North·Q+A

Frontline healthcare workers face violence as COVID-19 cases increase in the Yukon

Dr. Ryan Warshawski, the head of the Yukon Medical Association, says tensions over vaccines are beginning to cause physical violence at the Whitehorse General Hospital. Meanwhile, the ICU is 75 per cent full with COVID-19 patients.

Whitehorse General Hospital's ICU is 75 per cent full with COVID-19 patients

Whitehorse General Hospital in a file photo from earlier this year. Dr. Ryan Warshawski, president of the Yukon Medical Association, says tensions over vaccines are beginning to cause physical violence at the hospital. (Paul Tukker/CBC)

Dr. Ryan Warshawski, the head of the Yukon Medical Association, says tensions over vaccines are leading to violence at the Whitehorse General Hospital. 

"We've actually had two incidents in the last week where patients have been physically violent with their treating physician when it comes to COVID matters, which is obviously completely unacceptable," he told CBC's Elyn Jones on Yukon Morning Wednesday. 

Meanwhile, the ICU is 75 per cent full with COVID-19 patients and Warshawski has also had some difficult personal experiences with patients who regret not getting vaccinated. 

"I've talked to people who have COVID, who are unvaccinated, and every single one of them as they sit there on oxygen struggling to breathe, says, 'Is it too late for me to get the vaccine right now?'"

The following has been edited for length and clarity. 

How is our health care system doing at the moment? 

We're coping right now, but there's no doubt that we're experiencing the effects of this most recent surge in the pandemic. Right now, the ICU is 75 per cent occupied, all by COVID patients, and there are, at last count, five or six other people also admitted to the hospital. The majority of those are all unvaccinated, and there are some downstream consequences of this. 

Essentially, what happens now is the ICU actually turns into a pure COVID ICU, and we've opened up a second area of the hospital into a second ICU for people who need ICU care that don't happen to have COVID. 

Warshawski receives a COVID-19 vaccination in Whitehorse on Jan. 13. (Wayne Vallevand/CBC)

But the unfortunate reality is that like everywhere else in the territory, the hospital is suffering from staffing shortages, not just physicians, but in nurses, in laboratory tests and X-ray techs. And so we're having difficulty staffing our second ICU. 

And when you couple that with the fact that volumes are up significantly now because people need testing, it's difficult to get into the CTAC [the COVID Testing and Assessment Centre], the Walk-In Centre has unfortunately closed, leading to an increase in people presenting to the emergency room … what we're seeing is that, um, wait times are longer, staff are more tired, and this is actually leading to some negative encounters between patients and staff … in part due to frustration with how long wait times are and in part, unfortunately, due to people not wanting to have a conversation about vaccines. 

We've actually had two incidents in the last week where patients have been physically violent with their treating physician when it comes to COVID matters, which is obviously completely unacceptable. 

So I would like to just take this moment and ask anyone listening to be mindful of the fact that people at the hospital are working as hard as they can. They're tired just like everybody else. They're human, just like everybody else.

And we really need to make sure that [the hospital] maintains its status as a place where sick people go to get well. We want to have other discussions. There are other places to do that, but the hospital is not an acceptable place for those things to happen. 

New measures are in place to try not to overwhelm Yukon's healthcare system. Dr. Ryan Warshawski, president of the Yukon Medical Association, spoke with Elyn Jones about the impact increased cases are having at Whitehorse General Hospital.

What do doctors and medical staff need at this point? 

We need lots of different things. I think the main thing that we need is to make sure that we get as many people getting vaccinated as we can. The only way out of this pandemic is to have as high a vaccine rate as possible. And I know the following question is, well, how high does it have to go? And the short answer is, you know, no one can be 100 per cent sure of that right now. 

The Yukon is one of the highest vaccinated jurisdictions in the country, and we're still seeing the effects of a surge in this virus so we can make all the mathematical models that we want. But the reality is that what actually matters is the case numbers that we see on the ground. And so I think that the best thing that people can do right now, besides socially distancing and washing their hands and whatnot, is go out and get vaccinated.

The new measures that were put in place immediately and really taking effect on Saturday, do you think that is going to help things? 

I think it will for some people, certainly. Anecdotally, I've had some people who I was actually going to see for an appointment myself and they've had to delay things and say, I can't do it now because I'm not vaccinated, but I'm going to go get my first shot on Saturday. So I do think that some of these measures will help. 

