COVID19 update March 15, 2020

Saturday, March 14, 2020

COVID19 update March 15, 2020

      Cold viruses have been circulating in the human population for millenia. We treat it like some enemy plot. Some believe that it is a symbiotic relationship. It was romanticized in the classic film "war of the worlds", where the simple cold virus saved us from alien invasion.  We have all inherited the genetics needed to allow our immune system to handle the virus. It is far more effective than any drug or vaccine.  What has not been publicized enough is that pretty well ALL people with mild to even severe symtoms survive.  They dont  need to clog the health care system.  Grandma's advice of using acetominophen for fever and pain, hydrating, using mentholatum to unclog nasal passages, lozenges for sore throat and eating very healthy, works very well.  It is only the critical cases that need to go to hospital. They have developed severe pneumonia, that compromise breathing making all activity difficult, and usually require ambulance transport. The number of these in Canada can be counted on your fingers.   The coronavirus numbers are starting to support the notion that it is a slightly more severe cold.  Testing has been reserved for severe cases, contacts, and the odd politician or wealthy celebrity.  Using this data, the death rate was thought to be anywhere from 4-9%. New data suggest that like cold viruses, the numbers of cases are much higher, recovering well and not getting tested.  The death rate of about 2% is probably limited to the severe and critical cases. As more testing is done, it keeps dropping and will probably be less than 1%.

    My colleagues at the CDC suggest that it is circulating in the population, i.e. pandemic. Like most new colds, between 40-70 % of people will acquire the virus, immunologically process it and move on within the next year.  The term prevention is misunderstood.  The current measures being employed are not aimed to erradicate it, but to "flatten the curve". This is an epidemiological term that refers to new case rate.  Basically, our medical resources are far more effective at treating a trickle of cases over a year than a deluge suddenly.   This is not being explained well enough, and causing a great deal of anxiety and hysteria.  In times gone by, whenever a village was being attacked by invaders, it was the young and healthy who went out to face them first and protect the sick and old.   We need to do the same thing.  Everytime one of us gets the virus and recovers, conveys protection to all those around them, and they can safely look after the others.  The current measures will not erradicate the virus, but will make management of the rare critical case more effective.


As of march 12,2020.(exact data hard to confirm)  4185 Canadians thought they had Covid19, and were tested.  Only 152 tested positive.  Only about 19 needed to be hospitalized. Most of them are recovering. Affects males and females equally, and mostly over 40 crowd.  The rest are at home or recovered. The other 4000 probably had a cold or flu.   ONE elderly nursing home patient with numerous other illnesses succumbed to it.  Testing is difficult and restricted, and officials assume that most cases are milder and recovering without testing.

Canadian Influenza data over last 5 mos. As in other years, this is the main health problem in the system currently, and burdening it.

28,871 laboratory confirmed cases of various A &B strains. Untested numbers far higher. Fewer B types and A more severe and affects mostly older folks.  2136 have been hospitalized, 265 needed ICU and 85 deaths so far, of which 5 are in pediatric age group. 87% have other health problems. Many strain types not in vaccine.  Older folks have greater rate of vaccine failure.

  Fear is clogging our health system, and the worry is that future response will be difficult.  When one world leader makes a poor decision, others are forced to react and the domino effect begins.   We have a national program that has been bean counting various flu cases for decades, in the continued hope that we can predict spontaneous mutation results.  One of my colleagues with vast experience during SARS cannot see any science behind border closing. If these measures do work, then we should quickly see a decline in flu cases and other infections and have a way to measure it without spending an extra penny.

COVID19 update March 10,2020

Tuesday, March 10, 2020

Covid19 update march 10, 2020.    

Peel Health Hot line 905-799-7700

You can also click on the right side of our home page for background information.

Testing is only limited to people meeting strict guidelines. People with severe symptoms are directed to go a screening center which are located at Trillium Hospital and Osler Hospital in Bramptom.

The health department strategy is to not issue protective gear to doctors in offices and walk in clinics, and no testing kits. 

Out of country Travellers are now asked to self quarantine for 14 days. This is catching many of our physicians and staff in a position where we cannot run offices.  We will continue to deal with urgent health care needs and provide phone support as much as we can.

People with respiratory illness are asked to not attend office and clinic setting where regular care is taking place.

