The call came in on an afternoon in March: a patient at a medical clinic in Vancouver complained of chest pains.
Paramedic Jeff Booton watched the details flash across the screen as he and his partner made their way to the clinic.
It was his first potential case of COVID-19 and he felt both trepidation and a sense of duty.
“I see this job as working in the service of people. And getting to do so in the context of a pandemic is obviously wrought with fear and apprehension some days, but it’s work that still resonates with me,” he said.
When Booton arrived, he put on protective gloves, a fluid-repellent gown, N-95 mask and face shield.
After a physical exam, they got back in the ambulance and Booton did what he always tries to do: comfort the patient as they travelled together towards St. Paul’s Hospital.
“I can only imagine what he was feeling in that moment, but it must have felt like a true sense of vulnerability to what uncertainty lay ahead,” Booton said.
Booton was one of at least 125 health workers, ranging from dispatchers and nurses to hospital housekeepers, who cared for the patient.
This is the story of those who cared for a single case at St. Paul’s.
Dr. Shannon O’Donnell knew she had only a few minutes to prepare after paramedics phoned the hospital to warn that a suspected COVID-19 case was on the way.
“I was a little anxious,” she said. “We don’t know what we’re getting, how much distress a patient is going to be in or how sick they’ll be. And you know, you’re worried also about being exposed to infection.”
The paramedics brought the patient directly into a negative pressure room set up for high-risk cases. It reduces the risk of the virus spreading by air.
Like everyone the patient would interact with, O’Donnell examined him through a heavy armour of personal protective equipment.
COVID-19 has transformed not only the hospital but O’Donnell’s home life, too. She and her husband, also an emergency doctor, juggle the full-time care of their three children at home since schools closed.
Together, they decided that if there were a major outbreak, one would work at the hospital and self-isolate from the family, while the other would care for the kids.
“My husband likened it to both of us running into a burning building at the same time.”
For registered nurse Rachel Mrdeza, some of the hardest cases to handle have been the older patients who arrive short of breath, with a fever and chest tightness.
“You know they’re in the window of vulnerability for having quite a dire outcome from COVID. That is really hard to see,” she said.
Under normal circumstances, the emergency doctor would work with several nurses but only one is allowed in the isolation room at a time to protect against contagion.
By the time registered nurse QianQian Wu began her night shift, she was only the third nurse to see the patient.
Wu began her shift by putting on the uncomfortable protective gear that she would wear all night.
“It’s a little hard to breathe sometimes,” she said. “And sometimes you get sleepy with it on for a long time, it’s very warm.”
While the patient waited in the emergency department, blood samples and swabs were sent to the hospital’s laboratory.
Dr. Marc Romney, medical director of medical microbiology and virology, said manual molecular testing for COVID-19 typically requires five to 10 lab staff.
“It’s not like a pregnancy test you get from London Drugs, it’s much more complicated,” Romney said.
The virology lab has been transformed since the arrival of a machine in March that can automate part of the testing process.
The Roche cobas 6800 system was adapted from HIV testing to increase the number of COVID-19 tests the lab could do that month.
Romney excitedly talks about the changes and ideas they’ve come up with to deal with the pandemic.
“We’re under tremendous pressure to deliver, it’s been a challenging time. But we’re pleased.”
It has also come at personal cost.
One technologist was basically living in the lab and sleeping only five hours a night. Romney went weeks without a day off.
“The front-line workers are amazing and we are here to support them but I think it’s good for people to know there are also a lot of people behind the scenes working on this too,” he said.
“It’s not just machines that are being plugged into walls, it’s very human what we do here.”
THE TRANSITION TEAM
Suspected COVID-19 cases that appear more serious are accelerated to the intensive care unit for isolation. Back in the emergency department, Dr. O’Donnell called Dr. Mathieu Surprenant for an assessment while they awaited test results.
The 29-year-old clinical associate put plans to move back to Montreal on hold when the pandemic struck.
When he got the call from emergency, Surprenant headed downstairs with resident Dr. Charles Yang.
“In my mind I was wondering, OK what are the precautions I need to take in order to protect myself and other patients while maintaining the level of care I would typically provide for a patient,” Yang said.
The team examined the patient to develop his care plan before the patient was transferred to the ICU for monitoring overnight.
Best practices have changed rapidly on the new coronavirus, Surprenant said.
