Canadian hospitals are drawing up plans to launch off-site testing clinics to help prevent any future surge in demand for COVID-19 screening from overwhelming emergency departments.
A Toronto hospital has proposed some creative ways to handle the situation, including a pop-up screening clinic and offering tests at drive-through or walk-up windows.
Michael Garron Hospital (MGH) east of downtown Toronto and some of its community partners submitted a plan to the Ontario Ministry of Health on Thursday morning to set up a rapid-assessment clinic for people suspected of having COVID-19 in the offices of a family health team across the street from the hospital.
Michael Gardam, the chief of staff at Humber River Hospital in northwest Toronto, said Humber’s emergency department had not yet seen an onslaught of patients asking to be tested for COVID-19, the respiratory illness caused by the new coronavirus.
Dr. Gardam, a former director of infection prevention and control at the University Health Network (UHN), said that could change quickly if an outbreak sweeps through the community, as it has in countries such as Italy, Iran, South Korea and parts of the United States since the new coronavirus emerged in China late last year.
"I think then we will see a lot of people coming in with flu-like symptoms wanting to be tested.”
B.C. reported its first case of community transmission on Thursday. Infectious-disease experts say they expect the virus will eventually spread from person to person more widely within Canada.
The Ontario Ministry of Health has asked some other hospitals to submit applications to set up screening clinics, said Travis Kann, a spokesman for Health Minister Christine Elliott. In British Columbia, provincial health officer Bonnie Henry spoke this week with local health authority officials about the possibility of opening separate facilities to screen for the virus. Some hospitals set up similar screening clinics during the H1N1 flu pandemic in 2009.
“If we can aggressively find everyone who has COVID-19 and teach them how to prevent passing it on and have them self-isolate, that’s going to reduce the probability of them passing it on to someone else,” said Jeff Powis, medical director of infection prevention and control at MGH. “That’s how you control an epidemic.”
Another purpose of MGH’s assessment clinic, which could be up and running as early as mid-March, would be to keep the hospital’s emergency department from being overwhelmed by mildly ill patients seeking testing.
Dr. Powis said most of the patients coming to emergency departments seeking testing for COVID-19 are well enough to go home to await the results, and don’t need the full range of services offered at an emergency room.
MGH is proposing a screening clinic that would begin as a five-room operation open fours a day, but which could expand to 14 rooms and eight hours a days if a community outbreak in Toronto led to ballooning demand for tests.
If the situation warranted it, Dr. Powis said, doctors could assess patients virtually on their computers or phones, then invite them to a drive-through or walk-up window for a nasopharyngeal swab that will be sent to a laboratory for COVID-19 testing.
“Building these plans is like building a Lego house – one block at a time as you need it," Dr. Powis said.
Susy Hota, medical director of infection prevention and control at the UHN in Toronto, said her network’s emergency departments are “definitely seeing more people coming in [for coronavirus testing] who aren’t very sick.”
Like Michael Garron Hospital, UHN is exploring the possibility of offering off-site screening clinics, Dr. Hota said.
“As part of all of our planning, we’re looking at how we can do things differently,” she said. “Trying to find ways to offload the emergency department is a priority item for everybody right now.”