Covid19 is a more severe form of the common cold and most healthy people recover.  Current strategy is to limit spread.

A perspective for context.

Each day 7452 people pass away in the USA

Heart disease and cancer account for about 48 percent

Accidents account for another 500 a day of which 110 are gun deaths.

Chronic lung diseases account for another 500 and stroke almost the same

There are about 250,000 new cases of the various flu strains DAILY

8200 people passed away from complications of the flu in the USA, but many had other conditions.

COVID19 update

Sunday, February 16, 2020

COVID 19 Update Feb 17, 2020

Feb 17, 2020 update.


The cornonavirus  outbreak had its name changed to COVID19.  There are over 70,000 thousand people affected mostly in China, and this is derived from very soft data.  There have been 1700 health care workers affected, including 6 doctors who are now deceased.  It is unkown whether they failed to use rigorous precautions, or whether they failed.   We do have a small snapshot of better data by looking at closed data.  Of 11, 208 closed cases, 85% fully recovered and 15% are in the critical or deceased category.  There are a lot of variables, cultural and otherwise.  China has been convinced to use diagnostic criteria similar to the west, which will change data.  Traditionally, they complete death certificates differently than in the west.  There is no effective cure other than our immune system as of yet.   Lab testing is available for those meeting strict criteria.  Simple masks probably afford some protection but no where close to complete. Those planning to travel in the next few months, should watch the situation, and check insurance coverages.  They may end up stranded or quarantined or even in a foreign hospital.   Influenza in Canada compares much less significantly.   COVID19 is a single virus and data is from the last 30 days.  In the last 5 months,  numerous different influenza viruses have caused about 27,000 infections altogether  in Canada, but only 65 deaths, many of whom had other co-morbities.   

Urgent After Hours Care is Available

Sunday, February 16, 2020

Please see below for the clinic schedule.  Urgent care is available after 5pm and on weekends.  Call

905-279-9322 for further directions and to receive phone or virtual advice.

As the Covid19 situation changes daily, doctors have been asked not to see respiratory illness in clinic.


Clinic Schedule for the week of Monday, November 23rd to Sunday, November 29th
Monday, November 23rd - Dr. Cohen & Dr. Lane
Tuesday, November 24th -  Dr. Adam Chen
Wednesday, November 25th - Dr. Jawad & Dr. Nasirzadeh
Thursday, November 26th - Dr. Andy Chen & Dr. Daoud


Saturday, November 28th - Dr. Kadic-Mucevic (9 AM)




2020 Novel Coronavirus

Tuesday, January 28, 2020

2020 Novel Coronavirus- update

Feb 5, 2020

     Laboratory confirmed cases 21,000.  Estimated untested cases 37000- 130,000.   This uses the same science we use with influenza virus, where we extrapolate confirmed cases into the community.  China has the densist world population, and this can be met with problems and inaccuracies.  There are 427 deaths with confirmed data, but numerous other deaths are currently not added into the total unless there is laboratory proof, so toll is higher. Only 711 fully recovered, so death rates, etc, cannot yet be accurately determined.  Doubling time is 6 days.  Flights from the epicenter have been largely stopped, Risk in our region is low at this time.  Problem is that illness looks similar to most other circulating viruses and only laboratory confirmation can tell the difference, which is impractical on a large scale.  Seems that mild cough is first symptom, with the fever appearing up to a week later.  Death rate is significant but looks like over 90 percent of people recover.  Males, elderly and infirm seem to make up the majority of confirmed cases.  We may be in a lull spot between new waves of spread.  Time will allow better prediction.  No vaccines yet or effective cure.  Keep your immune system healthy. China is being proactive and moving forward.  Much talk has been with regard to the new 1000 bed hospital built for severe coronavirus patients.  To put in perspective, China has 33,000 hospitals and could fit almost the entire population of Canada into a hospital bed at one time!  Half a billion patients went through this enormous system last year, which underscored how difficult it would be pick out one particular illness that resembles many others.

