Innovations in treatment
First confirmed cases led to innovative virtual care program at Sunnybrook
Canada’s first COVID-19 patient was at Sunnybrook. Today his treatment might have been by video,
Dr. Jerome Leis vividly recalls treating Canada’s first confirmed COVID-19 patient during his weeklong stay at Toronto’s Sunnybrook Health Sciences Centre.
Each day, he and the care team anxiously waited for the patient’s symptoms to progress, poised to jump in with life-saving measures. But the patient — a 56-year-old Toronto man who had recently returned from a three-month visit to Wuhan, China — didn’t get that sick.
Now, one year later, Leis says this patient would not be admitted to hospital and would likely recover easily at home, never needing advanced medical care.
“He didn’t have any severe symptoms, just cold symptoms — coughing and fever,” said Leis, Sunnybrook’s medical director of infection prevention and control. “With hindsight, and after managing more than 4,000 COVID-19 patients through our hospital, if this patient presented today, we would treat him as an outpatient.”
Since Jan. 25, 2020 — one year since laboratory tests confirmed the first patient had COVID-19 — the virus has infected 742,531 Canadians and 18,974 have died. As of Jan. 24, there are 64,573 active cases in the country.
Canada’s first COVID-19 patient — and his wife, who experienced few symptoms while isolating at home — offered an early glimpse of how most people infected with the virus would fare.
These cases also laid the foundations for an innovative virtual care program at Sunnybrook that supports COVID-19 patients with mild to moderate symptoms while they isolate at home.
Launched in March, COVIDEO connects people who test positive for COVID-19 at the hospital’s assessment centre with a physician who is available 24/7 for questions and concerns. Patients are individually assessed for underlying health conditions, told how to monitor and manage their COVID-19 symptoms and offered advice on when they should seek help. “It gives us an opportunity to intervene early should the patient show warning signs,” said Leis, also an infectious disease physician. “Then we can proactively manage the case, so the patient doesn’t end up in the emergency department in a dire situation.”
The program, the idea for which emerged within days of treating Canada’s first COVID-19 patient, has since supported more than 4,000 people to recover from the virus in their homes, said Leis.
“This has been crucial,” he said. “It’s better for patients when they can stay in their home. But it also has helped to maintain our hospital capacity for those who need it most.”
Richard Carl and his family were among the first COVID-19 patients to be included in the COVIDEO program after returning with cold-like symptoms from a Colorado ski holiday at the beginning of March. Though Carl, his wife and two of his three adult sons all had mild symptoms — nothing more than cough, intermittent fever and some fatigue — the family remains grateful for their virtual care during a worrisome time.
“In those early days, it was so unclear what was going on or what the scope of the problem was,” said Carl. “While we didn’t have a lot of medical concerns, we did have a lot of questions. We were quite anxious and to have someone who could answer them with authority … that felt comforting.”
Dr. Nisha Andany, an infectious disease specialist at Sunnybrook involved with COVIDEO, said she recalls the fear COVID-19 patients had during the spring wave, when so much was still unknown about the virus.
“A lot of the rules and information were changing around that time: Who needs to isolate?
How long do you need to isolate for? What can you expect during the course of your illness? We saw COVIDEO as a way to provide some support to people who would largely be stuck in their homes.”
While the program will undergo a formal evaluation to see, among other things, whether it did reduce the number of emergency department visits, Andany said there are other, more anecdotal ways to measure its success.
“When patients tell you, ‘Thank you so much; I felt so alone during this time, and you were someone who called me every couple of days to check in and make sure I was doing OK,’ knowing you gave them support is something we want to provide with this program.”
As well, the COVIDEO team has many times helped patients get additional medical care when symptoms escalated, Andany said, from prescribing antibiotics to recommending a call for an ambulance.
“If we’re able to identify who may be getting a bit sicker at home — and they may not realize it — and get them the help they need, I would also count that as a success.”
Since the spring, COVIDEO has evolved to include additional components as its physicians learned more about COVID-19, and to accommodate the evergrowing number of patients needing outpatient care in the second pandemic wave. In recent weeks, Leis said it’s typical to add between 40 and 60 — and sometimes up to 100 — new outpatients to COVIDEO.
To keep up with demand, the program, which started with five infectious disease physicians, has grown to include other Sunnybrook staff, including family doctors and nurse practitioners.
It’s also added ways to help patients, most importantly sending an oximeter to the homes of those with underlying health conditions or whose COVID-19 symptoms are progressing.
“That’s a very useful tool for us to have some objective measure of how patients are doing at home,” said Dr. Philip Lam, an infectious disease physician at Sunnybrook. “Because sometimes it can be challenging, just by speaking to them on the phone or seeing them on video, to know how they’re actually doing. It also helps to give patients some reassurance that their oxygen levels are good, which I think helps from a mental point of view.”
Rachel Greenspoon received an oximeter from Sunnybrook the same day her COVIDEO physician, Andany, became worried about her worsening asthma symptoms.
The 67-year-old Toronto woman, who tested positive for COVID-19 at the end of November, was told to monitor her oxygen levels and call 911 should they drop below 94 per cent. Greenspoon said Andany also told her to check for swelling in her ankles, pain in her chest and blood in her mouth, all signs of blood clots, a potentially fatal complication associated with COVID-19.
“It was frightening, but something I had to know,” said Greenspoon, who was isolating in the upstairs of her home to keep her husband safe.
Though her oxygen levels re- mained stable, Andany did pre- scribe a course of steroids over the phone to help control her asthma, a strategy that worked.
“I don’t know if I had waited another day or two, if my asthma would have gone beyond what I could control,” said Greenspoon, adding the ability to call a physician at any time helped her and her husband manage their fears during isolation. “I think the steroid helped me over those bad nights and maybe kept us one step ahead of having to go to the hospital.”
Earlier this winter, the COVIDEO team partnered with a team of health-care providers, including dietitians and social workers, at Baycrest Health Sciences to offer patients additional supports, Lam said.
“There are psycho-social issues that can also be exacerbated with the infection as a result of isolation, time off work and financial challenges, for example,” he said. He noted a social worker could link a patient with financial supports, while a dietitian could help those with ongoing symptoms of nausea and diarrhea.
While other Ontario hospitals offer COVID-19 patients virtual care isolating at home, Lam said Sunnybrook’s COVIDEO was among the first to launch, largely because of the hospital’s experience with the country’s first patients with the virus. He believes these kinds of virtual care programs will likely exist after the pandemic wanes.
“There are scenarios where virtual care can provide highquality patient care … I think it’s here to stay.”
“We saw COVIDEO as a way to provide some support to people who would largely be stuck in their homes.” DR. NISHA ANDANY INFECTIOUS DISEASE SPECIALIST AT SUNNYBROOK
Scan this code to read about how health officials treated Canada’s first case.