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Emergency room nursing station

On front lines of COVID-19

Friday, March 20, 2020 @ 11:17 AM | By Chantel Josiak

Chantel Josiak %>
Chantel Josiak
The door opens to the worried face of a woman I’ve never met before. Over her shoulder I see the equally worried face of an older gentleman, her father. He’s sweaty and coughing and not quite able to stand up straight. I can hear his laboured breathing from across the room. I introduce myself as the public health nurse and explain that I am here to test for the COVID-19 virus. I hand them each a mask and tell them to sit down.

They watch carefully as I put on my own mask, face shield, paper gown and latex gloves. I can’t help but think of my own father and how worried I would be in this moment. I’m trying to act confident and professional, but I’m feeling frightened and exposed. At the end of a long day of testing for COVID-19, I worry about carrying this virus home to my husband and children.

Everyone from health-care consumers to those of us who work on the public health front line have questions and concerns about how COVID-19 will impact our lives. This article will examine the COVID-19 phenomenon through a health-care provider lens, discussing how this unprecedented pandemic could impact health-care beds and resources.

The first of this series will examine the potential lack of beds and resources. Part two will examine the mental and physical burden the impending COVID-19 crisis could place on health. In part three, we’ll dive into the struggle to stay informed.

The strain on resources

On an average day in Canada health-care resources are strained. Shortages are routine for staffing, hospital beds, operating room booking times, emergency room wait times and supplies. Some would say that scarcity and wait times have become a defining characteristic of our Canadian health care. The ability to provide care for those infected with COVID-19 in an already overcapacity system is a genuine concern.

From October to December 2019 in Alberta, 10 large adult urban hospitals, including three trauma centres, had an average hospital occupancy rate of 93 per cent or higher, with two over 100 per cent occupancy, according to the Health Quality Council of Alberta. One large trauma centre did not have data for this quarter, but in the prior quarter was at 102 per cent occupancy. This trend is similar in all provinces across Canada.

In the event of a crisis, more hospital beds and staffing will be critical. The strain on the system, and currently available resources, could be intense. Doctors and nurses across the country who are caring for the sickest of patients are concerned about a shortage of COVID-19 tests and supplies like face masks, eye shields, ventilators, beds and other equipment.

The risk of running out of physical supplies puts everyone at risk, by increasing the risk of health-care workers contracting the virus and being unable to care for the general public.

The way resources are used can exacerbate the problem. For example, most provinces offer health-care telehealth services. In the last week, telehealth has been inundated with calls. When people cannot get through, they call 911 or go to the emergency room, straining these essential and already strained services. Gloves, masks, sanitizers and basic supplies are being hoarded. How will the system, and the care providers, cope?

Where things are — for now

Every province is being asked to assess its state of readiness and identify critical gaps in supplies or capacity. Long-term care centres are “locked down” to prevent introducing the virus to a highly vulnerable population. Self-isolation and social distancing are the new norm. Hospitals have started to offload the strain on the system by discharging or transferring patients.

Non-urgent procedures and elective surgeries have been postponed, the results of which could be felt for years as patients move further down the already extensive wait list. Operating rooms, outpatient clinics and underused facilities will be turned into isolation and treatment wards. There’s little doubt that many more aggressive measures are coming.

But even if an adequate number of beds are available, there’s real concern that there won’t be enough doctors and nurses. Doctors and nurses are being moved throughout the system to provide care where it’s needed most. Thousands of current and retired providers have answered the call to help.

Still, all of us on the front line are worried. Most of us in health care are dedicated, hard-working and loyal. We have tremendous capacity to cope under pressure. But we’re not immune to the mental and physical fatigue of living through a crisis and, like everyone else, we’re not immune to this novel virus. We’re worried for our own health, the health of our families and the health of the thousands of patients who could be affected due to the incredible strain on resources.

This is part one of a three-part series. Part two: On front lines of COVID-19: Mental and physical burdens; part three: On front lines of COVID-19: The struggle to stay informed.

Chantel Josiak is a registered nurse and legal nurse consultant with Connect Medical Legal Experts, a national company that provides health-care expertise to lawyers involved in personal injury, medical malpractice and class action litigation.

Photo credit / upixa ISTOCKPHOTO.COM

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