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.
COVID-19 in B.C.: Dr. Bonnie Henry condemns anti-maskers, data correction, physical activity update, and more – The Georgia Straight
Tragically, B.C. has hit yet another new record number of deaths. In additon, the new case count remained high, and case numbers increased in other categories.
While there weren’t any new outbreaks, there were three stores and six flights with confirmed cases.
There were a number of updates, including updated physical activity guidelines and data corrections.
Although B.C. provincial health officer Dr. Bonnie Henry had announced on November 19 that all spin classes, high intensity interval training (HIIT), and hot yoga had to stop activity, B.C. health officials updated its guidelines for physical activity spaces on November 24, which includes further temporary suspensions.
All dance studios, yoga studios, gymnastics centres, and other spaces with group indoor fitness activity now have to temporarily stop those activities across the province while “new guidance is being developed”.
These activities include gymnastics, dance, martial arts, yoga, pilates, cheerleading, and strength and conditioning.
Venues will have to use the new guidance and post an update COVID-19 safety plan before resuming activity.
B.C. provincial health officer Dr. Bonnie Henry said that they are seeing a decreases in cases and outbreaks related to parties, wedding, and social events.
An encouraging sign is that she said they haven’t seen any surges linked to Diwali (November 14).
However, she said they are seeing surges in other settings, such as clusters in workplaces.
Henry explained that her mandatory mask order is designed to help staff at locations such as retail shops, and to enable police in taking action to address people responding in belligerent ways, and for “people to know there are consequences from taking unsafe actions”.
She said she has “no time for people who are belligerent and are trying to make some sort of a statement about anti-vaxx and think that this is not a truly challenging pandemic and I have no time for people who believe that wearing a mask somehow makes them ill or is a sign of a lack of freedom,” she said. “To me, it’s about respect for our fellow people who are suffering through this with us and about making sure we’re doing our piece in solidarity to get us through this really challenging time.”
As she said she also wants to protect the people who truly cannot wear a mask to receive the services they need, she wanted to emphasize the need for everyone to demonstrate respect for others.
Unfortunately, there have been some recent examples of those who have no interested in doing so.
Vancouver police shut down a party in Yaletown on November 21, where all of the guests were seated close together and weren’t wearing masks in violation of COVID-19 restrictions for social gatherings. After the party guests ignored health information from Vancouver police, officers issued a $2,300 ticket to the main occupant.
Meanwhile, a West End tenant issued letters to his neighbours in a condo building to inform them that he refuses to wear a mask and will sue anyone who makes him do so.
Henry said there was a technical error in the transfer of data from a lab to the health authority that affected case numbers in Fraser Health from November 17 to 24.
She said the error was detected yesterday and she provided corrected numbers. As well, a chart of corrections was issued.
However, the numbers that Henry read out at the briefing and what appear on the chart appear to be different.
The Georgia Straight has contacted the B.C. Health ministry to clarify the discrepancies.
Henry announced that there are 738 new cases today, including four epi-linked cases.
By region, that includes:
- 443 in Fraser Health;
- 169 in Vancouver Coastal Health;
- 70 in Interior Health;
- 35 in Northern Health;
- 21 in Island Health;
- none among people from outside Canada.
Currently, there are 7,616 active cases, which is an increase of 116 cases.
The number of hospitalizations continue to rise. Ath the moment, there are now 294 people are in hospital (10 more people since yesterday), with 61 patients in intensive care units (same number as yesterday).
Public health is monitoring 10,270 people, which is only 13 more people since yesterday.
Unfortunately, there are 13 new deaths, which is a new record for one day. The last record was 11 deaths on November 17.
The total number of fatalities is now at 371 people have died.
A total of 19,814 people have now recovered
B.C. has recorded a cumulative total of 29,086 cases during the pandemic, which includes:
- 18,167 cases in Fraser Health;
- 8,161 in Vancouver Coastal Health;
- 1,426 in Interior Health;
- 713 in Northern Health;
- 526 in Island Health;
- 93 people from outside Canada.
The good news is that there aren’t any new healthcare outbreaks.
Fraser Health declared the outbreak at Royal Columbian Hospital, which began in a medicine unit, as over.
Active healthcare outbreaks remain at 57 facilities—52 are in longterm care facilities while five are in acute care units.
In addition, there aren’t any new community outbreak and Henry said that the outbreak at MSJ Distribution at Valhalla in Delta has been declared over.
Loblaw reported cases at three of its stores:
- two employees who tested positive last worked on November 13 and 16 at Real Canadian Superstore (2855 Gladwin Road,) in Abbotsford;
- one employee who tested positive last worked on November 15 at Real Canadian Superstore at 350 Southeast Marine Drive in Vancouver;
- an employee who tested positive last worked on November 20 at Shoppers Drug Mart located at 1125 Davie Street in Vancouver.
The B.C. Centre for Disease Control (BCCDC) added six flights to its lists of domestic and international flights confirmed with COVID-19 cases:
- November 16: United Airlines 5312, San Francisco to Vancouver;
- November 18: Air Canada/Jazz 8265, Vancouver to Nanaimo;
- November 18: United Airlines 5436, San Francisco to Vancouver;
- November 21: United Airlines 5312, San Francisco to Vancouver;
- November 22, Air Canada 45, Delhi to Vancouver;
- November 23: WestJet 3349, Edmonton to Victoria.
For affected row information, visit the BCCDC website.
Today, there were 44 schools from three regional health authorities with new exposure dates.
