Blair Bigham is resident physician in emergency medicine at McMaster University in Hamilton.
Emergency doctors are a bit superstitious. We don’t like working overnight during a full moon, and we avoid shifts on Friday the 13th. So it’s a bit nerve-racking for me to type these words, lest a black hole open and swallow me up: The COVID-19 pandemic isn’t going to be as bad as we thought. At least not in Canada.
What a difference a month can make. In the middle of March, things were not looking good. Hospital managers were terrified by reports from New York, Italy and elsewhere as Canada’s health care leaders tried to create new capacity in a system already bursting at the seams. What a remarkable accomplishment – in just four weeks, most hospitals have found ways to double capacity, including valuable critical-care beds.
While I have been covering the intensive-care unit, I was impressed by what our leaders had accomplished, an achievement I would have thought impossible last month. My night rounds were the shortest I’ve ever done; half of the ICU beds were empty.
The blue placards meant to discreetly identify which patients had tested positive for COVID-19 were fewer than last week, and three – three! – COVID-19 patients who no longer needed ventilators were quickly transferred to wards, which also have capacity. Earlier this week, in the emergency department, I was downright bored as I stared at an empty tracker board.
All of this extra capacity begs the question: What happened to all the sick people? We are seeing fewer heart attacks, strokes and traumatic injuries, but the patients who do come to the ER are sicker than usual. Many come later than they should have. “I thought I’d stick it out because, you know, the virus,” one man told me when I asked why he waited until morning before coming to hospital.
Similar anecdotes abound. A child with meningitis who died hours after arriving at hospital after being sick for days, the parents too afraid to bring the child to hospital. A man who wasn’t able to refill his medication and now had to be admitted with heart failure. A woman with cancer whose surgery had been postponed, but whose pain medication hadn’t been extended.
Now, we have to plan for reopening hospital services. We’ve done a great job – maybe too good a job – of turning people away to make room for COVID-19. But the surge we worried about after March Break travels never materialized in most of Canada’s hospitals and, as time passes, the projected case loads become more manageable. On Wednesday, Canada’s Chief Public Health Officer Theresa Tam said “there is some cause for cautious optimism coming from our epidemiological data,” noting “the epidemic is slowing down.”
It seems we have averted a New York- or Italy-style catastrophe, though we were wise to move heaven and earth to get ready for such a scenario. It is now time to plan on resuming needed services that were put on hold just weeks ago; not everything can be done virtually.
Reopening our hospitals and addressing the backlog of surgeries, clinic appointments and imaging tests is a daunting task. It requires not only front-line health care workers, but also the business and logistical workers who support hospital work, vendors who supply vital stock and personal protective equipment to keep everyone safe as we mitigate the pandemic’s effects in parallel to providing routine care.
Our public health measures have served us well. But the consequences to people’s health go far beyond those triggered by the coronavirus and its resulting COVID-19; the domino effect it has on our usual medical practice could be more harmful when the dust settles. By slowly resuming some services, we can minimize the collateral damage of this pandemic.
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