Initially, for example, the idea was to intubate as soon as possible because if a patient gets too ill, his chance of dying on a ventilator increases. But intubation is also more invasive than other procedures and risky for health workers because it pushes droplets of the virus into the air.
Since the pandemic began, recommendations have relaxed to allow for other treatments first but it’s constantly changing, Surprenant said.
He believed intubation was needed, which meant calling in a group dubbed the COVID airway team.
THE COVID AIRWAY TEAM
Anesthesiologist Dr. Shannon Lockhart was part of the planning group that conceived of the COVID airway team.
Their idea was to form teams with respiratory therapists to perform intubations so that emergency and ICU doctors wouldn’t expose themselves.
Anesthesiologists self-selected into one of three groups: The first wave was ready to start serving on the COVID airway team immediately. The second would step in if the first wave got sick. And the third would not participate because they or their loved ones were at risk of serious illness if exposed to the virus.
For Lockhart, the decision to be part of the first group was easy.
“I’m 35 years old, I’m young and healthy. I have a family who is young and healthy, so the personal risk was pretty low for me,” she said.
When Lockhart heard the patient needed intubation, she had already examined him and was prepared.
Putting a breathing tube into a patient’s throat under normal circumstances takes between five and six minutes. But she said that has ballooned to between 60 and 90 minutes because of the extra protective gear and the cleaning or disposal of everything in the room.
After intubating the patient, the riskiest part of Lockhart’s new job is doffing her gear.
Lockhart and the respiratory therapist watch one another carefully as they remove the equipment piece by piece, monitoring for any possible slip that would allow contamination.
“It’s kind of an interesting position to be in when you’re trusting this person with this very important task but you may never have met them before.”
When Dr. Gavin Tansley met the patient, he was sedated and breathing through a ventilator.
Tansley had given the OK for intubation when Surprenant woke him up with a phone call.
In the ICU, the focus shifts to the more holistic care of all the patient’s major organ systems.
“Critical illness is a bit of a funny thing where you really do recognize how intertwined all of these organ systems are,” Tansley said.
“With COVID in particular we see very familiar patterns where often times the kidneys won’t be working 100 per cent, sometimes the heart won’t be working 100 per cent.”
When Tansley decided to become a doctor he wanted to help people heal. He didn’t realize at the time that in the ICU, he wouldn’t get to know his patients very well.
“Very often by the time I meet patients, they’re already sedated or on a ventilator or so sick that they can’t talk to you. So your relationship becomes with the family, and you develop amazing relationships with families,” he said.
By the time the patient reached the ICU, about 25 health workers had played a role in his case. Some interacted with him directly, while others played important but indirect roles in his care, ranging from hospital housekeepers to X-ray technologists.
About 90 intensive care staff saw him, and from there, he would be turned over to a general medicine team.
Recovery is a long road involving a wide network of specialists from dieticians to physiotherapists and social workers.
Kevin Novakowski is a respiratory therapist and in his 28 years of work, he’s never felt an illness create such a constant psychological burden as COVID-19.
“It’s kind of always on my mind,” he said.
In recovery, a patient begins physiotherapy to build his strength. Novakowski is there monitoring how it affects his breathing.
But the first major step towards independence is weaning a patient off the ventilator.
As Novakowski monitored the patient, he began reducing the ventilator’s power and gave him short trials without it.
Weaning is a gradual process. Off the ventilator, a patient’s breath rattles.
“They cough and they sputter,” he said.
The rattle may disappear then return when they stand for the first time, or when they start walking.
t’s a stressful process for patients. If they don’t keep coughing to clear their airway, infections can return.
During those first trials, Novakowski waits and listens.
“You listen to them breathing,” he said. “And then all of a sudden, it’s just kind of really quiet and their breathing just sounds like our breathing, normal.
And you think, OK. That’s good.“
This report by The Canadian Press was first published April 30, 2020.
A look at COVID-19 reopening plans across the country – CollingwoodToday
As COVID-19 vaccination rates increase and case numbers drop across the country, the provinces and territories have begun releasing the reopening plans for businesses, events and recreational facilities.
Most of the plans are based on each jurisdiction reaching vaccination targets at certain dates, while also keeping the number of cases and hospitalizations down.
Here’s a look at what reopening plans look like across the country:
Newfoundland and Labrador:
Newfoundland and Labrador has moved to the second step of its reopening plan two weeks ahead of schedule.
