Physician Role in Assessing Students Related to COVID-19
Summary of NLMA Advice to Physicians:
- Doctors should continue to see patients who have illness or require care.
- Patients who present with COVID-19-related symptoms should be screened using the Public Health COVID-19 Screening Algorithm. The most up-to-date version is available here.
- If a physician determines that a patient meets the criteria for COVID-19 testing, they will direct the patient to the appropriate contact for Public Health as outlined in the screening algorithm:
- Eastern Health: 1-800-563-3692/ 1-709-752-3638
- Central Health: 1-800-563-3690
- Western Health: 1-833-608-1115
- Labrador Grenfell Health: 1-855-268-1965
- If a physician determines that a patient requires emergency attention, they will follow the direction in the Screening Algorithm available here.
- Doctors should not provide notes to inform a school whether or not a student has COVID-19. Doctors cannot provide this answer.
- Doctors are not required to provide notes related to students who no longer have COVID-19 symptoms and who were never tested for COVID-19, in order to provide medical clearance to go back to school. This is not an MCP insured service. It remains at the physician’s discretion.
Background:
The provincial government’s Newfoundlandand Labrador Public Health Guidance for K-12 Schools document, advises that “anyone experiencing symptoms of illness should not return to school until they have completed the Newfoundland and Labrador (online) self-assessment tool or have been assessed by a health care provider to exclude COVID-19 or other infectious diseases; AND their symptoms have resolved.”
On September 14, Chief Medical Officer of Health (CMOH) Dr. Janice Fitzgerald further clarified (in a letter to the NLMA) that the intent of this statement is that in addition to being symptom-free, a student or staff member must meet one of the following criteria before returning to school:
- They completed the online self-assessment tool and COVID-19 testing was not recommended;
- They were assessed by a health care provider who determined that their symptoms are not associated with COVID-19, and therefore did not require testing.
- They completed the online self-assessment or were assessed by a health care provider, testing was recommended, and they tested negative for COVID-19.
The CMOH noted that in none of these scenarios do the Public Health guidelines require a doctor’s note to be presented upon return to school.It is the opinion of the NLMA that schools should not ask doctors to provide medical clearance notes for students to return to school. This would require doctors to see students who are no-longer ill to confirm they are not ill. This is wasteful of health care resources and is not an MCP-insured service. Students, parents and teachers should seek physician care to receive treatment and advice about an illness, but not to provide medical clearance to return to school. Furthermore, physicians cannot definitively “exclude COVID-19” as this can only be achieved through testing. Thus, schools should not require a medical note from a physician for this purpose.
This position is shared by the Canadian Medical Association, which states that “sick notes place an unnecessary burden on the health care system at a time where we all need to focus on addressing one of the biggest public health challenges of our time.”
The Government of Newfoundland and Labrador has already removed the requirement for sick notes for some individuals during the pandemic. On March 10, the Department of Health and Community Services issued a news release that stated “asking employees to get a sick note increases the potential spread of infection.” The Department of Health also announced that “regional health authority employees who are exhibiting respiratory illness symptoms will not be required to provide a sick note for absence periods of less than fourteen days.”
The Provincial government also issued a statement on March 27 with respect to COVID-19 Vulnerable Populations served by the Housing and Homelessness Sector, which was based on “best practices and protocols from provincial and national sources, as well as the World Health Organization.” The document stated that “employees should not be asked to provide medical notes at this time.”
It is the NLMA’s position that these principles adopted by the Government of Newfoundland and Labrador should also apply to students and employees working in the education sector.
Access to Online Learning
The Minister of Education has indicated there is a role for doctors in providing notes related to immunocompromised students who are exempt from in-person school attendance and qualify for online learning.
Today, the CMOH advised the NLMA that the requirement for students to present a doctor’s note to be eligible for online learning is not a Public Health requirement from the Department of Health and Community Services. However, we continue to seek clarification from the Department of Education and the School Board about their expectations.
In a letter to parents and guardians on September 8, the Department of Health advised that “children who have asthma, diabetes, congenital heart disease, autism, epilepsy, neuromuscular disorders, and other chronic conditions are generally not considered significantly immunocompromised.” However, the Department has not indicated which conditions should exempt a child from in-class attendance.
Other provinces (e.g. the IWK in Nova Scotia and the Government of Quebec) have provided criteria to doctors about which medical conditions exempt children from in-class attendance.
The NLMA has requested that the Department of Health and the Department of Education establish a contact group (including representatives from the School Board, Department of Education, Department of Health, CMOH, 811, and NLMA) to expedite clarifications of issues that are arising regarding the involvement of physicians in the administration of attendance at school.
Sincerely,
Lynette Powell, MD
President