Yes, you just have to assume that any cough, cold, runny nose, fever is COVID until proven otherwise.

SPEAKER_01 6:44

Got it. Um and then is that the same in an otherwise healthy adult or or amongst the adults is because what you just said is that some people will have severe symptoms. And my understanding was that those were people that already had comorbidities or a weakened immune system.

SPEAKER_02 7:03

So in the majority of cases, yes, that um it's the people with cardiovascular disease, um, immune uh difficulties, uh, lung issues, and uh more and a large population um that has a significant higher mortality rate is the older person. So persons over the age of 80 have a 15% mortality, um, and that doesn't necessarily um uh translate to only those people who have comorbid conditions, just the age themselves tends to uh put a person more at risk.

SPEAKER_01 7:49

Got it. Got it.

SPEAKER_00 7:51

Now you had said something about um until proven otherwise. And from what I understand, I was listening to the media, the media reports or the releases this afternoon, and um it it appears to me that that the province, uh the provincial health authorities are um really prioritizing who is getting tested. Yes. So if I'm at home, I'm relatively healthy, otherwise, I have a stuffy nose, I'm paranoid that I have the COVID virus, so I'm not going anywhere, I want to get tested. However, they're they're prioritizing so that I guess um the idea is that we contact our physician um and then the physician will tell us whether we need to go get tested or send us to be assessed for testing.

SPEAKER_02 8:45

Yes. The process of if you have symptoms and uh then what to do from there, I will just say, is evolving. And so again, what I say today might not be what's going to be determined as the path tomorrow. Right. Um, the main issue is health resources. So COVID has only been uh known in North Vancouver for a very short period of time, and we are already having issues with running out of swabs, unable to get masks, um, and not having the manpower to deal with patients presenting uh either to our family practice offices or to um the other healthcare facilities. The one thing, the one message that I really, really want people to follow and strictly follow, is please do not show up with your coffin-cold symptoms at your family doctor's office because the waiting room is full of very vulnerable people. And if you happen to be a COVID-positive patient who is faring well, you will most likely pass the virus on to six or more people in a very short period of time. Um and it's those vulnerable people that will become more sick and may die. So the guidelines that we are giving patients and that we've started to do in our office when we first heard that COVID was on the North Shore was in our office we are screening every person who calls for an appointment. Do you have fever, chills, runny nose, cough, shortness of breath? If you have any one of those symptoms, then you will be screened either by telephone or video appointment with your doctor. And in our clinic, I've been using uh video appointments for over a year now, so my patients are fairly used to being able to get a hold of me that way. In some family doctors, they don't have that set up yet, and so they might screen by telephone, and then depending on the risks uh will depend on the path. So, right now, um, if you are suffering with symptoms, but you are not a you do not have a proven COVID contact, then um it's staying at home, self-quarantining, monitoring your symptoms. Um if you have traveled to a endemic area uh in the last 14 days, um, have symptoms or have a known contact, then the physician will call the medical officer of health, public health, notify them. Um there will be arrangements for you to be swabbed and um to be monitored, and then all of your close contacts uh will also be monitored, but not necessarily quarantined. If you test positive, then all close contacts will then be notified and quarantined.

SPEAKER_00 13:03

It sounds like a really organized way to make sure that people who are potentially positive are getting fed into places that can deal with their symptoms and they're not going to be running into those vulnerable people who might be in their doctor's offices for heart attacks and rheumatoid arthritis and cancers and yeah, so you have to understand that we have quite a selection of different kinds of comorbidity in our waiting rooms.

SPEAKER_02 13:36

Some of our staff are at higher risk, uh, some of our doctors are at higher risk, and protecting our healthcare workers uh is very, very important because that's the thing. If you run out of health resources, and we're talking about healthcare workers and then um intensive treatments, if you stretch those, you go from having a lower mortality to almost increasing the mortality rate by 10 in your community. In your community. In your community. So the self-isolation means stay home, don't go out. Only go out if you have to, and if you are going to go out, wear a mask and hand sanitizer. Stay six feet away from anyone else, don't touch doorknobs, don't um cough in elevators, uh, don't spread your sickness.

SPEAKER_01 14:48

Okay, so let's talk about that in terms of the self-isolation, self-quarantine. So say mom feels a bit unwell and decides that maybe she doesn't know if this is COVID or not, so she's gonna stay home. But the rest of the people in her household carry on with their jobs and their kids go to school. Um, is that an acceptable self-isolation or should her immediate contacts also stay home?

