Up until two or three weeks ago, if people had symptoms such as fever, cough, or shortness of breath, they were directed to their local emergency room for testing. But medical professionals knew that the pandemic headed their way would likely overwhelm emergency rooms — and that they’d need an alternative.
So hospitals started setting up assessment centres with the help of public health; according to David Kaplan, the clinical-quality lead for Ontario Health and a family doctor at North York General Hospital, 58 of them have opened across the province to expand screening and ease the pressure on ERs.
There are a number of different models: some are drive-thru; others are in tents set up outside hospitals. People go to the centres on their own, are directed to do so by employers, or are sent by long-term-care facilities, homeless shelters, or public-health units.
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Joel Lockwood and Paul Das, both doctors at St. Michael’s Hospital in Toronto (where I work as an ER doctor), helped set up an assessment centre across the street from the emergency room in collaboration with Toronto Public Health. It can currently assess up to 400 people a day.
At the centre, Lockwood says, people can get information about what it means to self-monitor and self-isolate. A typical visit lasts between 10 and 15 minutes. Occasionally, there’s a lineup outside, but visitors practise social distancing. Lockwood says the system was “envisioned to be like a conveyor belt”: patients enter through one door and leave through another. Along the way, they have their vitals (temperature, oxygen saturation, heart rate) taken. Nurses and doctors get a medical history and may listen to the lungs. If a person meets the screening criteria, they test for COVID-19 with a swab.
The centre follows direction from Ontario Health about testing criteria, but there are limited kits and lab capacity. Lockwood says that “most people are not getting tested.”
Testing criteria can vary from place to place, Kaplan says, noting that “different parts of the province are using different protocols depending on local public-health guidance.” Some assessment centres pre-book times to swab people. He says that, before people visit a centre, they should check with their family doctor or local public-health unit to see whether they qualify for testing. If they don’t meet the requirements, he says, “People should stay at home and have less of the virus circulating around the city.”
Kaplan notes that testing criteria are continuing to evolve, as we’re still finding out more about the virus: “Clinical guidelines [usually] don’t change every five years, never mind every five days.” Ontario is building the capacity to test more people. A recent memo from Ontario Health indicates that the aim is to be able to perform 15,000 tests daily by mid-April.
The focus right now, he says, should be on limiting the number of people simply showing up at health-care facilities, including assessment centres. His team has developed a self-screening tool, COVID-19 Toronto, that’s being used at three hospitals in the Greater Toronto Area; the plan is to roll it out at facilities throughout the region. In the coming weeks, the tool will connect nurses with those at the highest risk of getting sicker — people undergoing chemotherapy, for example, or who are on dialysis. He says that connecting with a doctor or nurse is key when it comes to keeping people at home for self-isolation: “Not getting generic advice is helpful.”
Lockwood says that the downtown Toronto centre will continue to adapt as testing criteria and demand change. The space is modifiable and built with materials that can be easily sanitized. “[We are] willing to change the clinic,” he says, “for however the society and hospital needs us to do it.”