Ontario’s COVID, Cold and Flu Care clinics divert thousands of ER visits – why is their future uncertain?

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At their COVID, Cold and Flu Care Clinic in Brampton, Ont., Dr. Priya Suppal and her colleagues have seen more than 100 patients a day this winter, preventing many from having to visit an emergency department.

Now, as the tsunami of infections subsides, the team is ready and willing to switch gears. In their spacious office, located at a busy intersection on Hurontario Street, they have the staff, skills and capacity to provide other services for the city’s large, underserved population, including cancer screening, postsurgery follow-ups, diabetes management, childhood vaccinations, mental-health care and addiction treatment.

In fact, that was their plan from the start – to take on additional care for the community as the province transitioned out of the acute phase of the COVID-19 pandemic, said Dr. Suppal, the clinic’s medical director. “That was the whole idea,” she said. “Those were all the things Ontario Health was sort of saying we could pivot to.”

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Instead, this clinic, one of more than 70 COVID, Cold and Flu (CCF) Care clinics across Ontario, is facing the prospect of closing. Funding from Ontario’s Ministry of Health runs out at the end of this month, with no word as to whether it will be renewed.

Dr. Suppal and her colleagues say a failure to extend their funding would represent a squandered opportunity to alleviate pressure on overcrowded emergency departments and family doctors, who are in short supply – and to provide timely health care to those who need it most.

Like other CCF Care clinics, theirs receives Health Ministry funding through Ontario Health. Ontario Health directed all questions from The Globe about the future of these clinics to the Ministry of Health. The ministry did not respond to questions.

According to a November report from Ontario Health, there are 26 CCF Care clinics in the province’s central region, which covers an area that includes Brampton and Toronto. These clinics administered a total of 73,360 clinical assessments as of Oct. 31, 2022, the report said.

A survey of patients found nearly 20 per cent said they would have gone to an emergency department had they not been seen at a CCF Care clinic, which the report extrapolated to more than 14,500 potential emergency department visits saved.

In that same report, Ontario Health described these clinics as a model for providing the right care to patients in the right place at the right time. They demonstrated an ability to optimize resources and reduce the burden on emergency departments. Most clinics have been set up in what are considered high-priority areas, located near public transit. All are accessible by wheelchair and able to provide translation in multiple different languages, it said.

The report also outlined future opportunities for the CCF Care clinics, including providing patients with education on preventative care and support for navigating the health care system, expanding the scope of the clinics to provide episodic care that could be better managed outside of a hospital setting, and offering a point of connection to the health care system for patients without a primary care physician.

As The Globe previously reported, the number of people in Ontario without a family physician has surged since the start of the pandemic, up 24 per cent from March, 2020, to more than 2.2 million in March, 2022. Those most likely to be without regular primary care were people living in the poorest and most racialized neighbourhoods.

In the Brampton area, which has been among the hardest hit by COVID, an estimated 200,000 people do not have a family doctor, Dr. Suppal said.

The area is home to a large population of immigrants, refugees and international students, and many are essential workers whose jobs don’t allow them to visit doctors and walk-in clinics during regular hours. The Hurontario Street clinic is well-positioned to serve them: It’s open until 8 p.m., seven days a week and its staff speak nine languages.

The clinic emerged out of early community-led efforts to offer COVID testing and vaccinations. As mass clinics wound down, it took on the job of testing, assessing and treating patients with respiratory illnesses, at a time when these patients could not find doctors and walk-in clinics that were screening for COVID symptoms.

Brampton resident Rita Hundal and her family have visited the clinic on multiple occasions because her two daughters, ages two and five, were constantly sick this winter. One of those visits saved them from going to hospital when her oldest child was having difficulty breathing.

“We would have had to have gone to ER right away, and who knows how long we would’ve had to wait?” she said. Instead, her child was quickly treated at the clinic and they were sent home.

The clinic’s closing would also leave a gap in care for many with complex conditions who still require COVID assessments and treatment, said Dr. Sajjad Tavassoly, who works at the clinic. Patients requiring Paxlovid or remdesivir prescriptions often have issues such as renal problems, or are on chemotherapy or other medications that need to be adjusted, he said, but their pharmacists can’t make those changes and family doctors don’t always have the time or expertise to do so.

Dr. Suppal worries that staff will have little notice to find work elsewhere if the funding does not come through. Or, if the government does extend its funding, its decision may come too late, and she will have to scramble to reassemble a team and find a new location.

Dr. Tavassoly said what frustrates him most is the unmet needs of the community continue to grow, regardless of the government’s March 31 funding expiry.

“We have this deadline which is arbitrary. It has no significance when it comes down to the needs of the community,” he said, noting the number of patients without family doctors is worsening. “It made a lot of sense to everybody who was involved in these clinics, with the agenda of the government, that we will transition to care for these people. I’m not sure what happened.”

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