'Extremely anxious' health-care workers step up to staff COVID-19 ward

As hundredsof thousands of people in Newfoundland and Labrador follow orders to retreat to the safety of their bubbles, hundreds of health-care workers are mobilizing to fight a viral surge at the epicentre of COVID-19treatment in the province.

"It is a hard decision," says Dr. Douglas Drover, who's working in the Health Sciences Centre's COVID-19 ward. "We are worried about our families. We're worried about passing it on to loved ones, elderly people that we look after."

Drover, Eastern Health's chief of staff, says those concerns are heightened when people begin working at the specialized ward in St. John's.

"Everybody at the start of this is extremely anxious and extremely worried. All our health-care providers, people on the front line, are worried about their own health and safety, and that of their families," said Drover.

Despite that, he said, there has been no trouble staffing the ward.

We have not had any front-line staff come and say no.- Kim Adams

"The physician staff, nursing staffand allied health staff have been exceptional. To date, even without any discussion of compensation, we've had over 107 volunteer physicians willing to serve in the unit," said Drover.

"Our physicians have stepped up to the plate and we have said from the very beginning that we are adopting a policy of all hands on board."

Eastern Health quality manager Kim Adams saidshe hasseen the same reaction from nursesand housekeeping staff.

"We have not had any front-line staff come and say no," she said. "There is hesitancy and fear because that's just in the community, but these are amazing, remarkable people, and I'm just so proud to be working with them."

She said there have been a lot of discussions about personal protective equipment.

"We've not had any indication from the nursing staff that they're worried about PPE. Of course there's some concern about what the next few months may bring," said Adams.

Internal medicine physicians are leading patient care in the COVID ward. Other physicians supporting them are specialists from other divisions like urology, in Drover's case and family doctors.

"In the spectrum of COVIDcare that we are providing, we need people of all different skill sets. We will use them to support our critical-care team and they'll help out with emergencies should the surge require it," said Drover, referring to an increase in cases that Health Minister John Haggie said is inevitable.

The risk at ground zero

In the community, there is widespread fear about possibly having contact with someone who might carry SARS-CoV-2, the virus that causes COVID-19.

The risk of contracting the virus is clearly higher at the hospital ward where patients who have tested positive for the disease and need medical care are taken.

As of Friday, seven COVID-19 patients were in hospitalin Newfoundland and Labrador. The highest number of hospitalized patients so far has been 15.

While officials have confirmed some health-care workers have tested positive for the virus, Drover saidno health-care worker has become infected while working in the Health Sciences Centre's COVID-19ward.

"There was significant angst amongthe staff who were going to cover that ward when we opened inlate March but we have not had a single health-care worker become sick in that COVIDward coverage," he said.

Preparing for 'the surge'

Haggie and chief medical officer of health Dr. Janice Fitzgerald have repeatedly hammered home that a sharp increase of new cases is coming.

"We are, from experience of our other jurisdictions, not yet into our likely surge period. We are working hard to understand when that might be," said Haggie in early April.

Fitzgerald says if people don't physically distance and allow the virus to spread rapidly to thousands of patients it will be "catastrophic."

Health-care systems in some other countries, including Italy and Spain, have already been overwhelmed by outbreaks.

• Italy sits tight under lockdown, as deaths and infections jump and coronavirus spreads south

After the surge in Italy'snorthern Lombardy region, 51doctors half of them family doctors were among the deceased.

Drover says Eastern Health is doing everything possible to make sure that doesn't happen here.

"The COVIDunit isa negative-pressureward. So, you can stand outside a patient's room with no personal protective equipment, withoutrisk to your health," he said.

"If a nurse or doctor isrequired to go into a room and see a patient, then they don full protective equipment that includes mask, face shield, gown and gloves for fluid droplet precaution and aerosol."

Minimal contact between patients and staff

The ward isset up to minimize contact between patients and staff.

"All these rooms have patient remote monitoring. So we are able to connect with patients from the desk outside and monitor them continually without having to have a staff member actually in the room with a patient," said Drover.

Everyone has a role in this and if the public doesn't participate, they'll put all of us at risk.- Douglas Drover

He believes the province is ready to tackle a surge of new cases.

"We've done everything that other jurisdictions have done. In fact I think we've started early. Obviously if our public do not follow the health regulations, there is no way we are going to be able to cover the maximum surge. Everyone has a role in this, and if the public doesn't participate, they'll put all of us at risk," said Drover.

Eastern Health is preparingto open more COVID wards at the Health Sciences Centre, St. Clare'sHospital and possibly even Memorial University's Field House, an athletic complex with a large indoor track.

Drover says the province is planning for the worst-case scenarios.

"Even if we only see a mild to moderate surge, things will change. You will not have the same care and a critical unit that you have now," he warned.

"If we reach the peak surge, we will come up with novel ways to look after patients but it will be a different approach and we have to think that everything will be on the table," said Drover.

When the caseload overwhelmed hospitals In Italy, doctors were forced to make heartbreaking choices about which critically illpatients would get ventilators and which ones would not.

Some light as preparations continue

As of Friday, three deaths because of COVID-19 had been recorded in Newfoundland and Labrador. However, with a total of 103 patients recovered as well, Adams said there have been some bright moments at the HSC.

Some of the patients admitted to the COVIDward are among those who have recovered and returned home.

"That's been very emotional," said Adams.

"Very emotional for both the patients and the nursing staff. Very happy."

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