Fully and partially vaccinated travellers from Canada no longer have to provide proof of a negative COVID-19 test, nor do they have to self-isolate.
With 52 per cent of residents aged 12 and over now fully vaccinated, the province says its mandatory mask requirements will be up for review during the week of Aug. 9.
If case counts, hospitalization and vaccination targets are met, the province expects to reopen dance floors as early as Aug. 15, and lift capacity restrictions on businesses, restaurants and lounges while maintaining physical distancing between tables.
Nova Scotia has further reduced COVID-19 public health orders after entering the fourth phase of its reopening.
Under the new rules, retail stores can operate at full capacity, churches and other venues can operate at half capacity or with a maximum of 150 people, and up to 50 people can attend outdoor family gatherings.
Capacity limits for dance classes, music lessons and indoor play spaces have also been lifted.
Organized sports practices, games, league play, competitions and recreation programs can involve up to 25 people indoors and 50 people outdoors without physical distancing.
Day camps can operate with 30 campers per group plus staff and volunteers, following the day camp guidelines. In addition, professional and amateur arts and culture rehearsals and performances can involve up to 25 people indoors and 50 outdoors without physical distancing.
Meanwhile, fully vaccinated residents of long-term care homes can now have visitors in their rooms and visit their family’s homes, including for overnight stays.
The province has lifted all public health orders and its mask mandate has also expired.
All limits on gatherings are now removed, including in theatres and stores.
Restaurants, gyms and salons can also operate at full capacity, as long as customer contact lists are kept.
New Brunswick had earlier moved into the second phase of its reopening plan, which opened travel without the need to isolate to all of Nova Scotia after earlier opening to P.E.I. and Newfoundland and Labrador.
Travellers from elsewhere in Canada who’ve had at least one dose of a COVID-19 vaccine can enter the province without the need to isolate, while those who haven’t had a shot must still isolate and produce a negative test before being released from quarantine.
Prince Edward Island:
Prince Edward Island has dropped its requirement that non-medical masks be worn in public indoor spaces.
Chief public health officer Dr. Heather Morrison says masks are still encouraged to reduce the spread of COVID-19, and businesses are free to adopt stricter rules.
Officials say those who serve the public, such as in restaurants, retail stores and hair salons, should continue to wear a mask.
All health-care facilities will continue to require masks until 80 per cent of eligible P.E.I. residents are fully vaccinated.
Meanwhile, the province has allowed personal gatherings to increase so that up to 20 people can get together indoors and outdoors. Restaurants are allowed to have tables of up to 20. Special occasion events like backyard weddings and anniversary parties of up to 50 people hosted by individuals are permitted with a reviewed operational plan.
Organized gatherings hosted by a business or other organization are permitted with groups of up to 200 people outdoors or 100 people indoors.
On Sept. 12, the province expects physical distancing measures to be eased, as well as allowing personal and organized gatherings to go ahead without limits.
Quebec has lifted more COVID-19 restrictions, including extending closing times for bars and restaurants and increasing capacities for gatherings.
Quebecers can now drink alcohol in bars and restaurants until 1 a.m., gaining an additional hour from the previous restrictions.
Indoor venues and stadiums can now seat 7,500 people, and outdoor festivals can have up to 15,000 with pre-assigned seats.
Indoor public events can have up to 250 people while 500 people are permitted at outdoor public gatherings.
Quebec is, however, maintaining mandatory masks and social distancing in enclosed public spaces and transit.
The province earlier removed capacity restrictions in retail stores and reduced the two-metre physical distancing health order to one metre.
It permitted gyms and restaurant dining rooms to reopen in June, ended its nightly curfew on May 28, and also lifted travel bans between regions.
Ontario’s government has released its back-to-school plan, which will allow returning students to play on sports teams, use instruments in music class, go on field trips and ditch masks outdoors.
The plan places an emphasis on outdoor activities – allowing kids to play during recess with friends from other classes – and allowing shared materials again, such as toys in kindergarten.
Students will be attending in person for full days, five days a week – unless they have opted for remote learning – and high school students will have timetables with no more than two courses at a time.
The province is in the third step of its reopening plan, allowing for more indoor activities including restaurant dining and gym use, while larger crowds are permitted for outdoor activities.
Masking and physical distancing rules, however, remain in place.
Social gatherings are limited to 25 people indoors and 100 people outdoors. Religious services and other ceremonies are allowed indoors with larger groups of people who are physically distanced.