Due to the extensive number of schools with exposures, today’s list was published as a separate article.
B.C. reports 738 coronavirus cases and 13 deaths, marking deadliest day of pandemic – CTV News Vancouver
British Columbia added 738 cases of COVID-19 to its total Wednesday, as well as 13 more deaths from the disease.
The 13 fatalities is the most B.C. has ever recorded in a single 24-hour period.
There have now been 29,086 cases of COVID-19 in B.C. since the pandemic began and 371 deaths.
B.C. currently has 7,616 active cases of the disease, including 294 people who are in hospital, 61 of whom are in intensive care.
The new numbers came at a news conference from provincial health officer Dr. Bonnie Henry and Health Minister Adrian Dix.
The pair also announced a correction to data on new cases released in recent weeks. Among the changes was a reduction in the total number of cases reported on Tuesday. While health officials reported 941 new cases – a new record – there were actually 695, Henry said.
“I know we had a dramatic increase in the daily numbers,” the provincial health officer said. “That was a result of some of these data coming in at a different time.”
Henry apologized for the changes, which she said were the result of “challenges with a data system” in the Fraser Health region. She provided updated totals for that region for Nov. 17 through 24, as well as updated overall totals for some of those days.
“It’s always complex when we have many data systems trying to feed into a single report on a daily basis,” Henry said.
The changes mean B.C.’s record for new cases in a day is 835, which should have been the total reported for Saturday, Nov. 21. B.C. initially reported 713 for that day.
The total for other dates in that range have also been revised, with no other days topping 800 cases.
Before November, B.C. had never recorded more than 400 cases in a 24-hour period.
Wednesday’s update included no new outbreaks in the provincial health-care system, as well as the end of an outbreak at Royal Columbian Hospital.
That means there are 57 ongoing COVID-19 outbreaks in B.C. health-care facilities, including 52 in long-term care and assisted-living homes, as well as five in acute care.
Most of the new cases B.C. is recording continue to be located in the Lower Mainland. Wednesday’s update included 443 new cases in Fraser Health and 169 in Vancouver Coastal Health.
Elsewhere in the province, there have been 70 new cases recorded in Interior Health, 35 in Northern Health, and 21 in Island Health.
AstraZeneca manufacturing error raises questions about vaccine study results – CBC.ca
AstraZeneca and Oxford University on Wednesday acknowledged a manufacturing error that is raising questions about preliminary results of their experimental COVID-19 vaccine.
A statement describing the error came days after the company and the university described the shots as “highly effective” and made no mention of why some study participants didn’t receive as much vaccine in the first of two shots as expected.
In a surprise, the group of volunteers that got a lower dose seemed to be much better protected than the volunteers who got two full doses. In the low-dose group, AstraZeneca said, the vaccine appeared to be 90 per cent effective. In the group that got two full doses, the vaccine appeared to be 62 per cent effective. Combined, the drugmakers said the vaccine appeared to be 70 per cent effective. But the way in which the results were arrived at and reported by the companies has led to pointed questions from experts.
The partial results announced Monday are from large ongoing studies in the U.K. and Brazil designed to determine the optimal dose of vaccine, as well as examine safety and effectiveness. Multiple combinations and doses were tried in the volunteers. They were compared to others who were given a meningitis vaccine or a saline shot.
Before they begin their research, scientists spell out all the steps they are taking, and how they will analyze the results. Any deviation from that protocol can put the results in question.
Real or quirk?
In a statement Wednesday, Oxford University said some of the vials used in the trial didn’t have the right concentration of vaccine so some volunteers got a half dose. The university said that it discussed the problem with regulators, and agreed to complete the late-stage trial with two groups. The manufacturing problem has been corrected, according to the statement.
Experts say the relatively small number of people in the low-dose group makes it difficult to know if the effectiveness seen in the group is real or a statistical quirk. Some 2,741 people received a half dose of the vaccine followed by a full dose, AstraZeneca said. A total of 8,895 people received two full doses.
Another factor: none of the people in the low-dose group were over 55 years old. Younger people tend to mount a stronger immune response than older people, so it could be that the youth of the participants in the low-dose group is why it looked more effective, not the size of the dose.
Another point of confusion comes from a decision to pool results from two groups of participants who received different dosing levels to reach an average 70 per cent effectiveness, said David Salisbury, and associate fellow of the global health program at the Chatham House think tank.
“You’ve taken two studies for which different doses were used and come up with a composite that doesn’t represent either of the doses,” he said of the figure. “I think many people are having trouble with that.”
Oxford researchers say they aren’t certain and they are working to uncover the reason.
‘The Goldilocks amount’
Sarah Gilbert, one of the Oxford scientists leading the research, said the answer is probably related to providing exactly the right amount of vaccine to trigger the best immune response.
“It’s the Goldilocks amount that you want, I think, not too little and not too much. Too much could give you a poor quality response as well,” she said. “So you want just the right amount and it’s a bit hit and miss when you’re trying to go quickly to get that perfect first time.”
Details of the trial results will be published in medical journals and provided to U.K. regulators so they can decide whether to authorize distribution of the vaccine. Those reports will include a detailed breakdown that includes demographic and other information about who got sick in each group, and give a more complete picture of how effective the vaccine is.
Moncef Slaoui, who leads the U.S. coronavirus vaccine program Operation Warp Speed, said Tuesday in a call with reporters that U.S. officials are trying to determine what immune response the vaccine produced, and may decide to modify the AstraZeneca study in the U.S. to include a half dose.
“But we want it to be based on data and science,” he said.
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