TORONTO — Some of Ontario’s gastroenterologists who do procedures outside of hospitals say they are frustrated after not receiving a straight answer from the province as to when they can expect to receive COVID-19 vaccines – as their backlog of high-risk procedures and patient appointments mounts due to the pandemic.
“My nurses and my anaesthetist and I are in the respirator masks and N95 the whole day, like eight hours a day with the hairnet, and double gowns,” said Dr. Justina Sam, a gastroenterologist operating in Toronto, in a telephone interview with CTV News.ca Wednesday.
“We basically don’t eat the whole day, but we’re still not being prioritized. We’re not even being invited by the hospitals to attend their vaccine clinics,” she said.
Sam said she “completely” agrees with the priority to inoculate the most vulnerable — the elderly in long-term care facilities and front-line workers — in the very first phase of the vaccination rollout in the province. But her “main concern” is that there seems to be no way for hospitals to reach out to doctors working in the community, nor any invitations to get them in the queue for the inoculations.
“It’s been frustrating because we hear about other people who are not patient-facing staff who are getting their vaccines earlier,” Sam said, adding that the “need for speed” in getting the vaccine out is part of the issue.
“But those of us that don’t have [hospital] courtesy privileges or who aren’t associated with the hospitals have no way to even access to vaccines.”
“I’m worried that the hospitals are forgetting about those of us who are doing procedures that are actually higher risk in the community,” she said.
“Scoping,” as it’s colloquially referred to in procedures where tubes are inserted down the throat or up a rectum, is a big part of Ontarians’ health care.
Gastroenterologists and medical professionals performing endoscopies are in close contact with patients and perform procedures known as aerosol generating medical procedures (AGMP).
As COVID-19 is known to spread in droplets through the air, this puts an added risk to what are normally routine procedures.
“A lot of the international guidelines have said quite clearly that that upper scopes [in the throat] are considered an aerosolized and aerosol generating procedure,” said Dr. David Morgan, President of the Ontario Association of Gastroenterology, in a telephone interview with CTVNews.ca Wednesday. “In Ontario, the infectious disease groups have recommended that they’re not an aerosol generating procedure. But if…you’ve ever seen one, people are coughing and spluttering. There’s also concerns that stool also contains coronavirus.”
Out in the community
“Gastroenterology is done essentially in two places in Ontario,” said Morgan. “There’s gastroenterologists that work only in a hospital, and they may be associated with a university if it is a teaching hospital,” he said. “But there are 67 out-of-hospital facilities in Ontario where they do procedures and clinics.”
Morgan noted that for places like Barrie, Ont., out-of-hospital clinics were essential because hospitals cannot handle the volume of patients.
Morgan said the association has noticed a very high rate of appointment no-shows during the pandemic, as people feel “nervous” to go to a hospital while COVID-19 case counts are so high.
“We’ve had a delay of over 100,000 colonoscopies this year compared to previous years,” he said.
Sam said the testing for colon cancer screening, which was on hold for many months earlier on during the pandemic, has started again. She has been working seven days a week, including five days of virtual care and scoping on the weekends.
“I diagnosed quite a few cancers in the last number of months…these are necessary procedures. If someone has lost 10 kilograms and has rectal bleeding, this is a necessary procedure, we can’t shut down. You have to do these procedures,” she said.
That fear of catching COVID-19 in hospital pushes patients towards the clinics where they may feel the risk is lower than in-hospital procedures.
But that means potentially more exposure for the doctors, nurses and assistants who work there.
Morgan recalled a gastroenterologist in Scarborough being told that he “was at the same level of the hospital administrator of procurement” when it came to vaccine prioritization.
“That doesn’t make a lot of sense,” he said.
“The worry is that if these guys get sick, then they’re not going to be available to work in the clinics and there’s not going to be that safety net to care for patients out of hospital,” Morgan said.
“I hope the hospitals don’t forget about those of us that are doing some high risk procedures,” Sam said.
“I think there needs to be a more centralized system where we can perhaps log in and inform the ministry that we do this procedure so that we can be prioritized appropriately in the queue for the vaccine.”
The Ontario Ministry of Health told CTVNews.ca in an emailed statement Wednesday that the framework for prioritization is based on guidelines from the National Advisory Committee on Immunization.
“Currently, we are prioritizing the vulnerable population and those who care for them in high-risk settings such as long-term care homes and hospitals,” the statement said. “Other healthcare workers who don’t fall into Phase 1 category will be able to be vaccinated in Phase 2.”
They added that the ministry “cannot speak to individual situations,” and that “local decisions are being made.”
Ontario’s vaccine rollout
The province previously said it would vaccinate all health-care workers and long-term care home residents in the four priority regions –Toronto, Peel, York and Windsor-Essex- by Jan. 21
Now Ontario has released new deadlines and criteria for the COVID-19 vaccine rollout, saying Wednesday it hopes to administer the first dose of the vaccine to residents, staff and essential workers at Ontario long-term care homes and “high risk retirement homes” no later than Feb. 15.
The province also released details on its expected move into phase two of the vaccination plan by mid-April.
The five groups listed as recipients for phase two are seniors over the age of 80, those living and working in high-risk congregate settings, essential workers (beginning with front-line essential workers) people with high-risk chronic conditions and their caregivers and other communities “facing barriers related to the determinants of health.”
Phase three is expected to begin in August 2021, when “remaining eligible Ontarians” will be able to get the COVID-19 vaccine.
With files from CTV News Toronto Natalie Johnson, Katherine Declerq, and Alexandra Mae Jones
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