From the start of the pandemic there has been real concern about the effect of lockdowns on mental health patients. That is now evident in the second wave of the pandemic that has led to an increase in stress and anxiety, brought upon by new restrictions and the onset of a harsh winter. It has also caused disturbing levels of despair, suicidal thoughts, and hopelessness in the Canadian population according to a new survey released by CMHA in partnership with UBC researchers.
The survey shows that 7 out of 10 Canadians are worried about the second wave of the virus, with almost 58 per cent worried about a loved one or family member dying, and only 21 per cent feeling hopeful. As winter approaches, 40 per cent of Canadians say their mental health has deteriorated since March, with the decline ‘more pronounced in those who are unemployed (61 per cent), those with a pre-existing mental health issue (61 per cent), younger people ages 18-24 (60 per cent), Indigenous peoples (54 per cent), those identify as LGBTQ2+ (54 per cent) and those with a disability (50 per cent)’. Almost half of women (45 per cent) and a third of men (34 per cent) say their mental health has declined.
“Cold weather, uncertainty, eroded social networks and restrictions on holiday gatherings are hitting at a time when people are already anxious, hopeless and fearful that things are going to get worse,” says Margaret Eaton, national CEO of the Canadian Mental Health Association. “I am afraid that many people are in such despair that they can’t see past it.”
In times like these, the increasing adaptation of Virtual Healthcare for Mental health becomes more important. While the Government of Canada does offer tools, resources and virtual counselling for mental health and substance use support, it is not nearly enough for a population stuck at home and without any knowledge on how to deal with stress and anxiety. Still, here is how that can change:
- Anywhere-to-anywhere Virtual Health Visits
Providing patients and providers the ability to use virtual e-health (face-to-face) visits should be one of the most important priorities of any mental health institution. Tools like Microsoft Teams and solutions like Corolar Virtual Care (CVC) can help providers bridge the gap between care coordinators and patients.
- Remote Patient Monitoring
Monitoring patients from any location through connected or unconnected devices helps provide a guide for future references for the providers and maintain a close patient-provider relationship.
- Online Treatment and Resources
Online treatments and resources help patients receive treatment in groups or individually using an app or other digital services which provide self-directed learning and methods to connect with a provider.
- Clinical Digital Messaging
Maintaining a link through messaging between patients and providers such as text, email, instant messaging, or voice to text can go a long way in the averting the negative effects of large scale lockdowns.
While these are just some basic steps which are required in order to enable Virtual Healthcare for mental health patients during the pandemic, a long-term strategy for adoption of virtual health solutions is long due for Canada and the province of Ontario in the post-COVID era.
As the world has adapted to the challenges of remote and virtual work due to COVID-19, Microsoft has reported that nation-state actors are targeting healthcare organizations more, particularly companies involved in researching vaccines and treatments for COVID-19. These increasing cyberattacks threaten COVID-19 vaccines and treatments once readily available.
In the past few months, there has been an increased risk of cyberattacks as most organizations have established protocols to work from home at least till spring 2021. As reported by Microsoft, three nation-state actors have targeted seven prominent pharmaceutical companies in a bid to steal research data and vaccine plans in Canada, France, India, South Korea, and the United States. Microsoft says the attacks originate from Russia from a nation-state actor dubbed Strontium and North Korea called Zinc and Cerium.
The targets chosen by these nation-state actors include many vaccine makers that have Covid-19 vaccines in various stages of clinical trials. One of the targets also consists of a clinical research organization involved in trials, and one more that has developed a Covid-19 test. Many of these targeted organizations have finalized contracts or investments with government agencies in various countries for COVID-19 related work.
The pandemic has triggered a wave of cybersecurity threats, a recent survey by Black Hat found. 94% of those surveyed in the recent poll suggested that COVID-19 has increased the cyber threat to enterprise systems and data. The experts surveyed said that remote work was a potential risk, with 72% saying quarantined home workers could expose organizations to risk by breaking policy and not reporting cybersecurity threats.
Strontium, a Russian attacker, has been using password spray and brute force login attempts to steal login credentials. These are attacks that aim to break into people’s accounts using thousands or millions of rapid attempts. Zinc, on the other hand, has primarily used more conventional spear-phishing lures for credential theft, sending messages with fictitious job descriptions pretending to be recruiters. Cerium, meanwhile, is also engaged in spear-phishing email lures using COVID-19 themes masked as World Health Organization representatives. While most of these attacks were blocked by Microsoft’s in-built security protections in different products, it does bring to fore the pitfalls of a rapidly transforming digital landscape around the world.
