COVID-19 Positive; physician negative

COVID-19 Positive; physician negative

As we transition from summer into fall, Canada faces at least two major issues in healthcare. The first is the continuation of COVID-19. Although the majority of restrictions have been removed across the country, there is still a risk of infection and reinfection, especially as the virus mutates.

To complicate matters, with the traditional flu season upon us, there is a double viral threat to our health. In short, as people move indoors because of the weather, viruses of all kinds move with us.

The second threat to overall healthcare is the shortage of physicians, nurse practitioners, pharmacists, ambulance paramedics and other healthcare professionals. Add to this the deplorable state of many healthcare institutions, especially for congregate living, and it is clear how dire the situation is.

When these two issues are in play at the same time, what is the outcome? There are some five million Canadians without a family practitioner. What are they to do if they test positive for COVID? The guidelines for isolation and retesting are all over the Canadian map.

But each of us lives in only one province or territory. Your jurisdiction’s website highlights what’s relevant for you. What do you do if you test positive and you don’t have a physician or primary healthcare practitioner?

There are two Canada-wide approved treatments to reduce the effects of COVID:  Paxlovid and Remdesivir. Neither is meant to prevent COVID. Both are proven to reduce the severity of COVID-19 and to prevent hospitalization among particular populations. Across the country, the eligibility requirements for the two approved drugs are inconsistent.

Are you in an age-related at-risk category, which ranges from 50+ to 70+, but can be as low as 18+? Do you have chronic or pre-existing health conditions? Are you First Nations, Métis or Inuit? Have you received one vaccination, two, or none? One or more booster shots?

It all begins with testing positive. If you do so, first, you negotiate your jurisdiction’s website to determine whether you are even potentially eligible for either Paxlovid (taken at home) or Remdesivir (given intravenously in-hospital).

If you are eligible for assessment and you do not have a regular physician or nurse practitioner to complete an evaluation and prescribe medication, things get even more complicated. All the while, the clock keeps running. This is important because the drug regimens must begin within five days of experiencing symptoms.

Emergency rooms warn people to stay away if they have tested positive for COVID. The same is true for medical centres. Yet visits to these venues are often recommended for assessment.

There is good news if you live in Quebec, Alberta, Saskatchewan or Newfoundland and Labrador. Pharmacists there can prescribe Paxlovid to people who are experiencing symptoms and who have tested positive for COVID-19. The bad news is that if you live elsewhere in Canada, this is not the case.

Why not? Early in the course of the pandemic, pharmacists across the country were quickly empowered to administer COVID vaccines. Why can’t this expansion of pharmacists’ scope of practice take place relative to drugs to alleviate serious COVID cases? There is no clear answer to this question.

If you are not in the good news provinces and territories, you must rely on jurisdictional toll-free numbers to start the process.

For example, BC acknowledges that not everyone has a doctor. The provincial website suggests contacting Service BC. This leads to a four-part process to complete, which can take up to four days. This is cutting it short, especially if Remdesivir is recommended, requiring hospitalization.

Manitoba takes a middle ground by not spelling out the specific eligibility requirements, but again referring people who test positive to a toll-free number. It also mentions that “To improve access, one of the treatments (Paxlovid) will be available at 175+ pharmacies across Manitoba with a prescription. Use this list to find a location near you.” No mention is made, however, of how to get a prescription to bring to the pharmacy.

In Ontario, the recommended option for people who test positive and who do not have a regular health care provider is to visit a Clinical Assessment Centre. These centres “can test, assess and provide treatment options for COVID-19. You should visit one if you have symptoms and are at higher risk for COVID-19 and need to get tested and assessed for treatment (including antiviral treatment).” There are over 850 such centres around the province, with each catering to specific populations under specific circumstances.

Nova Scotia has an online assessment tool for anyone who tests positive and/or experiences symptoms of COVID-19. The tool establishes eligibility for potential treatment. It also facilitates referrals to physicians and others who are designated to prescribe and to dispense Paxlovid and Remdesivir. Not all physicians are.

New Brunswick’s government website advises “If you do not have or cannot reach your primary care provider, call 811 or visit to see a New Brunswick nurse practitioner or doctor online.” E-visits are covered by New Brunswick healthcare insurance.

On PEI, eligibility for treatment is very broad, ranging from 18 to 50+, the former with underlying medical conditions and the latter regardless of vaccine status. People who test positive, but don’t have a family physician, can call a toll-free number or visit a walk-in clinic.

Yukon’s government website does not specifically mention how to access treatment without a doctor, only that a doctor’s assessment and prescription is needed.

Northwest Territory advises a visit to one of the many health centres across the territory.

Nunavut has perhaps the simplest eligibility criteria, stating that treatment is available for “for adults 18+ who are considered high risk for poor outcomes.” The territory has established the COVID-19 toll-free hotline, accessible from 10 a.m. to 6 p.m. daily. It is the route to treatment assessments and prescriptions.

Vaccination remains the single most important deterrent against the virus. Oxymoronic though it sounds, and counter-intuitive though it is, vaccine uptake is declining, despite persistent increases in the virus across the country.

Yet receiving a shot is relatively simple and accessible. If only finding a family physician were that easy.

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