Tri-Cities doctors fear heading into flu season with no local COVID-19 assessment clinic

When doctors at the only COVID-19 testing clinic in the Tri-Cities announced it was closing Friday, Fraser Health quickly revealed that a new site in Coquitlam would soon open.

But those same doctors are worried that a crucial component in the region's defence against the spread of the coronavirus is still missing: a respiratory assessment clinic (RAC).

An RAC is a clinic where patients with COVID-19 symptoms can be assessed to determine whether they need a test or whether their symptoms stem from something else. Without such a facility in the area, patients may instead have to go to local hospital emergency rooms — which will likely begin getting busier as flu season gets underway. 

"Although the high-capacity COVID-19 testing site is much needed in our community, we must also stress the need for a local [RAC]," wrote Dr. Carllin Man and Dr. Jordan Sugie in a letter posted to their clinic website and sent to Fraser Health.

Man and Sugie independently ran the Tri-Cities COVID-19 and Influenza-Like Illness Assessment Clinic in Port Coquitlam, where patients could both be assessed and tested by a physician.

The new testing site in Coquitlam will open on Oct. 5, but Man says it only covers one half of the problem because assessments aren't usually done at testing-only centres.

In most communities, urgent and primary care centres have become de facto RACs during the pandemic, said Man, but none exist in the Tri-Cities — Coquitlam, Port Coquitlam and Port Moody — or New Westminster.

If a patient calls their family physician complaining of a sore throat, Man says most doctors would request they don't visit the family practice to be assessed because they could have COVID-19 and risk transmitting the disease to other patients.

As well, many family doctor offices aren't equipped with the proper protective equipment to treat someone who may have the disease, he said.

Previously, those patients would have been sent to Man's clinic — but with that option set to expire and no nearby urgent and primary care centres, he believes those patients will most likely be directed to their closest emergency room.

Flu season in the emergency room

COVID-19 already means there's added anxiety among emergency doctors this year, said Josh Koczerginski, an emergency physician at both Royal Columbian Hospital in New Westminster and Eagle Ridge Hospital in Coquitlam.

Every year, come flu season, the emergency rooms at both hospitals see a huge increase of patients with flu-like symptoms.

"In addition to patients with the flu, we are also going to be seeing patients with potential coronavirus," Koczerginski said.

He says this will result in a greater strain on hospital staff, longer wait-times and the potential for the spread of COVID-19, in an environment filled with higher-risk elderly and immuno-compromised patients.

"Somebody coming into the emergency department solely for a coronavirus assessment is potentially putting [patients] at risk of catching this virus," he said.

He says clinics are preferable for COVID-19 screening because they are controlled environments where patients need to book a specific time that allows for strict protocols to be followed — unlike emergency rooms, where there are many shared care spaces.

"As volume goes up, it becomes extremely, extremely challenging to ensure that social distancing… is always maintained," he said.

Fraser Health offers virtual assessments

Fraser Health refused to clarify to CBC whether the new testing site in Coquitlam will also provide assessments.

However, a spokesperson said the health authority is working with the Division of Family Practice — community-based groups of family physicians — to provide a virtual assessment option to support people in accessing the new site.

"This plan will ensure the assessment needs of the community are met," the spokesperson said in an email.

But Man isn't convinced that is a sufficient alternative.

"Some things you need to see people for. I can't listen to lungs over the phone," he said. "I can make an educated guess based on someone's symptoms that they may have pneumonia but it's not an actual replacement for listening to their lungs and seeing them."

Fraser Health said if a patient is determined to need an in-person assessment during the virtual appointment, they will be referred appropriately.

But Man says that still doesn't answer the question of where they will be referred to.

A new urgent and primary care centre is scheduled to open in the Tri-Cities in February 2021, but Man worries a six-month gap with no RAC could have serious consequences.