Published March 16, 2020.  12:50PM

Dear Members,

March break is usually a time of family, travel, relaxation and welcoming signs of Spring. Instead of that, this year we are faced with an entirely different situation as COVID-19 occupies our thoughts and changes all our plans.

As rheumatologists, we have responsibilities to our patients, many of whom are immunosuppressed, to ensure they have access to the best care, given the current situation. First and foremost, we need to keep ourselves healthy to be able to deliver that care. Following the guidelines of social distancing, meticulous handwashing and self isolation where indicated will improve the chances that we as treating physicians remain able to offer care without endangering our patients. In terms of office visits, thus far we do not have any clear directive to completely cancel offices but advice being given says we should refrain from offering all “non-essential visits”. This needs to be determined on a case-by-case basis, but we now have alternatives to offer including telephone visits and OTN video visits. Some office buildings have already been closed, making in-office visits impossible.

Here is some important information:

• The OMA president has said that he is doing the following: ALL of his patients are being screened for symptoms of viral illnesses and if they screen positive, they are being offered a telephone visit, using the newly approved telephone visit codes. There are of course, some people he must see in person. So his clinic remains open but the waiting room has been shut down. Patients call when they arrive, and then wait in their cars and they call or text them to come in when the office is ready. This improves social distancing.

I would also suggest offering patients appointments in the summer if they are stable.

• Each of us should review our own personal situations and determine what will work for us. Using hand washing, disinfecting surfaces and giving masks to patients exhibiting any signs or symptoms of respiratory infection are essential. Minimizing risks for ourselves and our patients while providing appropriate care should be our goal.

• Here is a statement from Dr Janet Pope, our Therapeutics Chair: “If there is no evidence of a fever or serious infection, medications should be taken for rheumatic diseases. If there are symptoms of high fever or a serious infection, then patients with rheumatic diseases should seek medical attention and mention they are immune suppressed and consider holding their biologics / disease modifying drugs. Do not suddenly stop your prednisone. Use hand washing, avoid touching your face, avoid crowds and follow advice from your local health authority to avoid the chance of getting COVID-19. Please get the flu shot if you haven’t already as influenza is still a risk. Avoid non essential travel.”
• We have reached out to EAP to see if we can avoid bringing patients in for EAP renewals during this crisis and they are working on solutions as I write this.
• The Ministry of Health has created new codes that now allow us to bill for telephone visits and video visits which can replace in person visits for now, with the same remuneration, even though physical exam will not be required.  Information on this can be found in the Members section (you will need to log in) under “Existing Members”.

• The ORA website has posted many online resources on COVID-19 from expert sources and these are updated daily at a minimum and more frequently as indicated.  We have a new section on resources for providing care during the COVID-19 pandemic including door signs and information on how to provide virtual care.  We will continue to monitor the situation closely and will keep you as informed as possible. We will also make ourselves available to answer questions to the best of our abilities on clinical and billing questions.

This is frankly a scary time with many unknowns. We are concerned for our families and our patients as well as our communities and our country. By following all the strategies above as well being ready to modify them as further information becomes available, we can continue to offer care in a safe, compassionate and effective way during this health care crisis.

“Always remember, you are braver than you believe, stronger than you seem, smarter than you think and twice as beautiful as you’ve ever imagined” Dr. Seuss

Dr Jane Purvis, ORA President
Dr Philip Baer, ORA Vice President, Adult
Dr Deb Levy, ORA Vice President, Pediatrics
Dr Felix Leung, ORA Communications Director