We are approaching a month since we returned to Canada from our trip to Cambodia and Vietnam. It sure was a different world just a few short weeks ago. When we departed for Southeast Asia in early February, the COVID-19 outbreak was an emerging concern, but it was still primarily contained in mainland China, with only a few dozen cases dispersed internationally. Even then, those cases were all linked to travel from China. As of this writing, the outbreak has evolved into a full-blown pandemic with over 300,000 confirmed cases worldwide and there is clearly established community spread. There are devastating outbreaks occurring globally, most notably in Italy, Spain, France, Germany, Iran, South Korea, and, in spite of much denial from a certain political leader, the United States as well.
Since our return home, I have resumed my work as a hospitalist physician at an acute care community hospital, and several people in my social network have been asking about what my life is like these days. We have been lucky in Canada to be one of the last countries impacted by COVID-19, but there’s no denying that it is here and growing.
This post is not intended to be informational in terms of providing health education or advice, but rather just a few thoughts and observations I’ve collected as a frontline physician during these extraordinary times.
The hospital is quiet but the atmosphere is tense.
The hospital where I work is actually fairly quiet at the moment (shh, don’t tell), with our patient census running on the lower end of average these past several weeks. Because we are interpreting this as the calm before the storm, there remains a palpable air of anxiety amongst all of us. Our infectious disease team has recommended broad criteria for testing of inpatients, so about half of my roster is being investigated for COVID-19 and it is definitely at the forefront of my mind on a daily basis. It’s hard to go even a few minutes in the day without overhearing or being pulled into a conversation about COVID-19, in addition to the daily email and teleconference updates we are receiving from the powers at be. My personal workload is manageable right now, but there is certainly a degree of mental exhaustion from being so on edge.
Infection control is a major effort.
Within the past week, the hospital has implemented several infection control measures, including a screening procedure for staff, banning all visitors, and cancellation of elective tests and procedures. We have had to attend mandatory sessions on proper application of personal protective equipment, and it sure feels like I spend a large part of my day donning and doffing protective gowns, gloves, and masks. There have been whispers that we are already running low on PPE and that worries me. I estimate that I wash or sanitize my hands an average of 40 times per day, so I am expecting that my skin will soon look like that of the Crypt Keeper. I’m also getting a lot of practice perfecting my decontamination procedure, which currently involves the following steps:
- Change out of scrubs and work shoes.
- Pack up scrubs and white coat into laundry bag.
- Apply CaviWipe to my ID badge and phone screen.
- Wash my hands, again.
- Upon return home, wash my hands and give Mr. Chuckles a socially distanced air kiss.
- Throw scrubs and white coat into the washer.
- Jump into the shower.
So far, I have not yet had to manage a positive COVID-19 case but there is still that underlying fear of getting sick and transmitting it to others in my household or community. We have already lost a couple physicians on my team to self-isolation (fortunately only due to contact exposure and not because they are sick), so I plan to continue furiously washing my hands in order to get through the rest of my time on service.
Family caregivers are so valuable.
Hospital administration was forced to make the difficult decision to ban all visitors starting last week. It was an appropriate step to take, but it really has highlighted the importance of personal caregivers, especially for our frail elderly patients. The saddest thing I witnessed this week was an elderly man telling his nurse that he loved and missed his family. The majority of my patients are seniors, many of them so weak that they need around the clock care for basic tasks like feeding and toileting. It is simply impossible for nurses to attend to all of them for hours at a time, so we often rely on family and private caregivers to be at bedside even to just provide familiar faces to reorient patients suffering from delirium or dementia. It is a great loss to no longer have these supports around, but unfortunately necessary during this challenging time.
Discussing advance care directives is more important than ever.
The reality is that many of us will eventually be impacted directly or know someone who becomes ill with COVID-19. Most people will have only a brief, mild illness but a significant minority will become critically ill and experience this as a terminal event. In the hospital setting, physicians are encouraged to have a ‘goals of care’ discussion with every patient regardless of their clinical condition, and it is really important in our current climate. I would say that most people I’ve encountered do not have a clearly established advance care directive, leading to very difficult circumstances when families are left to make devastating decisions for their loved ones around life support and withdrawal of care. It may not be the most lighthearted conversation, but reviewing your wishes is essential when you are still well and have your mental faculties intact. If anything, it is an act of love to help your family avoid being placed in an impossible situation.
Managing misinformation is a struggle.
Medical misinformation is the bane of my existence (hello, anti-vaxxers!) but the extent of fake news that has built up around this pandemic is unprecedented. I blame the rise of social media. Have you noticed how everyone online these days claims to have a friend who is an Ivy League university virologist, epidemiologist, or public health expert? I should really set some filters on my newsfeeds so I can avoid getting so worked up, but I keep getting sucked into it. Everyday, I wake up to new posts on Reddit, Twitter, and even my condo community’s Facebook group from self-proclaimed know-it-alls with their ‘informed opinions’ on how the pandemic should be managed, or worse yet, how coronavirus can be treated. Like I said earlier, this post is not meant to serve as formal health advice, but I can offer you the following basic facts.
- Coronavirus particles will not blow in through your window. You can keep your windows open.
- Drinking gallons of water to flush coronavirus particles into your stomach acid will not help.
- Essential oils will not cure coronavirus.
- Your toilet paper fort will not protect you against coronavirus.
- There is no link between coronavirus and Corona beer. I really want to hear about the proposed logic behind this.
There are several official and credible sources of information about COVID-19, like the World Health Organization, Centers for Disease Control and Prevention, or your local public health office. These are the sources that I am using, and I would recommend that you do the same, rather than circulating unverified information you read on blog XYZ which may very well be written by a student of Hollywood Upstairs Medical College.
Wash your hands, stand six feet apart, and take good care.