Jan 31 2020:  Positive Cases in every region of China: Estimates of 8-10,000 cases, over 300 deceased. First physician fatality reported.  Spread confirmed to at least 20 countries. 3 confirmed cases in Canada,  19 under investigation.  Canada- China flights suspended, Travel advisory against travelling to China.  Influenza A, continues to exert its annual effect in our catchment area.  WHO considers calling the situation a pandemic.  Economies will be severely effected which at this time is becoming a significant worry.Canadian officials are reveiwing and ensuring that adequate containment and response measures are ready to go if needed.

wed jan 29th:  the virus has spread to at least 16 countries. Global response varies and depends on the governement.  Hong Kong has closed borders,Russia has closed borders.  The decision to close a border is made by the government of the country. WHO continues to debate the usefullness of this measure.  Canada continues to welcome chinese travellers.  Overall numbers of infection and death continue to DOUBLE DAILY. Toronto area appears to be the hub at this time and has a case that appears to have spread locally, without any history of travel but contact with a traveller.   Infection seems to favour males in their fifties.  Children are affected much less, unlike influenza A, which continues to be our major viral problem currently.   The WHO feels that it is still early and continues to be in the outbreak stage.  It has not been contained as of yet and neither has the animal source been identified.  Efforts underway to develope a vaccine. A blood test is available but requires access through a special hotline and strict criteria must be met. 


Please see below for more info and how to screen and prevent.



2020 Novel Coronavirus

Monday, January 27, 2020

2020 Novel Coronavirus update:

You have probably heard by now of the new virus emerging in Wuhan China.  I would like to remind you that it is a work in progress. Information is being refined on a daily basis. We are in the middle of our flu season and there is a great deal of influenza A present in our community. In Wuhan China and surroundings,  there presently are approximately 100 million people being placed under restrictions. The risk of acquiring this virus is not considered great when you look at the entire country of Canada. However, we continue to welcome visitors by the thousands through our airports mainly Toronto and Vancouver. Just exactly how this will affect the situation appears to be a daily guess. Those visitors and travellers are appearing in our backyard and the situation will require more vigilance and care. Some countries have reacted by limiting travel from affected areas and closing their borders to these travellers while they examine the situation. There is a balance between losing commerce, tourist dollars, travel arrangements etc. However the cost to a publicly funded health care system can be staggering and possibly unsustainable as well.  It is a lesson that complicates the situation in any country without universal healthcare such as China. True numbers are difficult to obtain since many individuals do not have  the funds or desire or trust to approach the appropriate level of healthcare and screening.

More concerning is the recent observation that the virus can be transmitted by healthy carriers up to two weeks before showing any signs or symptoms. It takes close contact to get infected. The virus is not thought to be active or able to live on surfaces and temperatures below body level. This is an advantage. However, airlines recirculate their air in a closed cabin space  amongst hundreds of people for hours at a time. It is a favourable environment for incubation and transmission to occur.

We have learned a great deal already. The virus has been characterized and is similar to the SARS virus. Interestingly it is a distant cousin of the common cold. A blood test has been developed to confirm and diagnose those affected with it. Like influenza, there currently is no active treatment and there is work being done to produce vaccines.  The reality is that most people in our region who may panic and feel they have this virus will most likely be afflicted with influenza or  another respiratory virus. The problem is that you cannot tell the difference and need to await testing. Your own immune system is the key and paramount in helping you fight it. Remember, the viruses  do not exist to kill their host. They simply want a place to replicate and spread. It is the genetic mutation that becomes too overwhelming, but theoretically could put itself out of existence. The other problem is that many respiratory viruses mutate regularly to allow survival. Taking the above measures of handwashing, and extra vigilance helps a great deal.

Just to add some point of comparison. Influenza A is the bad influenza. It is composed of dozens  of different strains many of which are related and others not.. Unfortunately there is a active circulating strain that is not in the vaccine. However most people who get infected will recover quite nicely. The death rate is really very small and estimated at about 1 in a 1000 people if not less. By comparison, the atypical coronavirus has a death rate of between 5 to 15%. The exact numbers not yet known. This is a substantial difference on several orders of magnitude. As of today the atypical coronavirus has not affected the pediatric population to any great extent. Influenza a is quite active in this population.

