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17th - Dec

Be generous in spirit - protect your loved ones and strangers alike this holiday season, says ICU doctor

By Dr. Bruce Cload

As an intensive care unit physician in Saskatchewan, I asked myself what I could do this holiday season. I look after COVID-19 patients and I do not want to put others at risk. I have isolated to work and home. I have stopped working out at the gym; I have stopped going out for coffee. I limit my shopping; instead, I just try driving around.

I have not seen family and many friends for more than eight months, except through social media. This holiday season, I will love and visit my friends and family at a distance so I may visit in person in the future. How long can I do this? I’m not sure. Yet, this is made easier knowing that collectively through these actions, the people of Saskatchewan will mitigate COVID-19 infections, preventing the burden of disease and deaths.

I am one of many physicians who look after COVID-19 patients. In addition, I am part of a small group of doctors who are ICU physicians. I offer you a glimpse inside the ICU, with COVID-19 patients on life-support and the extent and limitations of our resources.

We are their doctors. We are the few

ICU doctors care for critically ill patients. These patients need to be supported by machines or they will die — patients on a ventilator, patients after cardiac arrest, patients after major surgeries, patients with significant trauma, and patients whose organs are failing. Some are patients who cannot breathe for themselves, whose hearts cannot beat to maintain their blood flow, who would die without advanced and invasive machines. When COVID-19 patients get a breathing tube and a ventilator, we are their doctors. We are few.

On any given day in the ICU, each patient’s needs are addressed by a multi-disciplinary team. Each nurse has only one patient. On rounds, this nurse provides a detailed report of each body system of the patient. This is followed by a review of the ventilator by a respiratory therapist, the tube feeds by a dietician, medications by a pharmacist, mobility and activity by a physiotherapist and the needs of family by a social worker. ICU care is meticulous and methodical, aimed to each aspect of the patient by a team of health professionals. It may take half an hour to discuss the routine care of one patient. 

A COVID-19 patient struggles to breathe. Oxygen and a drug, Dexamathone, are the first life-saving therapies. As air hunger worsens, a COVID-19 patient is maintained by a ventilator that may be needed for weeks before recovery. Surviving patients will be afflicted with reduced lung function, loss of muscle strength and post traumatic syndromes.

Families can visit only if there is imminent death - only for compassion. In the spring, a family could view their loved one on a tablet; now a few may watch through glass, unable to touch them, unable to interact with them. Their loved one is deeply sedated, not moving, not acknowledging, not recognizing. Some patients placed on the ventilator may never again speak to their family, never again smile at a loved one.

Other patients remain isolated in single enclosed rooms. They are lonely and can barely see the faces of their caregivers, who are wrapped and obscured by full gown, mask and shield.

As residents of Saskatchewan, we have all shared the hardships of the pandemic — social disruption, travel restrictions, isolation, compromised mental well-being, and relationship stress. If you have COVID-19 and you spread it, on average you will give it to two people. If they spread it, then it spreads again, again and again, then 32 people will have the virus. Five will need significant medical care with possible life-support and one will die, connected to you by this spread. You can spread COVID-19 with minimal or no symptoms.1

As health-care workers, we are privileged to serve. We have an obligation to the people of Saskatchewan and Canada; we swore an oath to deliver the care that you deserve. We hear about numbers of ventilators or lack of oxygen supply, but health-care workers are also limited, too. There are less than 30 ICU doctors in this province. We are few.

We worry that we will be thinly stretched; we worry that we will break.

Concern is reflected on the faces of my colleagues. With this COVID-19 surge in December, we are afraid that there will be too much work, that we will fatigue and burn out. We worry that we will be thinly stretched; we worry that we will break. We fear that we will not be able to provide the care that the people of Saskatchewan deserve. We are few.

What happens if there are not enough trained critical-care health workers? One strategy is to stretch resources. Nursing care would no longer be one nurse to one patient; ICU physicians would guide physicians redeployed from other areas to deliver bedside care. We would lower the intensity and quality of care across all ICU patients to manage more patients. We are few.

Next, care could be rationed. 2 Decisions would be made as to who would receive advanced care and who would not. This rationing would not be done by individuals but by committees based on ethical principles judging survival chances and years of life lost.

Early in the pandemic, it was said that if COVID-19 rationing is needed, physicians would have difficult decisions to make. Actually, it is our collective decision as people of Saskatchewan - how we socially distance and wear our masks over our noses, how we quarantine if exposed, how we isolate if infected. Any rationing of care would be the consequence and sum of our individual actions. We, the people of Saskatchewan, would be responsible.

As COVID-19 continues into the holiday season, it is hard to see the impact of our individual actions. We may become numb. We should each ask ourselves not what our province should do for us, but rather what we can do for our fellow residents of the province.

This is the season of generosity, of friends, family and of companionship. Give of yourself now; be generous in spirit by protecting strangers and friends; be kind thorough distancing, limiting your bubble and following the guidelines of the Chief Medical Health Officer. See a future of hope by separating now. Give of yourself, so there is a future for all of us.

 


1 These estimates are based on open source data with a reproducibility number of 2 (Reproducibility number for Saskatchewan has been estimated to be 2 at times in the fall of 2020 around Thanksgiving and at publication to be around 1.5 (https://epiforecasts.io/covid/posts/national/canada/) and a case mortality rate of 2.9% for Canada ( https://coronavirus.jhu.edu/data/mortality ).

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