Nightclubs and similar establishments are open to 25 per cent capacity. Crowd limits have expanded for retail stores and salons, which can offer services that require masks to be removed.
Spectators are permitted at sporting events, concert venues, cinemas and theatres, with larger limits on crowds for outdoor events.
Museums, galleries, aquariums, zoos, bingo halls and amusement parks are also open with larger crowd limits on outdoor attractions.
Manitoba is loosening some COVID-19 restrictions and removing its mask mandate.
Premier Brian Pallister says Manitobans will be able to enjoy more freedoms when the rules change Saturday.
All restrictions are removed for private gatherings and businesses, including hair salons, libraries, retail stores, malls and gyms.
The rules around capacity will be loosened for religious services, weddings and funerals. Museums, galleries and movie theatres can still only have 50 per cent capacity but can open up to unvaccinated people.
Sporting events and casinos can open to full capacity but will be restricted only to those who are fully vaccinated.
Restaurants and bars will no longer need to restrict the space between tables and people dining are not required to eat with only those in their household.
Masks are no longer required but are strongly recommended for people who have been unvaccinated. They will still be necessary when going into a hospital or care home.
Dr. Brent Roussin, Manitoba’s chief provincial public health officer, says it’s the largest loosening of restrictions in the province since the beginning of the pandemic.
Saskatchewan has removed all public health orders — including the province-wide mandatory masking order, as well as capacity limits on events and gathering sizes.
Premier Scott Moe says the province decided to go ahead with full implementation of Step 3 of its Reopening Roadmap because more than 70 per cent of residents over the age of 18 and 69 per cent of those over 12 have received their first dose of a COVID-19 vaccine.
Despite the lifting of the health orders, Regina and Saskatoon say they will still keep up extra cleaning in municipal facilities.
All remaining COVID-19 restrictions were lifted on July 1.
There are no longer limits on weddings, funerals or bans on indoor social gatherings. In addition, there are no more limits on gyms, sports or fitness activities, no more capacity limits at restaurants, in retail stores or in places of worship.
Anyone with a confirmed case of COVID-19 will still be required to self-isolate and protective measures at continuing care centres may remain.
Alberta, meanwhile, has announced that close contacts of people who test positive for COVID-19 are no longer legally required to isolate, nor are they notified by contact tracers.
And as of Aug. 16, infected individuals won’t need to isolate. Testing will also be curtailed.
The overall requirement for masks in public indoor spaces has ended, but masks may still be required in taxis, on public transit and on ride shares.
Some remaining COVID-19 health restrictions in continuing-care centres have also been eased.
The province is no longer limiting the number of visitors, however, visitors still need to be screened for COVID-19 symptoms or known exposure, and masks are still required in common areas.
The province recommends people wear a mask at all times when visiting a care home if they have not been fully vaccinated, including children under 12.
Limits on dining and recreation activities have been eliminated, and residents are not required to be screened if they are re-entering the building or go into quarantine if they have gone off site.
The province took the next step in its reopening plan on Canada Day when most COVID-19 restrictions were removed and outdoor gatherings of up to 5,000 people got the go ahead.
Restaurants and pubs no longer have limits on the number of diners, but people are still not allowed to mingle with those at other tables. Masks are no longer mandatory and recreational travel outside the province can resume.
Casinos and nightclubs are open again, but some barriers remain in place and socializing between tables is not allowed.
Provincial health officer Dr. Bonnie Henry says some businesses may want people to continue wearing masks for now, and everyone should comply with those requirements or face the potential of fines.
Some restrictions have been reinstated in part of a health region in the Interior after an outbreak led to rapidly spreading infection in that area of the province.
That means masks are mandatory in all indoor public places in central Okanagan communities including Peachland, West Kelowna, Kelowna, Lake Country and West Bank First Nations lands. Gyms and exercise facilities must also require patrons to wear masks and reintroduce enhanced cleaning and physical distancing.
The face coverings are recommended outdoors in the region if residents are unable to physically distance, but they will be optional for children under the age of 12 when they’re attending summer camps or similar settings.
The Nunavut government has released a long-term plan that will work toward treating COVID-19 like any other vaccine-preventable disease.
The plan, which is called Nunavut’s Path: Living with COVID-19, will move Nunavut from restrictions to what it calls “baseline measures,” which it says are the lowest level of restrictions still needed in the territory to reduce the risk of introduction of the virus. The measures will be assessed every two to four weeks.
