Case 39: Local Transmission (COVID-19 III)

Gigi Derdus* is eleven years old. Just as I’m heading out for groceries, her mom, a close friend, texts me. Call me if you have a chance to chat.

Gigi’s had a fever and cough for twenty-four hours. It’s Wednesday, March 18, 2020, and although she hasn’t been anywhere since the country went into shut-down, she was in a classroom full of students just five days ago. Gigi’s a tough kid. She’s healthy, spunky, and smart. I ask Gigi’s mom a few questions – any shortness of breath? No. Eating and drinking okay? Yes. Other than the cough and fever, acting normally? Yes.

“It’s already in the community,” I tell her. “So, at this point, there’s no need to go to the hospital for testing, but you need to isolate.” Gigi’s grandfather, who lives with her, has a few medical problems. Gigi’s mom has already separated the two – keeping one on the top floor of the house, and one on the bottom. “You know how to self-isolate,” I say, “right?”

“Yes,” she says.

“Perfect, so just assume that Gigi has it and isolate her. She’s young, and otherwise well, so if she does have it, it’ll likely just pass like a regular flu.” This is a strange word. Isolate. In twenty years of practicing medicine, I don’t ever remember using it so routinely. I guess it goes hand-in-hand with another word: Pandemic.

Thursday, March 19, 2020, 9:00 am: For those who don’t have a health professional to call for personal advice, there is an online tool being circulated by Toronto area hospitals. It lands in my inbox this morning. It’s designed to help people decide whether or not they should go to a hospital for assessment if they’re ill with COVID-like symptoms. I fool around with the assessment tool. It asks eight ‘Yes/No’ questions, and, based on the user’s answers, it spits out a recommendation. It’s an excellent initiative and will undoubtedly keep people who don’t need to go to the ER at home.

I think about Gigi and click “yes” to the first two questions: Yes, I have ‘a fever, chills, or shakes.’ Yes, I have ‘a new or worsening cough.’ I click no to the final six questions (No, I’m not short of breath. No, I have don’t have any other medical problems. No, I’m not over sixty). I note, however, that question seven asks about travel history. Specifically, “have you traveled outside of Canada in the last 14 days?” The answer is set to no.

I click submit. It gives the following advice:

Based on your answers, there is currently no need to go to an assessment centre or emergency department. You will not be tested for COVID-19. Continue to monitor your health and stay home for at least 7 days. If you are still experiencing any symptoms, you should stay home for another 2 days after your symptoms fully resolve.

I don’t see the word “isolate” anywhere. In fact, this sounds like the advice I’ve been giving for flu-like symptoms for the last twenty years – up until about a week ago.

I go back and change one answer – Yes, I’ve traveled outside of Canada in the last 14 days. (Just to clarify, I haven’t, and I don’t have a cough or fever either). I click submit. The following advice appears:

Based on this assessment, there is currently no need to go to an assessment centre or emergency department. You will not be tested for COVID-19. However, you are to self-isolate for 14 days. For instructions on how to self-isolate, please see the guide published by Toronto Public Health: How to self-isolate.

This is the right advice for Gigi and anyone who has a cough and/or fever. It shouldn’t apply only to those who have traveled. It’s been established for almost a week now, that Canada is a country in which there is local transmission. Even Ontario’s first suspected COVID-related death had no known history of travel.

I think about my mother. If she develops a cough or fever, I’ll tell her to self-isolate for fourteen days. That being said, the advice of her son is no match for what’s posted on a website along with the logos of three major hospitals. “Don’t be stupid,” I can hear her telling me. “The website said I just have to stay home for seven days and if I’m okay for two days, I can go out.”

“Okay, mom, whatever,” I’d say, to which she’d respond:

“Okay. Do you want me to bring over some chicken curry?”

I text Gigi’s mom: How’s Gigi? Make sure to just assume that she has it, and keep her isolated for fourteen days. There’s still advice being given to only isolate patients with travel history, which is ridiculous. It’s already here.

The link to the self-assessment tool can be found here: https://covid19toronto.ca. If you’re using it inside Canada, and you want up-do-date advice, click “yes” on “Have you traveled outside of Canada within the last 14 days?” Like I told Gigi’s mom, and as my colleagues and I have been saying for several days, it’s already here. Hopefully soon, the online tool will be updated.

For instructions on how to self-isolate, please see the guide published by Toronto Public Health: How to self-isolate.

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*names changed

4 comments

  1. Yes thank you for taking time to write. Love your blog. It’s a cool insight to such a noteworthy profession!
    Even though you are Carlo’s friend, I’ll still give you credit😁
    (I’m one of Natalie’s sisters.)

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