The numbers tell the tale when it comes to the toll taken by COVID-19. The daily count is both public and accessible. But what’s not so apparent is the physical and emotional impact the virus has had on front-line healthcare workers who were in the trenches battling the pandemic as it moved through its third wave and into its second year.
We are only weeks removed from the peak of the third wave, when physicians warned that escalating cases and admissions to intensive care units (ICUs) threatened to lead to a triage situation involving life-and-death choices as to who got treatment, and who didn’t.
And although the numbers continue to drop from the peak of the third wave in April when they were consistently over 4,000 new cases a day, healthcare workers remain both vigilant and busy caring for COVID-19 patients. Recently, City Scene talked to Dr. Chris Martin, Chief of Critical Care at the Royal Victoria Regional Health Centre, about the very real and recent dark days of the pandemic, how they impacted the healthcare system and personnel, and whether brighter days are ahead as summer beckons.
“We have seen a little bit of a plateau. It’s still busy but it is not going up anymore. It had been going up pretty steadily for about two or three weeks, and it has kind of levelled off. The surge plan has worked, and the restrictions, as much as they suck, are working. And, the vaccinations are huge … without them we will never be able to get out of the lockdown, the same thing will happen again,” he said recently.
“So, we are seeing a flattening and some positive signs. It’s still very busy, but … there is some positive news.”
The surge plan of which he speaks allowed the centre to expand critical-care capacity from 16 ICU beds to 35 beds throughout the hospital. The effort included renovating the endoscopy unit to act as a surge critical-care area, and critically ill patients being treated in the cardiac-care unit. Other measures included converting the Centre for Education and Research into another COVID-19 unit, equipping the centre with three such units, and opening a Regional Pandemic Response Unit (PRU) field hospital in the parking lot (not for active COVID patients).
In addition to the logistical pressures of handling the surge in patients, Martin said a particularly disturbing trend of the third wave driven by new variants was the age and health of people being treated for COVID-19.
“We have a lot of patients who aren’t on ventilators yet … a lot of these patients are young, in their 40s and 50s (the youngest RVH patient being 38). It’s tough to see someone who may be just a little older than me, or my own age, and they are scared to death, short of breath,” he related.
“You are having this conversation with them wearing a full respirator, you look like a spaceman and they can’t see your facial expressions. There are a lot of people like that on the wards, and we are trying our best to keep them off the ventilators … but for a lot of them, it’s just a flip of a coin as to who goes on a ventilator and who doesn’t.”
On the day we talked with Dr. Martin, he described what one might see if observing the activity in the ICU. Under normal circumstances, 12 to 13 beds in ward would be occupied, leaving a “few extra beds for emergencies.” Covid changed that.
“For the last couple of months we have essentially been at surge levels in the ICU, actually having to take over a second unit because depending on how busy we are, we fluctuate up towards 21 patients and then back to about 16 or 17, which I think is our lowest. We are still well above our average numbers.”
Numbers of activity COVID patients don’t tell the entire story
Any one point, the centre had 61 COVID patients. However, the number of active patients don’t tell the whole story. For instance, the centre currently has 21 active COVID-19 patients, but another 13 who no longer test positive but who are very sick and require critical care.
Before the pandemic, many of those beds would be filled with recovering post-op patients, but not now. All the beds are occupied by COVID-19 patients. Last month, Ontario Health President and CEO Matthew Anderson sent a memo to Ontario hospitals telling them to “ramp down” all but emergency and essential surgeries to prepare for a surge of COVID-19 cases. The RVH complied, still doing emergency and urgent cancer surgeries. With a backlog now close to 5,000 cases, the centre had to cancel almost 300 procedures and surgeries per week since that request came in.
Healthcare workers are not only battling stress and fatigue, but also frustration and, yes, anger, at the refusal of some people to accept the reality of COVID and the need for distancing restrictions. Hospitals may look empty at first glance, fuelling misconceptions about the severity of the pandemic, but look a little deeper and the truth becomes more apparent, said Dr. Martin.
“I understand where people get this perception. When you walk into the hospital, it’s quiet because there are no visitors (and) because the clinics and operating rooms are shut down. When you get into the ICU (however), it looks very busy.”
Behind those walls and away from public view, medical staff are “trying our best to keep” patients off ventilators.
“Patients are either super sick and ventilated, or they are scared and short of breath. Luckily, with all the transports and the patient movements, we have just barely skimmed by being completely overwhelmed. Two weeks ago, I wouldn’t have been sure we wouldn’t end up having triage,” he said when interviewed.
Patients are in individual rooms, with IVs attached to pumps outside the rooms to keep nurses from having to enter them. Caring for a patient in an ICU bed “takes an army of people,” explained Dr. Martin.
“If someone comes in on a ventilator with COVID, environmental service workers get the room totally clean and ready to go. It takes four people to move the patient onto the bed from the EMS stretcher. There is a respiratory therapist and a primary nurse, and there is a dietician who will see the patient, a pharmacist, a physiotherapist, physician, and a physician assistant.
”Every two hours, he continued, the patient has to be moved and cleaned, a process that takes three or four people, wearing full respirators and personal protective equipment.
“So, in the course of a day, there are probably 10 to 12 people involved in the care of that patient … and often a core of four people who are in there every hour. To expand from 15 patients to 20, people might say that’s only five more patients, but it’s about 30 people a shift. It’s a massive undertaking to expand even by 25 per cent, and honestly without shutting down the operating rooms, we wouldn’t have the staff to do it. We are running pretty close to capacity on a daily basis.”
Restrictions on socialization hamper healthcare workers ability to have ‘COVID downtime’
The centre is still getting directives to receive patients from stressed hospitals in GTA hotspots, such as Brampton. The RVH has accepted more GTA transfers than any other single-site hospital of its size, receiving 212 GTA patients, with the vast majority being COVID-19 patients. In late April and early May alone, 71 GTA patients were transferred to the RVH.
While the general public may be bristling at pandemic-related restrictions, healthcare workers who deal with the virus on a daily basic may feel the impact of those measures more acutely, as there are limited opportunities to socialize, perhaps stepping out of the ‘COVID zone,’ if only for a short time.
“The first wave was a lot of fear, the second wave just ripped through nursing homes, and the third wave has been fatigue of the critical-care and acute-care services in the hospitals,” said Dr. Martin. “The hard thing is really how long it has been going on and not really knowing where the end of the tunnel truly is … it seemed to move further away every month, and that’s been the hardest part on staff.”
Large gatherings of people protesting the restrictions, as well as people who simple refuse to acknowledge the severity of the pandemic, are also sources of frustration.
“People are working overtime, out of their comfort zone day after day to try and save as many lives as they can. And then to see people protesting who don’t even think it is real … that’s a tough one for a lot of people to swallow. I think all of us are frustrated with the lockdowns and the restrictions (but) the biggest frustration is with (a small minority of people) who think this is a hoax, that it is not really happening.”
For people who think the distancing measures were excessive or unnecessary, Dr. Martin has a clear message.
”Without the lockdowns in the absence of vaccinations, we would have been overwhelmed. We have just gotten by, and I can’t imagine or want to imagine how bad it could have been. It would have been a disaster. We don’t have a system that can take that amount of pressure. There would have been thousands, tens of thousands of deaths that were very preventable.”
Looking ahead, Dr. Martin is optimistic better days are in the offing.
“Seeing the vaccination numbers … that for me is the marker of when we can finally get out of this. If the vaccine supply keeps coming, I think when they lift the restrictions this time, it will be better.”