However, these cyberattacks are not the first time this year that the healthcare sector has been targeted. The pandemic has led to a wave of ransomware attacks in the United States, most recently infecting a University of Vermont network in New York and Vermont. Earlier in the pandemic, attacks targeted Brno University Hospital in the Czech Republic, Paris’s hospital system, the computer systems of Spain’s hospitals, hospitals in Thailand, medical clinics in the U.S. state of Texas, a health care agency in the U.S. state of Illinois and even international bodies such as the World Health Organization.
Healthcare organizations must adapt to the digital roadmap critical for the next phase of COVID-19. For this, investing in virtual products and services that are safe and backed up by leaders in cybersecurity like Microsoft is incredibly important for North America’s healthcare sector.
The Ontario government approved an additional 13 new Ontario Health Teams across the province and announced it is providing $2.4 million in support for improving patient and connected care. The Ontario Health Team are charting a new course to deliver care by bringing together health care providers and organizations and binding them as one coordinated team to improve patient experience and outcomes. This new collaborative care model is helping the province provide an integrated response to COVID-19 and end hallway health care.
Providing details on this new development, Premier Doug Ford, Christine Elliott, Deputy Premier and Minister of Health and Merrilee Fullerton, Minister of Long-Term Care said:
“Today’s investment will not only help our province respond more effectively to the current global pandemic, but it will also help us end hallway healthcare and build a better, patient-focused health care system for the future,” said Premier Ford. “While these new teams will provide better support for more Ontarians, we won’t stop until every person and every community in Ontario has access to this new improved model of care.”
Ontario Health Teams is an initiative of the Government of Ontario to better connect and integrate healthcare facilities across the province. With OHTs, patients will get seamless access to care from one provider to another including hospitals, home care providers, and community health clinics, with one patient story, one patient record and one care plan. While the focus on establishing these health teams has wavered since the onset of the pandemic, the addition of these 13 new Ontario Health Teams brings the total to 42 teams which will cover 86 per cent of the province’s population at maturity.
Today, Ontario Health Teams are starting to coordinate programs to link disparate hospital systems, primary care clinics, long-term care homes, virtual care services, online appointment booking and even patients’ access to their health information digitally.
“While still in its early stages, Ontario Health Teams are already breaking down long-standing barriers to better connect care for both patients and our frontline heroes,” said Minister Elliott. “These teams have demonstrated remarkable responsiveness to the COVID-19 outbreak by helping to address challenges in a variety of areas, and they are essential to building a connected health care system centred around the needs of patients.”
“COVID-19 has highlighted the importance of continuous learning: the more we learn, the better we can protect ourselves, including our residents in long-term care,” said Minister Fullerton. “The coordination of care through Ontario Health Teams is a significant collaborative initiative that supports our commitment to modernizing long-term care in Ontario.”
As more and more Ontario Health Teams are authorized, meaningful engagement and partnership with patients, families and caregivers will become a key consideration for providing care and improving how Ontarians experience a health care system focused on patient outcomes.
Thousands of patients in Ontario have been able to access virtual healthcare over the past several months, and with the new Ontario Onwards action plan, it is set to become the new norm. The Action Plan is expected to build on the existing digital infrastructure to provide best-in-class, user-centric, secure digital health solutions to Ontario’s people and providers.
This pivot towards virtual healthcare is essential as COVID-19 has forced the rapid adoption of telehealth services in Ontario. This is reflected in the fact that only 8% of primary care visits were attributed to virtual care in Q1 and Q2 of 2019. However, once COVID-19 turned into a pandemic and became rampant in early 2020, almost 43% of Canadians preferred their first point of medical contact to be virtual. To ensure seamless transition to virtual healthcare, the federal government pledged an initial investment of $240 million in virtual care and equitable access to virtual care services.
Recently the CMA, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, established a Virtual Care Task Force. The task force identified areas that might require improvement to deliver virtual care seamlessly. Specifically, the taskforce identified, need for regulatory changes across provincial/territorial boundaries, developing new health care delivery models, improving digital health literacy, and access to the internet. The task force found that the continued adoption of virtual care is mostly reliant on educating patients on how to access it.
By including some of these recommendations by the Virtual Care Task Force in the Ontario Onwards action plan, the province can edge closer to its goal to becoming the most advanced digital jurisdiction in the world. Within the next two years, the program will ensure that 70 percent of Ontarians’ services use most, like enhanced virtual health care, are available online.
However, it is an uphill task as a lot of challenges remain. Provincial funding for virtual care is set to end on March 14, 2021, and it is imperative that the province make it a permanent option.
This is one of the reasons why the Ontario Medical Association (OMA) says it has been collaborating with the province on a model that would include virtual care. “The OMA is committed to working with the government to continue virtual care in a way that makes sense for patients and physicians alike,“ says Dr. Samantha Hill, OMA president. “I think not just physicians, but patients have seen the value.“
The province of Ontario had been on the precipice of change in the healthcare domain for a long time before COVID-19 struck. With the creation of a new agency called “Ontario Health” in 2019 along with the creation of Ontario Health Teams, Ontario healthcare was ready to take off with a dedicated focus on coordinating care across different settings for patients. However, the onset of the global pandemic has had a major impact on the regional health care delivery including outpatient care, primary care and home and community care.
