Doctors and nurses describe dread as COVID-19 cases risk overwhelming hospitals
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Yesterday and severe cases across the country are increasing over the past week there were on average every day more than fourteen hundred people being treated in hospitals. Some areas of canada have seen that they now had to scale back on routine medical procedures because the hospital beds getting four. Much concern about icu. Capacity you have specialized medical resources personnel. And they're getting exhausted as well. Dr darren markland knows exactly what dr tamas is talking about. He's an intensive care. Physician and enough at royal alexandra hospital in edmonton dr good morning. Good morning you're about to head into a shift at the icu this morning. What do you think you'll be walking into well after the weekend. I think we're going to have and very important meetings about what. We're going to resource and staffer unit today and for this week. That's a big sigh as you start to answer that question. Well i think like Most canadians Were all a little tired of this But we also see what's coming and there are cells in the air already. I mean the first one hit because of thanksgiving. And we're waiting for the next one to hit because of halloween and so when you see exponential growth without a plan brings a lot of anxiety in the frontline healthcare workers. So when you say that you're going to need to have meetings around resource allocation tell me. What does that mean. What sort of decisions are you to have to make in the next few hours. So we have had a surge plan set up from the beginning of the pandemic. But it's one of these plans that It looks good on paper but is dependent on staffing and resources and hard decisions and so up until this point we've been running a full icu. But able to turn the patients over so that everyone gets the care they need but within this week next week. We're going to have to expand the icu in start drawing resources away from the laws We've already cut down elective surgeries to bring in more resources and prevent admissions. But we're going to have to do more. We'll have to reduce more surgeries. I take on take on more staff from other units and that process will have to continue as it does You start to get stretched a little thin and as that process exceeds our capacity then you have to make more difficult decisions about things like who actually will benefit the most from care and that's called called triage and that's somewhere we don't want to get to if we don't have to do you feel that that's inevitable. I think there are things that we can do that. We have to do them quick. We have to do them rapidly and we have to initiate the process. Now we still have two weeks of surge even if we initiate things right now And so yeah. There can be some very tough decisions in the next week to two weeks in the intensive care unit serve pressure. Is there on on frontline stuff like yourself. I mean you said that we're all tired and we are certainly but you're right there and you're working long hours right you know at at at the the the the tip of the spirits they say so what kind of pressures they're on people like yourself it's interesting. There's different types of pressure. I remember during the first wave. We just kept waiting for things to hit us and when it didn't post the guilt that you know canadians were so supportive and we never hit that first wave because everyone did the right thing Now with that in our back pockets Everyone's a little more realistic. We're seeing it where we've been doing this for eight and a half months The hospital moves much slower than it used to because of isolation everything is an additional challenge putting on the appropriate. Ppe taking it off ensuring that you don't make a mistake because one mistake will lead to an outbreak which can paralyze your hospital. That is an incredible weight and then add it to our nursing and Medical staff and physicians who are also trying to keep the rest of their life in order with their kid going to school and dealing with intermittent Quarantines and sick family members at this point. We're really seeing morale in the hospital. Start to take a dip for yourself. I mean are you frightened about what you know is going to await you when you when you arrive at work today or tomorrow or later this week you know. Fear doesn't factor into it anymore. I think we just done it long enough. We've had enough experience with we know what's going on It's more a dread about seeing what's coming And not seeing a definitive clear plan to deal with it as of yet. It's kind of like the cassandra complex. We know this was coming forever. We predicted it or epidemiologist. Knew it was going to be an issue. And now it's here and following the predicted curves and yet the measures are half hearted and not effective. You mentioned nurses. I wanna bring darlene jackson into this conversation. She's president of the manitoba. Nurses union that province currently has the highest per capita rates of covert infections in the country darlene. Good morning to you morning. Tell us what's happening in the small city of steinbach. What are you hearing about the situation at the hospital her. This steinbeck is a small town. That's just a small city just about fifty kilometers to winnipeg and It has almost become an epicenter of Cova nineteen in manitoba We're hearing that nurses are Are working crazy overtime hours. Just to keep up. They are going out and triaging patients in their vehicles. in the circular driveway of the hospital just because The emergency department is so jam packed with patients. There's no bad there's nowhere to move them Patients out of emergency and in order to bring another patient in there. They're going to have to rearrange the whole department. So they're going out and triage union vehicles if the patient stable enough they stay in their vehicle at their unstable than they have to come back into the emergency department. Rearrange