COVID-19: Staging environment

Proportionality

• Consider available capacity to provide those services, both real and anticipated.

Minimizing harm to patients

• Strive to limit harm to patients wherever possible.
• Activities that have higher implications for morbidity/mortality if delayed too long should be prioritized over those with fewer implications for morbidity/mortality if delayed too long.
• Consider the differential benefits and burdens to patients and patient populations, as well as available alternatives to relieve pain and suffering.

Equity

• All persons with the same clinical needs should be treated in the same way unless relevant differences exist (e.g. different levels of clinical urgency).
• Special attention should be paid to actions that might further disadvantage the already disadvantaged or vulnerable.

Reciprocity

• Certain patients and patient populations will be particularly burdened as a result of our health system’s limited capacity to restart services.
• The health system has an obligation to ensure that those who continue to be burdened have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.

All healthcare settings are encouraged to switch to virtual visits whenever possible. This decision should be based on an assessment of patient frailty in combination with self-management capability, in terms of both health and technological literacy, as well as technology access.

• Does the patient have a phone or internet at home?
• If the patient has access to internet, are they comfortable downloading and using apps, following links, watching videos, downloading attachments, taking and sending photos and videos?

Use the assessment guide Considerations for balancing in-person and virtual visits in Primary Care during COVID-19 (CMAJ blog, May 2020) to evaluate factors of staff and patient health, care efficiency and effectiveness, access, patient-centredness, and equity in the context of new protocols and practices.

Use the assessment guide Considerations for balancing in-person and virtual visits in Primary Care during COVID-19 (CMAJ blog, May 2020) to evaluate factors of staff and patient health, care efficiency and effectiveness, access, patient-centredness, and equity in the context of new protocols and practices.

Used when providing guidance/best practice/recommendations re delivering care/permission to do something. 

For example:

• If your practice has capacity to perform tests on site, follow the COVID-19 testing guidelines (PHO, May 5, 2020).

• The World Health Organization issued a scientific brief (April 19, 2020) stating that there is currently no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of NSAIDs.

Used when providing external links to recommendations/further information. 

For example:

Used when conveying REALLY important information that applies to the whole population, high risks, red flags, gov’t requirements, etc.  The point of use is to make the user STOP and read.  So we tended to use it sparingly otherwise the impact of the icon will be diluted.

For example:

• Any persons experiencing one of the following should be told to self-isolate and tested as soon as possible:
  • Fever (temperature of 37.8°C or greater)
  • New/worsening cough
  • Shortness of breath (dyspnea)
  • Sore throat
  • Difficulty swallowing
  • New olfactory or taste disorder(s)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.)
• There is only low-quality evidence available on COVID-19, as it is an emerging virus. Many studies being released have not been peer-reviewed. Among those that have been peer-reviewed, many are small, retrospective observational studies and thus have serious limitations and risks of bias. While the findings of emerging COVID-19 studies can be useful in helping to broaden our understanding about how the virus might operate, the results of COVID-19 studies should not be considered validated.

• As reports of children experiencing a multi-system inflammatory syndrome multiply, the Canadian Paediatric Surveillance Program issued a Public Health Alert (CPSP, May 12, 2020) encouraging those providing paediatric care to familiarize themselves with the presentations of this emerging syndrome. It has now been included in the case definition and is reportable to public health.

Generally used when conveying information that applies to the part of the population, things that are “strongly recommended” but maybe not yet mandated, cautions, etc. Similar criteria as the (!) icon, but with a content that isn’t quite as MUST READ. The point of use is to make the user PAUSE and read.  Used more frequently.

For example:

• OCFP and CFPC suggest strongly considering PPE use for all patient encounters that involve less than 6 feet of separation due to the possibility of asymptomatic and pre-symptomatic transmission. For more information on PPE, see Infection prevention and control: PPE, HCW infection control, cleaning.
• While rare, clinicians should be aware of this potential syndrome and maintain a high index of suspicion to identify cases. Some patients have deteriorated quickly and have required intensive care unit admission for vasopressors and mechanical ventilation.
• Caution should be taken when using NSAIDs in the context of acute respiratory infections (ARI) and patients with the following conditions.

Commonly used and understood icon that conveys “geolocate”. Used when linking out to regional/local resources.  

For example:

• Ontario West COVID-19 Health Navigator: If you are a primary care provider in the Ontario West region, see information from eHealth Centre of Excellence on how the navigator works and how to sign up.
• Toronto COVID-19 Self-Assessment Tool

Used for when we provide talking tips.

For example:

• Responding to questions about unproven therapies for COVID-19: “Though research is underway, there are currently no medications recommended for preventing or treating COVID-19 because there is not enough evidence to make any conclusions yet” (CMAJ, 2020).
• “This is your home and we will make every effort to make you comfortable in your new room with all of your belongings.”
• “In-room dining is important for you and other residents so that we can protect everyone, including yourself.”