In a short period of time, healthcare experts form all over the province came up with urgent reforms which were necessary to tide the COVID wave and are now considered a critical embed for the long-term strategy of providing a coordinated and connected healthcare system in Ontario. The three major reforms and recommendations for the provision of care include:
1. The need for a long-term strategy for in-person and scheduled Virtual Care
With the sudden onset of the pandemic, maximizing services that appropriately reduced in-person visits using virtual care became the need of the hour. Virtual care is defined as any interaction between patients and/or clinicians or members of their circle of care, taking place remotely, using different means of communication including telephone or audio and video applications, with the aim of improving effectiveness of care .
Since virtual care is more than video visits and phone calls. It required a massive overhaul of the existing infrastructure in Ontario. It included digital supports for self-care (e.g., curated apps, wearables); online education and self-management tools; provider-to-provider supports using secure messaging, e-consultation, phone backup, and specialized platforms (for specialist to primary care provider communications); provider to-patient supports (e.g., email, messaging with patients over email, text, or other secure platform, real-time consultation at a distance); and remote home monitoring.
2. Upgrading policy and procedures for infection prevention and control
Since the world hadn’t seen a highly communicable disease like COVID-19 on such a large scale, the healthcare experts in Ontario had to come up with a risk assessment to overhaul policy and procedure in line with the high risk of exposure, something never seen before. Some new policies introduced for primary care in Ontario included:
- Training staff to reduce the risk of exposure through active and passive screenings for COVID-19
- Addition of personal protective equipment used in addition to engineering and system control and administrative control measures
- Creating distance between visiting patients through properly defined waiting areas, and plexiglass barriers at reception
- Use of virtual care systems to triage patients and only scheduling priority visits.
3. Collaboration with regional and local health service organizations
To deliver full breadth of services that support patients’ complete continuum of care, regional and local health collaboration is a must. Collaboration and integration of services between providers and across regions can have exponential effect in improvement of health outcomes. This type of collaboration can be possible if:
- Providers identify new partners upstream and downstream and gauge the impact that the gradual increase of services may have on their resources
- If applicable, providers work with their Ontario health team partners
- When possible, providers consider working with other organizations and other providers that provide overlapping services to establish team-based approaches
- Providers confirm that partners are available and, when required, care can be coordinated in a timely manner (e.g., assessment centers, community laboratory, pharmacy, home and community care, primary care, rehabilitation services, specialists)
The Ontario government is investing big money for the largest provincial testing initiative in Canada by providing $1.07 billion for expanding COVID-19 testing, case, and contact management.
Apart from that, the government is focusing majorly on investing $30 million for priority sectors including long-term care homes, retirement homes, and schools. These investments are expected to go a long way for the province to buckle up for a second wave of COVID-19.
“We’ve put over $1 billion on the table to help track, trace and isolate cases of COVID-19 through the largest and most robust pandemic testing initiative in the country,” said Premier Ford recently. “By ramping up our daily testing capacity to 50,000 tests and closely monitoring our long-term care homes and schools, we can quickly respond to any outbreaks and surges and stop the spread of this deadly virus in its tracks.”
Monitoring public health trends carefully and investing in virtual services infrastructure is one of the major priorities of the government as the race of COVID-19 vaccine doesn’t seem to be revealing any real results.
“As part of our plan to ensure the health system’s readiness for future waves of COVID-19, our government is dramatically expanding our testing capacity, launching more testing locations and adding more case and contact management resources to trace and isolate new cases,” said Minister Elliott. “In doing so, we will also support long-term care homes, schools and hospitals to effectively prevent, track and contain outbreaks of COVID-19.”
Here is how Ontario government has maintained public health measures for testing and case and contact management till now:
- Providing a provincial COVID-19 lab network with 40,000 daily test capacity
- Setting up over 150 assessment centres;
- Testing long-term care home residents and staff to prevent outbreaks
- Providing 1,700 extra contact tracers for contact followups
- Launching a new, custom-built case and contact management digital system to improve data quality and timeliness and eliminate the use of the multiple tools being used across the province and the integrated Public Health Information System (iPHIS) for COVID-19;
- Launching COVID Alert, the COVID-19 exposure app currently being used by more than 7 million people
While there is a definite need to provide more assistance to affected communities and families, the move to digital healthcare and the launch of new virtual services has made a positive impact in Ontario’s fight during the pandemic.
To learn more about digital health solutions that organizations are adopting in Ontario, click here.