January 13, 2022
Important COVID-19 Update:
Changes to the COVID-19 Care Pathway in London-Middlesex
From Dr. Gord Schacter, London Middlesex Pandemic Clinical Lead
(supported by the Western Ontario Health Team)
With the exponential surge in COVID -19 cases in the community we need to recognize that Primary Care providers may be the first point of contact and access for symptomatic patients. Most patients with mild/moderate COVID-19 symptoms can be managed by primary care providers in our community.
Recently there has been some changes to the COVID-19 Care Pathways in London-Middlesex. Thus, to support Primary Care Providers in their ability to assess, monitor and manage COVID-19 in our community the following information should be of assistance.
Patients can be directed to the Government of Ontario COVID-19 Self-Assessment Tool.
The Ministry of Health has published a reference list of COVID-19 symptoms, signs, and clinical features that have been most commonly associated with COVID-19. This information is current as of January 4, 2022 and may be updated as the situation on COVID-19 continues to evolve.
Individuals with severe symptoms (see below) should be directed to their nearest emergency department or to call 911.
Severe Symptoms:
  • Severe difficulty breathing (struggling for each breath, can only speak in single words)
  • Severe chest pain (constant tightness or crushing sensation)
  • Feeling confused or unsure of where you are
  • Losing consciousness
Monitoring COVID-19 patients
Clinical Practice Guidelines recommend that all COVID-19 patients should self-monitor symptoms including self-monitoring of oxygen saturation. Patients can become decompensated after initial diagnosis. Since testing guidelines have recently changed, follow-up with all probable COVID-19 patients by the Primary Care Provider is therefore encouraged.  
Beginning January 1, 2022:
  • The London Urgent COVID-19 Care Clinic (LUC3) will ONLY be accepting patients from hospitals.
  • Middlesex London Health Unit is no longer referring COVID-19 positive patients to LUC3 for triaging into the COVID-19 Care Pathway.
Thus, I recommend removing the LUC3 referral from your EMRs. 
For Oxygen Saturation Monitoring in the community please direct community referrals to one of 2 programs:
  1. South West Home and Community Care Support Services (HCCSS) to provide oximetry and monitoring through community Remote Care Monitoring. For EMR friendly versions of the referral form please go to the SWPCA website and search for South West HCCSS- COVID19 Remote Care Monitoring Program Adults Referral.
  2. COVID@Home Monitoring Program. You can order pulse oximeters to use in your practice for your patients. You will have to manage the monitoring of your patients yourself. Please direct patients to go to the ED if O2 Saturation is <92%.
Oxygen Saturation monitoring in the community is not recommended for pediatric COVID-19 patients as it is not a reliable method of monitoring severity. 

To refer to the Paediatric Virtual COVID Clinic:
  • Use this form.
  • Find EMR friendly versions of the form in the SWPCA website; search for LHSC - Paediatric Virtual COVID Clinic Assessment Request Form.
Management of COVID-19
The LUC3 Clinic has created a helpful document to aid primary care providers in managing COVID-19 patients.
Adults and Children:
excellent up to date resources for assessment, monitoring and management of COVID-19.
For more information, contact:

Dr. Gordon Schacter
London Middlesex Pandemic Clinical Lead
Supported by the Western Ontario Health Team 

Email us at:

Check our website: www.lmprimarycare.ca

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