The Vancouver hospital’s emergency department where nurse Andrea works is braced for an influx of novel coronavirus patients.
Staff are screening every patient who walks through the doors, asking them an algorithm of questions — if they’ve travelled, if they are experiencing a fever or chills — to decide who will be tested for COVID-19, said Andrea, who requested her last name be withheld as she is worried about repercussions at work. She is not allowed to say if anyone has tested positive.
Andrea goes into each shift expecting the unexpected, a break from her usual ER work as the country bows to the pandemic. There have been changes to the personal protective equipment she wears, for example, as best practices shift and supplies run low.
“We are going in blind every single day with new procedures and policies, we’re just kind of thrown into it and have to adapt on the fly to ever-changing demands,” Andrea told HuffPost Canada. “It’s very taxing and leaves a lot of us feeling very vulnerable and unsure.”
Watch: Trudeau says distancing measures could last months. Story continues below.
Many more sick people are coming to the emergency department than usual, but at the same time the hospital is “oddly quiet,” said Andrea, noting that it appears people are finally “using the emergency room for emergencies.”
She expects it’s “the calm before the storm.”
“I think it’s just a matter of time before we see more people. There’s been exponential growth in B.C. [COVID-19 cases] in the last couple of days,” she said.
Health officials report about 260 confirmed cases of the coronavirus in B.C, including eight deaths, and 846 cases and 12 deaths across all 10 provinces, as of March 20. Canada has tested for COVID-19 far more than the U.S. (44,000 tests versus 33,000) but it is also facing a huge backlog in results.
Canadian hospitals are preparing for a jump in cases, as seen by countries like Italy in recent weeks. A month ago, only three Italians had contracted the virus, cafes and stores were open and tourists flowed through the country. As of Friday, Italy is under a mandatory lockdown and is grappling with more than 41,000 cases and 3,400 deaths — surpassing China.
HuffPost spoke to front-line health-care workers across Canada about what they’re seeing, how they’re preparing, and what advice they have for Canadians in these unprecedented times.
Andrea’s message is simple: “Wash your hands. Stay at home whenever possible, even if you feel healthy. Think of the chain reaction that’s happening [with infections]. It’s absolutely necessary.”
Most importantly, she said, “Stay calm. If you take these steps, we’ll be just fine.”
In Toronto, emergency calls for patients experiencing flu-like symptoms that may indicate a COVID-19 infection have increased “exponentially,” said a paramedic, who requested anonymity fearing job repercussions for speaking publicly.
The paramedic, 52, worked through the SARS outbreak. That marked an important turning point in health care, as front-line workers started wearing protective equipment on the job.
What’s different about COVID-19, he said, is that it’s “so contagious.” Fear is piercing through the “invincible” mentality paramedics normally have, but they remain “ready all the time,” he said.
Earlier this week, one co-worker called him after being at a hospital where a patient in the waiting room was sick and “white as a ghost.”
“He goes, ‘Dude, I don’t want this.’ I go, ‘I know it’s scary.’”
The paramedic is also genuinely afraid of getting infected, and that it could be fatal, and one Toronto paramedic has tested positive.
“’I’ve had bad [cases of the flu], but I don’t think I’ve ever had a bad cold or flu thinking that I could be the person that would die from it,” the paramedic said.
He wants Canadians to be prepared for the fact more people are going to die, but to know that the pandemic will eventually pass.
He’s hopeful the government’s actions will be successful in slowing the spread of the virus and that “next time around, we’ll be more prepared.”
The rural nurse
If Jean Anderson needs an N95 mask, she has to fill out a form to sign it out. It was never like that before the COVID-19 pandemic, said the nurse of 44 years. During the SARS outbreak, it was mandatory for anyone who was screening or interacting with high-risk patients to wear N95 masks.
Watch: Will a face mask sanitizer protect you? Story continues below.
The concern this time is there will be a shortage of supplies, so Anderson, 63, wears a regular procedure mask with a plastic visor, gloves and a paper gown.
“You have to fill out a form and track [the N95 masks], and say where they were used and why they were used because there’s simply not enough to go around and that’s a real concern,” said Anderson, who works at a dialysis unit and emergency department in a hospital in rural southwestern Ontario. Her hospital is the only testing centre in the area.
Anderson is assisting with screening at the hospital, but the problem is that there are not enough kits to test all patients who might have COVID-19. The directives are also changing. The first day she was screening, she was to test anyone with symptoms, she said. That rule soon changed to swab only health-care providers, or people who needed to be admitted, in line with the province’s latest testing guidelines and instructions from doctors.
“If we all panic, that’s when things really break down.”
No one in the region has been admitted to hospital for COVID-19, and there’s only one positive person in the neighbouring county self-isolating at home, Anderson said.
“People are coming in, and even people who are coming with runny noses, maybe a slight temperature, sore throat or a cough, we can’t swab them, so we’re sending them home,” Anderson said, noting many have been directed to go to the hospital by their employers or family doctors’ offices — a trend that’s slowing as people get more familiar with the guidelines.
Another concern is staffing. “With the sheer volumes [of patients], we have unique challenges because of our small numbers of staff and our remoteness. We don’t have the same resources,” Anderson said.
The phones are ringing non-stop where pharmacist Alex Averback works in Campbell River, B.C., especially after officials announce COVID-19 emergency measures, like travel restrictions earlier this week.
“Hospitals are not overwhelmed yet, but pharmacies are,” said Averback. “Now that (the pandemic) is ramping up, I’m staying calm because you need to. If we all panic, that’s when things really break down.”
Patients want to fill prescriptions early, or get six months’ worth of medication in advance, Averback said. She worries about drug shortages.
“You don’t need to stockpile medications, and if you do, it’s just going to cause problems,” she said. “If everyone is very prudent and supplies only what they need, we will be fine.”
It’s a message echoed by pharmacy associations, including in B.C., which said in a statement earlier this week, “Pharmacists aim to make sure all patients have access to their medications, so they are generally not providing more than a 30-day supply to support those who are self-isolating.”
Averback said doctors and pharmacies are working well together to ensure everyone’s prescriptions are faxed in and filled quickly. Pharmacies offer delivery, and patients in self-isolation can send family members or friends to pick up their medication.
When she explains to patients why they can’t have six months’ worth of pills, their complaints turn into words of understanding. “It’s the good side of people that we’re seeing,” she said.
The medical laboratory technologist
Hospital lab technologist Maria Roussakis is well acquainted with working long, pressure-filled hours at a hospital in the Greater Toronto Area. Across the country, the profession responsible for running 440 million medical tests a year, faces a chronic labour shortage at the best of times.
Roussakis isn’t running COVID-19 tests — that’s being done at public health labs — but her colleagues have had to miss work to self-isolate or take care of children, resulting in a backlog of blood, urine and other tests. She is working everyday this week to fill in the gaps.
Her lab exemplifies the reverberating effects of the pandemic on all levels of health care, she said.
“There’s a lot of culminating factors that heighten stress and anxiety,” said Roussakis.
She is in awe of her peers conducting the COVID-19 tests. “I’ve heard such great statistics about how many tests they’ve been able to put through in a day.
“It’s so amazing because these are not simple, put a sample on a machine and get values tests. There’s so much preparation, organization and time management. I applaud these people in the labs to handle all of this under pressure. I’m really thankful.”
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Correction: Maria Roussakis is a medical lab technologist, not a technician.