Right now, baseline measures include limiting household gatherings to 15 people and opening restaurants and bars at 75 per cent capacity. As of July 30, masks were no longer mandatory in Nunavut but their use is still strongly encouraged.
The plan says the ultimate goal is to end the territory’s public health emergency, which has been in place for more than a year, and eliminate all public health restrictions.
Since mid-June, fully vaccinated travellers have been able to fly into Nunavut without isolating. Non-vaccinated individuals still need to isolate in one of the territory’s designated isolation hotels in southern Canada.
For now, all schools in Nunavut also plan to reopen at full capacity for in-class learning this fall.
Nunavut has no active cases of COVID-19, but the plan says that variants of concern represent the most significant risk factor as the territory considers its next steps in easing restrictions.
Up to 25 people are allowed in a business that is following an approved COVID-19 plan. Households can have up to 10 people with a maximum of five guests from another household.
Non-essential travel outside the territory is not recommended, and leisure travel into the territory is not permitted.
The territory is no longer requiring masks to be worn in public places in Yellowknife and three other communities.
Chief public health officer Dr. Kami Kandola says it’s still a good idea to wear a mask indoors when there is a crowd, poor ventilation, or shouting or singing.
The Yukon government has lifted a series of public health restrictions as active COVID-19 infections decline and the vaccination rate rises.
Starting Wednesday, the territory says masks are no longer required in indoor spaces but are strongly recommended when it’s difficult to practise physical distancing.
Shops, grocers, bars, restaurants, recreational centres and transit operators should be respected if they request that clients wear masks.
Self-isolation after domestic travel is no longer required for both vaccinated and unvaccinated people, while bars and restaurants may return to full capacity.
Certain public health restrictions remain in place, including limits on the number of people who can gather at gyms and recreation centres. Social gatherings are still limited to 20 people indoors and to 100 outdoors. Organized events of any kind are capped at 200 people, with physical distancing required at all children’s gatherings.
Unvaccinated people should stick to six people and keep their circle small, the territory said in a statement announcing the rule changes.
Schools will return to “near-normal” operations this fall, offering full-time, in-class instruction.
Students won’t have to wear masks in class, but masks will be required for adults and kids aged five and up in common areas.
School buses are set to resume normal operations with masks required for drivers and children five and up.
This report by The Canadian Press was first published Aug. 5, 2021.
The Canadian Press
Several care homes in B.C. Interior battling COVID-19 outbreaks amid region's case surge – CTV News Vancouver
The surging COVID-19 case numbers in B.C.’s Interior Health region appear to be spilling over into long-term care homes.
Three new outbreaks have been declared in local long-term care facilities since Monday, according to the Interior Health website.
Two of the homes – Cottonwoods Care Centre and Brookhaven Care Centre – are in Kelowna, where increasing COVID-19 transmission recently prompted a renewed indoor mask mandate for the Central Okanagan.
The other outbreak was declared at Kootenay Street Village in Cranbrook. A fourth outbreak discovered last month at Nelson Jubilee Manor, another long-term care facility in the region, remains active.
Details on the number of cases confirmed at each facility are not available on the Interior Health website. CTV News has reached out to the health authority for more information, including on how COVID-19 might have been introduced into the homes and whether the concerning Delta variant has been detected at any of them.
As recently as July 18, B.C. health officials were celebrating more than a week without a single outbreak at a long-term care home or assisted living facility anywhere in the province.
Case numbers have been surging since then, particularly in the Interior Health region, which accounts for 945 of B.C.’s 1,764 active coronavirus cases.
Provincial health officer Dr. Bonnie Henry said Tuesday that the “vast majority” of recent cases involve people who have not been immunized against the disease.
Some families with loved ones in long-term care have expressed concerns at the lack of transparency around staff vaccination rates. The B.C. Care Providers Association recently said there are some facilities where only 70 per cent of employees are vaccinated – well below the province-wide immunization rate for eligible residents – but the government has repeatedly declined to provide site-specific numbers to the public.
There have also been calls for mandatory vaccinations of care home workers who work with vulnerable residents, including from seniors advocate Isobel Mackenzie.
Henry has said B.C. will not require care home employees to get immunized against COVID-19, but that those who don’t get vaccinated will be required to keep wearing masks at work and submitting to regular testing.
She also recently alluded to possible “consequences” for those who continue refusing the vaccine.
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