make a bad put a structure in a hallway to get that patient in and they are working with the same staff. They've always worked with and it just is It's actually a nightmare. In this problem right now. Sarah newfield is an er nurse at that hospital and cbc spoke with her listen to what she described. It has been mentally and emotionally and physically. Absolutely exhausting is pushed us past what we thought we were able to handle and reciting to question. How is this sustainable. Where short-staffed every day. I think everyone is feeling the weight and the pressure darlene jackson. Tell me more but what you're hearing from nurses of what it's like to work in that environment whereas you say there's not enough space in the hospital. You have to treat people in in a parking lot. Well i i will tell you that are exhausted. They're frustrated. We knew that wave two was going to be much bigger than wave one. We absolutely knew that but our government basically sat on their hands for the for the entire summer when we could have been encouraging retired nurses to come back to work stopping up doing everything we can to get ready for wave two and basically nothing was done so we've moved into way to a numbers are growing. We had almost five hundred new cases yesterday. We're up twelve percent Infection rate and nurses are exhausted. You and this province went out and bought equipment. I mean we bought hundred ventilators with the space to put an in. But we don't have anyone to man that equipment and that's the biggest issue. How concerned are nurses about contracting the virus themselves and they're right in this environment in a hospital that is full to bursting presumably vulnerable as well. Well we've had about one hundred nurses infected since it started the second wave. And you're right. They're very vulnerable. I talked to a nursing steinbach. Who tells me that When she goes to work in the er she gets one n ninety five mask and not mask is gonna last year for her twelve hour shifts. So what happens. Is that every time. You don don. On that nasa that you've been exposed to covid patients with the risk of exposure get tired. So if you're taking breaks your dawning and doping at least five times during your ship. So what's happening is nurses are now not taking that mask off to hydrate or have breaks because number one. They're so busy they don't have time for a break but there's also a huge fear they're going to expose themselves just taking up single mask off. How's it possible. I mean that sounds like something from the beginning of the first wave. And then i thought we as a nation had figured out how to get appropriate and adequate supplies of p. We're still seeing many many many facilities in many units that are monitoring and rationing and ninety five. We have an agreement with With our shared health in this province that nurses can do point of care risk-assessment Which means they basically make risks on every patient prior to contact with them and then they are supposed to decide based on that. What p p the the you but what. We're finding when a nurse does do. Pcr a and requested then ninety five in some facilities. They have to fill a questionnaire on why they need that And ninety five or answer multiple questions and justified out which no one has time for. We are crazy busy in this province. No-one has time to be justified. That they why they need in in ninety five for a patient. So we're dealing with those issues on a daily basis. And i'm and we're back with a brand new season of seat at the table. The podcast where we have in depth conversations with notable guests from media sports and pop culture. But this time we're capturing personal stories about the power of the black lives matter movement the urgency of this moment and really what it will take to move forward seat at the table is available now on. Cbc listen on spotify or wherever. You get your podcasts. i'm not. I add host of ideas in this age of click bait and online. Shouting ideas is a meeting ground for people who want to deepen their understanding of the world. Join me as we crack. Open a concept to see how it plays out over place and time and how. It matters today from the rise of authoritarianism to the history of cult movies. No idea is off. Limits ideas is on the cbc. Listen or wherever you find your podcasts. Dr collins has been listening in. She's the president of the canadian medical association. I want to bring her into this conversation. Dr good morning to you morning. It's interesting in hearing from our previous two guests. They both said we knew this was coming. We knew that the second way was going to be worse than the first wave. Why haven't we if we knew this was coming. Why haven't we been prepared. We'll certainly Your previous speakers have given gut wrenching stories about what's going on at the coalface and i think what this speaks to is that There hasn't been a lack of collaboration and coordination Our public health officials from p hack on down have been working hard They have been looking at evidence on a on a daily basis. vote where to go and how to manage this pandemic. But i think we're the breakdown has occurred. Is that that. Information has not necessarily been brought together in a collaborative way with with levels of government. And by that i mean federal provincial municipal rate out to the health authorities in the hospitals where Dr mark and and miss jackson and many other healthcare workers are working. And so there's not been a a coordinated plan to address what we're seeing now and moreover To act now to change the working situations for these Your your previous speakers. Dr collins if you take a look at the situation beyond the er icu's as we heard from. Dr markland are at a crisis. Point right now. What impact with the surgery. Cases have on the larger healthcare system for things like nonessential surgeries for diagnostic procedures. Yeah that's a great question and it's a great concern and and we actually saw that Poster the first wave or earlier this year