SPEAKER_02 15:18

So if someone is asymptomatic, it is very unlikely that they are going to spread the virus.

unknown 15:25

Okay.

SPEAKER_02 15:26

They might be carrying the virus, but it's very unlikely that they are going to spread the virus because the virus is spread by coughing and those droplets spreading. And when you cough and you spread those respiratory droplets, they can travel up to six feet. And that's why we are saying if you're out, wear a mask or cough into your elbow so that you're not coughing into your hands and then touching a doorknob. The virus can live about 10 days on inaminate objects. So uh someone who coughs and then touches a doorknob, a person can get sick from that doorknob five days later, touch it, and then scratch their eye because it's itchy, and they've got COVID, they've got the virus.

SPEAKER_01 16:20

And the numbers of times you touch your face. Have you paid attention to that?

SPEAKER_00 16:23

That's the hardest thing I've been noticing to treat to catch yourself. Oh, I almost have to put my hands in my pocket and sit on them.

unknown 16:31

Yeah.

SPEAKER_02 16:31

So some people are saying, um, if you are well and in public, you probably shouldn't wear a mask because most people end up touching their face more when they're wearing a mask. I've heard that. And this is the advice that I am giving my family, if you are having to travel in a bus or having to enter into a crowded elevator or having to enter on a plane, um, then wear a mask.

SPEAKER_01 17:12

Okay, so let's talk about the concept of flattening the curve.

SPEAKER_02 17:18

Flattening the curve is the way to not stress our health resources. So if we delay people getting infected, if we have time to spread the presentation of sick people to the hospital over a longer period of time rather than an acute short period of time, then we have available resources for the more intensive care that's needed for the vulnerable and sick. If we do not prevent the spread of COVID-19, the percentage of sick people who are going to be severely sick is still the same. And that means that if larger numbers of people are carrying COVID, have COVID, then we have larger numbers of people requiring acute care. And then you have to make decisions like they've made and had to make in Italy about who gets a respirator and who does not.

SPEAKER_00 18:36

And I've heard that that, and correct me if I'm wrong, because I don't know if these numbers are correct. I've heard that there are estimates that anywhere from 30 to 70 percent of us will get the COVID virus.

SPEAKER_02 18:52

I um I I think that a large percentage of us will be exposed to the virus. Okay. Yes. And this is why over the last few days we have seen um governments take what seems like extreme measures, aggressive measures, but they're doing it. And it's because of what has been learned in China, it's because of what we've seen happen in Italy and Iran, and it's also because of data that we have from way back in the early 1900s with um the flu, the flu pandemic. Um, there were comparisons of cities that acted quickly and had significantly lower mortality rates than those cities that did not act quickly, with um canceling parades, canceling gatherings, um, keeping people at home, closing businesses. And the numbers suggest that the more aggressive we are at the beginning of a COVID outbreak, the uh better chance we have of decreasing the morbidity and mortality from this virus.

SPEAKER_00 20:25

I have a question about how how BC is handling this, and I don't know if you can speak to this, but um uh I have family in Ontario, and so we've been sort of talking back and forth about what what's happening, and in North Vancouver things were showing up much more quickly. It appeared that that things were starting to ramp up here sooner than in other places, and yet um they have closed all their public schools, the libraries, the recreation centers have shut down. Um here we chose to leave the schools open until March break, and I don't see the rec centers closing, and I don't see the libraries closing. And um I'm I'm just curious as to what the differences are in those different jurisdictions and and why would the response be so different?

SPEAKER_02 21:17

Uh that is a very good question, and I think it comes down to um education, um collaboration, and um really trying to have that balance of personal freedoms versus um mandated uh protocols. So the work that is going on in North Vancouver, I would say is very impressive. There is a lot of work going on in the background. To ensure that we have adequate resources, that we communicate. But all of this is happening so fast that the urgent things are being dealt with first, and then of course the less urgent things are flowing from that. I think, you know, uh from the announcements a day or two ago to what's been happening even this morning or even two hours ago, um, there is a tsunami effect happening where Whistler Blackhome has just closed.

SPEAKER_01 22:44

Yeah, that was for March break, which is yes. I'm really impressed, Blackhome just letting you know. Yeah, no.

SPEAKER_02 22:52

Um so I know that there were definitely communications from the schools uh to families. Um I think that if the school break was not to start for another week, I'm sure that after the last 48 hours, schools would have been closed. Um, it just wasn't at that level or that point to close schools early.

SPEAKER_01 23:28

Um there's an example of a school that's not in the public system but near my house, and they received an email, I think, today that next week all school will happen online. Yes. So the kids are gonna stay home and they're gonna do online learning for a week.

