This article originally appeared in the May/June 2020 issue of the Ontario Medical Review magazine.
Physicians are pitching in wherever necessary to fight COVID-19
When COVID-19 hit, Dr. Allyn Walsh realized that resources would be stretched thin. The Waterloo family physician knew that it was essential to attend to patients while keeping them home as much as possible. She also wanted to free up colleagues for the frontline, and ensure the ranks were strong should doctors be sidelined by illness.
Through the Stonechurch Family Health Centre, Dr. Walsh is now supervising medical residents who are providing care. With other doctors in the clinic involved in COVID-19 assessment and testing centres, she provides a key backup. Dr. Walsh remains on standby to advise patients by phone or video conference.
It’s a big change from her normal routine. Until this March, Dr. Walsh was happily retired from clinical practice and teaching at McMaster University. She came back for one reason: to help fortify the medical community.
In the war against COVID-19, conscription hasn’t been necessary. Doctors are stepping up to help in any way they can: coming out of retirement, signing up for refreshers in emergency medicine and critical care, and raising their hands to take on new assignments. Our future doctors – today’s medical students – have also embraced critical volunteer roles.
All of it buoys Dr. Walsh. “You see how quickly people are pulling together,” she says.
She’s in an at-risk age bracket, so is working from home. It had taken her 10 years to plan for her 2018 retirement, but mere weeks to jump back in once she saw how COVID-19 was progressing. With her CPSO membership and CMPA insurance in place, she offered to temporarily return to Stonechurch, where she had practiced for 31 years.
“It’s what I always learned in my professional training: you stop, think and take action,” says Dr. Walsh.
Other doctors are doing that far beyond their typical roles. At William Osler Health Centre, which operates sites in Toronto and neighbouring Peel Region, Dr. Roberta Minna is Corporate Chief of Surgery. With the OR shut down except for emergencies, she was eager to assist where needed most.
By April, Dr. Minna had worked at the hospital’s COVID-19 assessment clinic, and pitched in as an ICU extender. That’s an 8:00 p.m. to 8:00 a.m. shift to help the ICU doctor on call. “You feel like you’re a senior resident again,” she says.
Her colleague, Dr. Vivek Panchapakesan, has also done some ICU shifts at William Osler. He’s a plastic surgeon, and jumped at the chance to contribute to the COVID-19 response. “It’s taking power over a sense of helplessness, and redirecting it,” he says. To prepare, he read up, reviewed online resources from Critical Care Services Ontario, and did independent learning via lectures on YouTube. “I picked up a lot very quickly,” says Dr. Panchapakesan.
Starting in the ICU in the second week of April, he handled rounding for three-to-four patients. Dr. Panchapakesan was semi-responsible for their assessment, and presented plans to the ICU physician. “If it comes to it, we’d be able to manage a ward of COVID patients with high-level supervision,” he says.
Dr. Rajiv Gupta, a urologist, also assisted in the William Osler ICU. Looking at the COVID-19 trend lines, he wanted to get ahead of the curve. So he started to job shadow ICU doctors, along with cramming on critical care.
For 20 consecutive days, Dr. Gupta did rounds in the ICU. He and the other surgeons focused on the COVID-19 patients for a very practical reason: it was easier to deal with the same type of case affecting the lungs, as opposed to addressing other patients where multiple things might be failing at the same time.
“That’s what helped us get up-to-speed faster,” says Dr. Gupta. If there’s a future surge, he says William Osler is now better positioned to staff the ICU with reinforcements.
COVID-19 has prompted an all-hands-on-deck response in other ways. For Dr. Kathryn Tinckam, a Toronto nephrologist, it took her to fill-in duties as a personal support worker of sorts at a nearby long-term care facility. It happened after the Rekai Centres, a pair of long-term care homes in downtown Toronto, found themselves short-staffed and put out a plea for reinforcements. Dr. Tinckam was among the dozens of doctors and nurses who answered the call.
“They said you won’t be working as a doctor, you’ll be working as a PSW. It was clear when we arrived that we were reporting to the charge nurse,” she says.
Dr. Tinckam was happy to volunteer in any capacity, whether it involved nutrition, hygiene or just plain compassion. All are components of care for the LTC population, she says: “And if we don’t care for them when they’re in long-term care, they’ll be in acute care in a week and a half.”
“As a result of COVID-19, physicians are being asked to redeploy in ways we never imagined,” says Dr. Brian Hodges, University Health Network’s Executive Vice-President Education and Chief Medical Officer.
