COVID-19: The New Normal

This article first appeared in healthing.ca, and is reproduced here for those of you who don’t go to that website.

I was on call this past weekend for my Hospital (Collingwood General and Marine).  It’s considered a “Level I” hospital which (in my opinion) expertly provides care for common health conditions to the 75,000 residents in its catchment area.

Driving to Collingwood on Saturday (I live just outside of town) was, well, jarring.  You see, it was the second Saturday of March Break.  We are near Blue Mountain, Ontario’s largest ski hill.  This is supposed to be our busy season.  My patients rely on tourism to make the local economy go. But Blue Mountain is closed because ofCOVID-19. Other businesses were closed as well. And the town was eerily empty.

As I drive by the hospital, I see “the tent.”  That’s the place where all people who enter the hospital must go first to be screened for potential COVID-19.  The disease is now in what’s known as the “community spread” phase.  People who haven’t travelled may have got it and are giving it to others.  Essentially, anyone who has signs and symptoms of a cold or the flu, is presumed to have COVID-19.

As I walk into the tent to get screened, I marvel at the courage and integrity of not just the doctors and nurses who work there, but at the volunteers staffing the station.  These volunteers must all wear Personal Protective Equipment, and they are constantly wiping down the surfaces.  They still volunteer, even though they are potentially exposing themselves to a serious illness – even after it was announced that our hospital had a patient with COVID-19.  I am truly inspired by their profound commitment to the community that they serve.

As I contemplate all of this, I realize I’ve gone the wrong way. I’m currently averaging over 125 new emails a day, the majority of which deal with COVID-19 and I’ve somehow missed the one that informs me that staff need to go through a separate, dedicated entrance.  The email said I have to show my badge.  (It’s a small hospital, we all know each other, and I don’t think I’ve shown my badge to anyone in 25 years).

A quick walk around the back to the screening site.  It’s necessary.  It’s important.  I agree with it being done.  But it’s still weird to be screened at a place you’ve worked at for so long.

I walk by housekeeping and wave hello to some of the unsung heroes – the cleaners -who were having a meeting.  Once a patient with any transmissible disease (whether COVID-19, or MRSA, or C.difficile or other) is discharged from hospital,  it falls to the cleaners to follow rigorous and thorough cleaning protocols, to ensure that the next person in that room doesn’t get the disease.  Truly unsung heroes they are, who never get the credit they deserve.  While, – all I can offer them is a public thank you, I hope they know it’s heartfelt.

My call group has 12 inpatients this weekend.  It’s less than usual.  The nurses, as always, know the patients really well and fill me in on concerns they have.  It’s the usual mix of medical and surgical conditions.  My initial thought is to grumble once again about the fact that talking to patients takes less time than documenting on our click happy Electronic Medical Records system.  But I realized that the fact that this one thing hasn’t changed actually provided me with a sense of normalcy, for which I’m grateful.

I can sense that the staff are concerned about the circumstances. Yet despite this all of the nurses, ward clerks, cleaners, doctors and many others, are doing their jobs at peak efficiency.  Kindness and consideration for patients is evident in all of them.

Next stop, a shift at the after-hours clinic.  The clinic has changed drastically in the past week.

A volunteer meets patients at the front of the building and explains that they have to call a number and wait in the car.  When it’s their turn, I call them, and see if I can handle the problem over the phone.  If they have symptoms of a cold or the flu, they are not allowed in the building as we don’t have a protected room or personal protective equipment.  Patients with mild symptoms are given advice to get better at home.  Those with more serious symptoms are sent to the COVID-19 tent at the hospital.  The family doctors in our area have a good working relationship with the hospital, and we are able to work together and co-ordinate care in times like this.  I wish every part of Ontario had this.

I’m able to treat about 70% of the patients this weekend by telephone.  It’s not ideal, but it improves Social Distancing, which is now an urgent requirement to help flatten the curve and slow the spread of COVID-19.

The next day, is essentially lather (for twenty seconds people!), rinse and repeat.

So, what thoughts do I have about the new normal?

It strikes me that this is going to be life for the next several weeks at a minimum.

I’m worried about many people on marginal incomes, who will be feeling economic pain in the coming weeks.

I’m worried that Social Distancing, which is really physical distancing, will lead to social isolation for many members of the community, and we will see an increase in mental illness over the next few months.

I’m on edge, hoping that we don’t see the same disaster as Italy is going through, and I know my colleagues are as well.

Yet with all that, I also see a lot of hope.  From across our community, volunteers are staffing the registration desks at the hospital and the after-hours clinic to help out.  The nurses and doctors continue to maintain an incredible degree of professionalism and kindness towards the patients, even though their lives could be at risk.  Physicians are donating unused swabs to the hospital so they can screen more people. I’ve had numerous offers from physicians to volunteer in the assessment centres.

I don’t know how long this situation will last.  I don’t know what history will say about us.  But what I will always remember is that despite the fear, anxiety, and stress, it was the kindness, generosity and courage of the people that shone through.