SPEAKER_02 23:43

And that's what they're doing at many of the universities as well. So my son's in university, and his classes and exams are now going to be online. All remote.

SPEAKER_01 23:54

We have the technology. Yep, we have it.

SPEAKER_00 24:00

We're certainly seeing some fear-based behaviors in the community. There are stories and social media images that show that stores are selling out of not only things like masks and gloves and Lysol wipes and hand sanitizer, but toilet paper and dry goods and even groceries. Amazon was at one point selling hand sanitizer and related products at astronomically inflated prices. Um, I was interested today to see that in their daily media briefing, and so today is Saturday, um, BC Health Minister Adrian Dix and BC Provincial Health Officer uh Dr. Bonnie Henry addressed this issue specifically, saying that they have been, I guess, uh in contact with retail associations and retailers across the country who guarantee that there is lots of stock of all of these things, um, but that due to panic buying and and sort of over-enthusiastic preparation, um that's what's happening in the store. So at the media briefing, they were really trying to encourage calm and encourage people to get back to their normal patterns because there isn't a shortage.

SPEAKER_02 25:15

Again, it's about flattening the curve, and we want to decrease the number of patients that are exposed or peoples that are exposed to COVID virus. Um we want to prevent that peak. We also want to prevent that peak of panic because that's also not going to be healthy for our community. Um so the stay calm and carry on is a good thing to a good mantra. Uh carry on, but wash your hands, wash your hands, wash your hands, wash your hands, stay home if you're sick. There it is.

SPEAKER_01 25:58

Wash your hands, don't touch your face, don't touch doorknobs, and if you're sick, stay home. Stay home. And that is probably all that's necessary.

SPEAKER_02 26:12

There are some other things that um you can do. You can make sure that you're eating healthy, staying hydrated, getting your exercise. There's nothing wrong with going hiking in the mountains where there's no one around. Yes, we have we have those things around us.

SPEAKER_01 26:33

We are very lucky. We are very lucky.

SPEAKER_02 26:35

We have seven days of sun with a two-week self-quarantine mandate. You know, we can definitely be out in the bush um doing exercise.

SPEAKER_01 26:49

I was in the woods today, and the happiest people were all in the woods. And we could all smile at each other as we walked past each other. Um, that was wonderful. So, yeah, if you can get outside, use the resources available to you.

SPEAKER_02 27:04

There is some evidence in China that they're using high-dose IV vitamin C for their very sick patients. Um, so making sure that you're taking your vitamins is um important.

SPEAKER_01 27:23

All those basic things that we do to keep ourselves healthy. Get enough sleep. Yeah. Good quality sleep. Try not to be too worried about it all.

SPEAKER_00 27:34

I'd like to just throw a question in kind of on a personal level. I have a Pilates studio and I have colleagues who have Pilates studios or yoga studios or fitness gyms of various kinds. Um I know that most of us, I know I've been very proactive in uh educating clients to wash their hands before they come in and as they leave. We are sanitizing, sanitizing, sanitizing. We've made all kinds of changes to make sure that the room is as clean and safe as it can possibly be. Um I just wonder at this point, is it wise for me to remain open as a business owner? Am I being unethical in having a business where people are breathing together and sweating together? And yes, we're doing our best to keep everyone apart. Um I guess I'm just I I'm sort of at a point where I'm not sure whether it's time to to close the doors and be be really proactive and say, yeah, this stops here. I'm not gonna let this happen in my space.

SPEAKER_02 28:47

If we could be confident that every single person in our community is socially responsible and stays home if they are sick, I do not see a problem with keeping your facility open. The problem is that many physicians have expressed concern because even coming to a physician's office, people will not divulge that they have fever, cough, runny nose. They will not clean their hands with hand sanitizer and they will not put on a mask. They walk by our big sign that's blocking the door, and they walk right by it and talk to our medical office assistants and whisper in their ear, I think I need to be swabbed for COVID.

SPEAKER_00 29:44

Wow. Right.

SPEAKER_02 29:46

Again, it is this social responsibility. You need to respect your brothers and sisters.

SPEAKER_01 29:54

All right. So let's just summarize that because I think it's really important. If you think you have COVID and you want to test, you should stay home and call someone. Your doctor.