To help meet the need, Dr. Hodges (who’s also education lead for the Toronto Region Critical Care Capacity Steering Committee) was part of a team that put together Critical Care Learning. The online resource, from the Michener Institute of Education at UHN, is open to physicians, nurses, respiratory therapists, physician assistants and others anywhere in Ontario who want to refresh their knowledge around critical care. The site also includes material on palliative care and bioethics, team-based models of care, team wellness and resilience (to ensure health care workers are supported to take care of each other and themselves through this pandemic).
Dr. Hodges says such resources are invaluable in reducing the anxiety and bolstering the confidence of doctors (and others) as they rapidly move to unfamiliar environments.
“I am aware of health professionals who have required immediate learning only hours before about their clinical assignment,” says Dr. Hodges. “At a minimum, they can review videos on the use of PPE and the model of care they will be joining – for example, an ICU or a long-term care home.”
If they have more time, people can take modules on specific skills, including ventilator maintenance, cardiac rhythm interpretation for the ICU, and mobility for long-term care.
The needs driven by COVID-19 continue to grow and evolve. Doctors and health care facilities alike must adapt quickly. In early April, the OMA selected BookJane as its technology solution partner to boost surge capacity. BookJane, used throughout Canada and the U.S., is a platform that helps care communities to more efficiently address labour shortages.
In the weeks prior to the announcement, the OMA worked with BookJane to tailor the app. The goal: “To ensure Ontario’s physicians are working where they are most needed to fight COVID-19,” says Allan O’Dette, OMA Chief Executive Officer.
Doctors can register through the BookJane mobile app. The proprietary platform allows any hospital or health care facility to broadcast a service request to physicians across Ontario, based on proximity and availability. The requests appear on a physician’s phone through the app. Through BookJane, sites can secure a physician in seconds.
BookJane is working with other caregiver associations to migrate their memberships to the platform, so that hospitals can access one hub for their range of staffing needs.
To complement the efforts of Ontario’s doctors, the province’s medical students have mobilized in a major way.
“We’ve been taken out of the clinical environment, but this is our community and we want to do something,” says Debbie Brace, who chairs the Ontario Medical Students Association (OMSA), and is in her final year at McMaster University. “We’ve seen an onslaught of grassroots initiatives.”
She says the range is inspiring, from sourcing equipment to serving some of the basic personal needs of frontline staff. For instance, as their work demands increased, health-care providers required more support at home. That was a focus of volunteer initiatives at McMaster University, the University of Ottawa, the University of Toronto, Queen’s University and Western University. Student response teams from the faculties of medicine pitched in by providing child care, grocery and pharmacy runs, and pet care. All of it alleviated stress for doctors.
On the procurement side, Queen’s and U of T medical students were involved in 3D printing that produced hundreds of masks and face shields per week. University of Ottawa students collected 4,000 surgical masks, 600 N95 respirators and 80,000 pairs of gloves in just five days. Students at the other schools worked on similar drives.
To assist medical students in finding opportunities to give back, OMSA also created an online directory of initiatives aimed at supporting local communities during COVID-19.
Needs are great everywhere, and in many jurisdictions the student efforts have proved indispensable. Dr. Sarita Verma, dean of the Northern Ontario School of Medicine (NOSM), noted that even before COVID-19 there were inequities in remote northern communities. “This crisis has revealed that health care [in northern Ontario] is stressed to its limits,” she says.
NOSM students Sarah Mavin and Alannah MacLean co-led the Northern Ontario PPE for HCP campaign. As COVID-19 spread, they scrambled to organize PPE drives in 30-plus communities across a huge region that extends from Kenora to Muskoka. The effort aligned with the government distributor for critical PPE supplies in northern Ontario and the OMA, to help with stop-gap PPE needs for health care facilities.
The group collected 85-plus needs assessments from health care facilities across northern Ontario, have a database of sewing groups, and provide designs of gowns, caps and masks. They also created a distribution platform for 3D-printed face shields (with a capacity of about 7,000 per week), piloted in Thunder Bay and set to launch across northern Ontario shortly after.
The northern PPE campaign involves more than 100 volunteers. Mavin, who had previously started a student-led clinic in Sudbury, wasn’t surprised by the rush to help: “I knew that as a group we would come together to fight this pandemic,” she says.
Apart from the enormous medical response, MacLean says COVID-19 demanded an entrepreneurial spirit. When you’re dealing with everything from logistics to fundraising, you’re forced to learn and make decisions on the fly. That’s useful training too. “It teaches us to be proactive. Because of a crisis, we had to take action,” says MacLean.
That has been the rallying cry throughout the medical community. The COVID-19 crisis has tested health care capacity, but it has also been a unifying force. Doctors have shown solidarity across the system, coming through for their patients and each other.
“I was really enjoying retirement, but this is what I was trained to do,” says Dr. Walsh. “We’re all in this together.”
Stuart Foxman is a Toronto-based writer.