At the canadian medical association. We just released a study that showed a marked increase in wait times for surgeries for example hip and knee replacements But we didn't look at. What we know intuitively is that the delay in patients presenting to Their healthcare providers Results in in a delay in diagnosis and treatment for some pretty serious medical conditions patients were then and we'll be now reluctant to present for the fear of of contracting kovin and in hospitals. Dr murkland pointed out You just have to move all your resources to caring for the most deal so elective surgeries will will be cut back. diagnostic procedures Emery that are important in in defining a health problem We'll be cutback. Resources have to be channel to caring for the most sick so this is going to have a far reaching effect. We know the backlog from the first wave is high. I suspect that it will be much greater given this second wave or or just. We're calling it we've seen in the last couple of days Growing concern from doctors across this country and experts calling for long strict lockdowns to get covid cases down to zero. Is that the right approach called. so what what. Cma what we're saying is that that we need to listen to the experts in this and and and public health P hack has been the bedrock of the foundation in the management of this pandemic or in providing the best or the most up-to-date recommendations. We know this virus changes. We know the science and the advice around changes so it's to listen to Whatever their best recommendations are and to recognize that there's not a one size fits all what what edmund to needs and what Northern alberta needs maybe are quite different. The atlantic bubble is a whole different situation So it it's what ever that community or that area needs to reduce its its community Presence of cove it and prevent it from getting into the hospital dr markland. What about for your as Dr collins said at the coal face Do we need not these little circuit breaker lockdowns. But something more significant to stamp this thing into the ground i think everybody's negotiating With both the public and the government right now because Our chief medical officer of health job is to try to balance the greater public need with the the medical issues that are going on and not been an issue for a while. The we had a of people put together a letter who Who argued for the circuit breaker Just so that we could at least get our contact tracing contact tracing were flying blind but that would not stop community progression and we would be at another point where resources would be overwhelmed even with a two week blocking If you look at what. They've done in melbourne They did a much more strict. Six week Lockdown and we're able to get to community spread almost enough. So what do you want. What do you want to see from the government. We asked to speak with the albert to health minister who wasn't available for an interview but said that the government is is reluctant to have lockdown. Because that would end the government's words throw people out of work indiscriminately. So what do you want to see from your government. At the very least i need two weeks At best six I need an honest. I need an honest fact based dialogue with the health minister so that we can actually know where we're going. I don't need half-measures darlene. Jackson for you. The minister of health manitoba also not available to speak with us this morning. But what do you want. See from your government. Well we are right now in a circuit breaker two weeks and maybe extended to another four weeks. And i sincerely hoping extended to another four weeks. I know that our ice to user drowning and our contact tracing is so far behind me. And we're never going to get on top transmission if we can't catch up on the contact tracing and those public health nurses are working hours and hours overtime and we can't catch up so i think we need to shutdown dr collins. What about from the federal government. We should also mention. We asked to speak with the federal health minister. Patty hi do. We didn't hear back but what can be done on a national level as calling for. Is that all governments. Come together to come up with the best path forward to protect the health of all canadians. And at this point in time most specifically we need to protect the health and the ability of our frontline healthcare workers to care for these patients and for other patients no matter what's implemented as dr mclaughlin said we've got at least another two weeks of this ahead of us and but but those people working those emergency rooms in those. Icu need to know that. Someone's got their back that they have hope in the last minute will go to you. What is your message to canadians right now. I think we've done this before. I think we could do right thing before. I know we can do the right thing now. i know we need more support for people out there for elderly and people who are marginalized. But if we don't start doing the right thing and being civil and coming together on this we will see deaths and loss of family members like we have never seen before At least in the last several decades it needs to be done now and you optimistic that we will do the right thing you say can but will we do the right thing. That depends on it. Depends on every single person out there. and de-politicize this issue of covert. I think is the first step is good luck this morning. You're about to step into a very busy situation. And i appreciate you taking some time before your shift to talk to us. Thank you my pleasure. Doctor dr collins thank you very much thank you. And darlene jackson. Our best to your members and thank you you. Dr collins is the president of the canadian medical association. Doctor darren markland intensive care physician and in a frolic at the royal alexandra hospital in edmonton just about to begin. His shift in the icu. And darlene jackson president of the manitoba nurses union for more. Cbc podcasts go to cbc dot ca slash podcasts.