SPEAKER_02 30:03

Call your family doctor, call 811 811, uh, or go on to Health Links website or Vancouver Coastal Health website or the CDC website. So all those websites will have most up-to-date, I think, for patient information. Health links is probably the best. I know that yesterday patients were having to wait four to six hours on hold to be spoken to on Health Links. They're overwhelmed. Um, there are more resources that are being put to answering those phone lines. And you know, as a community, we need to understand that at this point in time we need some patience, um, some calm. There is work being done, it just takes time to put those um applications in place. But for the general population, 811 seems to be the most reasonable um contact for physicians. Again, it's they have their own uh protocols depending on how well or sick the patient is.

SPEAKER_01 31:27

Do you feel that because I've heard that um people state the Canadian healthcare system is well prepared.

SPEAKER_02 31:35

So the Canadian healthcare system knows how to manage acutely ill patients. That being said, if the general population does not follow the guidelines of protecting your brothers and sisters if you are sick, uh the healthcare system will easily get overwhelmed.

SPEAKER_00 32:02

So it's up to us. It's up to us. It's just that's it's that simple. We have to really be clear about our own health and our own boundaries. And if we think we're sick, stay home. We stay home. Period.

SPEAKER_01 32:15

Period. Close business, stay home, cancel the trip, do all the time.

SPEAKER_00 32:21

Well, and I mean that's too when we get into uh I don't know if the cancel the trip is a situation because I think a lot of those those trips, that money's gone. But um just in terms of I'm thinking in terms of small business, I've been hearing that the government has introduced measures that will come into play if you have to close your business or if you are um negatively affected by this whole situation. Um maybe it's closing, maybe it's uh staff out, you can't, you know, maybe the staff is sick or or looking after, I think there have been changes in the uh employment insurance so that there's not a wait period for employees if they've been laid off or if there's something because of COVID, there are some changes. Um so that from my perspective was really encouraging. Um sort of thinking ahead and and thinking, okay, I've got some staff to look after, and so I want to stay open as long as I can because they're relying on a on a paycheck, but at the same time, I have vulnerable people, you know, that have that are very elderly or that have conditions of one kind or another that come into my space.

SPEAKER_02 33:34

Um can you use some sort of virtual platform so that people could do their classes in their own living rooms?

SPEAKER_00 33:47

We are in the process of putting that together as we speak.

SPEAKER_01 33:52

There you go. And I've been definitely um thinking of and and imagining the remote arm of my practice actually for 2020, and suddenly I think it needs to start now.

SPEAKER_00 34:07

I would just like to take a moment um to speak into I think the level of overwhelm that that I personally feel in the face of the hysteria around the virus, not about the virus itself, um, but you know, the the reactions, the misinformation, the panic that you see online and in the community sometimes. Um and as a as a member of the community and as a person who owns a business here, I am trying to be responsible and really pay attention to what's the latest information coming out. Um so I can act appropriately. But the constant, that heightened energy around this right now is kind of overwhelming sometimes. And sometimes I just need to turn it off and go for a walk. But I can only imagine that the pressures in the medical community are exponentially more massive than that. And I wonder how you're coping, how are you doing with all that?

SPEAKER_02 35:09

Well, I understand that Dr. Henry has a um fan club, and uh it is a well-deserved fan club because her leadership has been incredible.

SPEAKER_00 35:26

So calm.

SPEAKER_02 35:29

And proactive. Yes. Uh the I have been um sitting on a committee, an emergency response committee, and we've been meeting many times throughout the week and communicating almost continuously, and there are many people sitting around this table, and the focus and determination to be successful in containing this virus is unbelievable. The amount of work that has come to fruition in five days has been unbelievable. So I am very confident that we will be okay as long as people understand that they need to participate in this process.

SPEAKER_00 36:27

We're all in it together.

SPEAKER_02 36:30

This is a tsunami alarm, and we need to organize to protect ourselves, to protect our vulnerable, and to respect one another before the tsunami hits. We need to take the advice of the authorities seriously. We need to not be selfish with our own needs because if we ignore the warnings, there will be substantial death.

SPEAKER_01 37:16

I think that's a good place to leave it. I think we had our questions well answered. Uh and we've had some really clear instruction. Susanna and I are gonna put some links to some resources in the show notes of this episode. Um, definitely to the places that Dr. Haluenko has mentioned. Um I'm gonna put a link to a really clear article that I like a lot that has got some graphs and some really clear information about this flattening the curve idea for those of you who think that they need a little more information. So, wash your hands, touch your face, home if you're sick. Be good for your brothers and sisters. We will see you next time. Small Conversations for a Better World Podcast. Have the coffee on. If you liked what you heard, we encourage you to head on over to iTunes and leave us a five star review. Better yet, subscribe and leave a review. That really helps to make it easier for others to find us to help broaden this small conversation.