Another question that we are  getting frequently is with regards to travel. As the situation is changing on a daily basis due to the numbers seem to be doubling every day, it is difficult  to render travel advice. It is impossible to determine which countries may choose to close their borders and impose travel restrictions. The approach is different around the world. Even China has a history of underestimating the numbers. Their population is so massive that it is a daunting task no matter who you are.  If you do travel, I suggest get up-to-date information from the Centre for disease control website and prepare for a possible response should the situation worsen very quickly.

stay tuned for reliable links and further updates as they come available:


2020 Novel Coronavirus

Monday, January 27, 2020

2020 Novel Coronavirus update:

Screening for 2019-nCoV - If you are presenting with the following:


      1. Fever and acute respiratory illness, or pneumonia


AND any of the following:


      2. Travel to Wuhan, China in the 14 days before the onset of illness




      Close contact with a confirmed or probable case of 2019-nCoV




      Close contact with a person with acute respiratory illness who has been to Wuhan, China within 14 days prior to their illness onset


*Some people, such as the elderly and people who are immunocompromised, may not develop a fever. The presence of new/worse cough or shortness of breath may be enough to trigger further precautions.




Ask Patients to:


  • Wash their hands;
  • Wait in separate isolation area if possible or keep a two-metre distance from other patients and clinic staff;
  • Wear a surgical mask.


Initiate Droplet and Contact Precautions for Suspected Coronavirus Cases:


  • Apply vigilant hand hygiene;
  • Use gloves, gowns, fit-tested, seal-checked N95 respirators and eye protection when entering the same room as the patient or when transporting or caring for the patient;
  • Postpone elective procedures that generate droplets (e.g. dental care).

* For more information on Routine Practices and Additional Precautions,


Flushots 2019

Saturday, October 26, 2019

Flushots 2019,,, Oct 29, 2019, the health department has finally shipped the flushots. Although again it is later in the season, they are available. We have high dose shots for our patients over 65 years of age.  If you suffer from chronic respiratory or immune conditions, you are higher risk and should receive.  We will attempt to distribute them on a drop in basis, BETWEEN regular patient appointments.    Please contact us for a good time to drop in. 

New Fit Kit

Friday, July 19, 2019

New  DNA colon cancer screening.

We want to notify you that Ontario is transitioning from the guaiac fecal occult blood test (FOBT) to the fecal immunochemical test (FIT) as the recommended screening test for people at average risk (50 to 74 years old) of developing colorectal cancer on June 24, 2019.

FIT is a more sensitive colorectal cancer screening test and detects twice as many advanced neoplasms (colorectal cancer and high risk adenomas) as gFOBT. Patients with an abnormal FIT result will then have a colonoscopy.

Key Changes:

– Only one stool sample is needed instead of the three needed for FOBT.

– No medication or dietary restrictions.

– Less contact with the stool than FOBT….so less messy!

– The kits are not available for pickup from our office. When you are due for screening, your physician will complete a requisition, send the requisition to the lab,  and the lab mails you a kit to complete. You can either: bring a completed kit either to Lifelabs (the ONLY lab that will accept it)  or you can mail the kit. The kit must arrive at Lifelabs within 14 days of completing the kit. Also, the FIT testing kit is much more expensive than the old FOBT kit, so please complete your kit when you receive it, and try not to misplace the kit or let it expire. These kits are very costly to replace, although replacement kits can be made available if needed.

No clinics held July 8-16, 2019

Sunday, March 03, 2019

Dr. Kujtan and support staff will be away during this time.   Associate support and medical staff will be reviewing messages and results from ordered tests.  Prescription renewal requests will be honoured for appropriate circumstances, otherwise assesment will be required.  Phone messages will be reviewed intermittently.   Urgent medical assistance will be available from our locum and associates on a very limited basis.  Referrals and appointment requests will be dealt with and honoured on a case by case basis.  Non urgent messages will be returned by our support staff after July 18. Appointments for Forms and letters requests will  be scheduled in the August- Sept cycle as they usually involve extensive and long appointment times, and subsequent administrative time.  Please ensure that you have all the details required for your requests.  These can be summarized on paper and provided with your request.    After hour clinics for urgent matters will continue to run as normal and up to date access will be posted on the website.   Stay healthy.

after hours urgent care schedule
Monday july 8 5-8 pm Dr Remtulla and Dr Cohen 2000 credit valley road.  unit 508
AFTER HOUR MEDICAL CARE   call 905-279-9322 to obtain information about which physician is providing urgent care at which address. We suggest you call before heading to the office.