Significant concerns: Changes to COVID-19 measures

July 30, 2021

Dear Members:

On July 28, Alberta Health announced significant changes in the public health measures for COVID-19. I have written to the Minister regarding my concerns, and I want to share these points with you.

The pace at which public health measures are ending is troubling. I do not disagree that moving from pandemic state to endemic state is the future but would strongly advocate for a less precipitous approach. This would allow the impact of removal of masking and public gathering restrictions, the increase in prevalence of the Delta variant and the upcoming return to in-person learning to be better understood. It would provide more safety for Albertans, manageability for the health care system and ease public anxiety during this transition. There will doubtless be plenty of public debate in the weeks ahead and this would be facilitated if government will provide the evidence on which their decisions are based.

Furthermore, it seems there is expectation that community clinics are to take up the task of testing once public assessment facilities close. Clarity and support for this are needed. I have heard from many of you remarking that workload has already increased significantly owing to the care deficit that has built up over the last 18 months. This will no doubt increase as we move into the fall and face the resurgence of other viral infections. Not all community practices are in a position to administer testing. Those that are, will require support including remuneration, personal protective equipment and proper infection prevention and control protocols and supplies. Additionally, a clear process needs to be in place for those situations when a physician cannot administer testing. 

I recognize that there are provisions for the Tarrant surveillance network and wastewater monitoring of COVID-19 rates. These results should be shared publicly against evidence-based metrics so that Albertans can appropriately determine their risk. Even so, it appears that there is an over-reliance on hospitalizations and ICU admissions as the primary indicators. I am worried that this will lag too far behind spread of the virus in the community. By the time patients land in hospital or ICU, community care may be overrun. Community primary care was instrumental through the pandemic in keeping patients out of emergency departments and hospitals: we need to ensure this capacity remains.

We are concerned about keeping Albertans safe while ensuring that community practices remain stable.

The AMA will support our members to provide the best care possible in this time of change, e.g., working with partners on a guideline to support primary care and other community providers to triage, test and treat patients for the point when COVID-19 is one of several diseases in the community with similar symptoms. Physicians can find resources on the AMA website.

I know that everyone is tired – physicians, our care-team colleagues and the public. This galvanic set of changes is particularly hard to absorb as a result. There is hope for Albertans in the vaccines and the outstanding care they will receive when they need it. In seeing more patients protected, there is hope for physicians. In the meantime, be kind to each other. Look after yourselves. Remember that the Physician and Family Support Program is available 24/7 to assist you if you need it.

I take the opportunity to provide some thoughts for Albertans. I urge everyone who has not yet been vaccinated, to do so as soon as possible. 

• If you have concerns, please reach out to your physician to discuss them. The more of us protected by double vaccine status the better we will be. 
• If you are sick, stay home: the lifting of mandatory quarantine does not change our obligations to society. With the closing of the public assessment centers, testing for COVID-19 will become less available and likely restricted to those at highest risk. 
• If you feel that you want to take steps such as masking to protect your health, you should feel empowered to do so. 
• If your physician requires you to wear a mask in the office, wear one. There are vulnerable patients around you that deserve every opportunity to stay well.

I always appreciate hearing from members. Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org  
• Comment publicly on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

 Sincerely,
 
Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association
 
P.S. This letter replaces an update I intended to provide today regarding last week’s Board meeting and directions in our discussions with government.  Please look for that update early next week.