I'm hearing other people — again, this is anecdotal — say to me that they don't like feeling that they're being forced to do something. And I think it's just important to recognize that really, no one's getting forced to get a vaccine. No one's going to come to your house and hold you down. But the reality is that actions have consequences and we need to make sure that as a society we're able to continue to function moving forward.

This isn't about forcing people to get the vaccine. This is about taking the exact same measures that we take for something like … I think the best analogy, personally, is drunk driving. 

If a drunk driver was incapable of hurting anyone but themselves, well, maybe we don't make drunk driving illegal. But the reality is that if you're driving a vehicle, while intoxicated, you could hurt somebody else, you could hurt a family. You can have a negative effect on society and it's the exact same thing with this virus.

All that's happening with this vaccine mandate in my view is attempting to recognize the impact that unvaccinated individuals are having on the health care system, on the economy and on the rest of society. 

We've seen protests and a petition against vaccine mandates. How does that make you feel? 

It makes me feel sad, is the short answer here, and I think it's really interesting to look for some historical context on this. 

If we go back in time 20 years, there was a vaccine called Gardasil that came out and Gardasil was a vaccine for the HPV, the human papillomavirus. The main thing that we were worried about was the fact that this virus causes cervical cancers. 

There was a big push to try and vaccinate young girls before they acquired the virus, which is typically around the age of 10. The thing that we have to talk about, though, is that HPV also infects men. About 14,000 men per year get oropharyngeal cancer and anal rectal cancer that is caused by HPV. 

And what's really unfortunate about this is that the discussion we had about the Gardasil vaccine was not: is it a safe vaccine? Is it effective at preventing HPV? And does preventing HPV prevent cases of cancer down the line? For which the answer is very clearly, yes. But the discussion we had was, you know, are we encouraging 12- and 13-year-old girls to have greater sexual activity than they would otherwise have had? And so this discussion suddenly shifted from a discussion about the efficacy of the vaccine to a political discussion about young people being sexually active.

What's really interesting about this to me, is at about the same time the Gardasil vaccine came out, the hepatitis B vaccine came out, and hepatitis B is also a virus that can be spread through sexual activity, and it was also being administered to young people in about the same age. And yet there was no political discussion about this. No one decided to make this their issue of the day and get up on a soapbox and make a lot of noise about this. And as a result, basically everyone is vaccinated now for hepatitis B and we've seen a dramatic decrease in hepatitis B infections. But as a result of this political discussion, half the population — men —are typically not vaccinated for Gardasil and actually, many women are still not vaccinated with Gardasil for HPV because we had the wrong conversation. 

I'm not saying that we don't have to talk about vaccine mandates, but as a doctor, the question that I think we need to ask about the vaccine is, is this vaccine a safe and effective treatment for COVID-19? And the answer is very clearly yes. There's tremendous data on this that is out there right now. We know that this works. We know that it is safe. We have given it to hundreds of millions of people. This is probably one of the best studied vaccines in the history of humanity at this point in time. 

Are you concerned that, if there are health care workers who won't get the vaccine, that's going to affect staffing levels even more? 

We did a survey of the membership of the Yukon Medical Association, so all physicians, and we're, before the mandate, I believe, 100 per cent vaccinated. So it shouldn't affect our physician availability. 

There is, of course, the concern that this may start impacting some hospital servicing in terms of nurses and allied health services. But in talking to the hospital about that, they think that we'll be able to survive. 

I mean, I think we're going to have to see. But it is one of those things that's unfortunately very important. I think patients have the right to be, you know, treated by someone who is properly immunized and not going to potentially infect them with COVID-19. 

And certainly, this is not a unique thing to hospital staff. When I got into medical school, I had to prove my vaccination status for measles, mumps, rubella, hepatitis A. Like, hey, like this isn't the first time I've ever shown my [immunization record]. I personally am not concerned about that.

What about the fact that many physicians and medical staff also have kids? What kind of effect could that have if you have to stay home if your kids are infected? 

That is a profoundly challenging thing. I have young children, and if one of them, if their school is closed or if there's a COVID notice or, you know, one of them gets COVID, the reality is that they're going to require child care. And so that's a problem faced again not just by doctors, but also by all the human beings who work at the hospital. 

I think the short answer to that is we need to make sure that we have rapid testing that's available for these staff members so that if there is a COVID exposure, I need to be able to get tested quite quickly because I may in fact work in the emergency room. That's something where we're working on at the operations level. It is, you know, one more challenge because again, I think it's safe to say that right now when it comes to staffing, the hospital is functioning, but we really can't take a big hit, really in any of the areas of staffing.

When it comes to other things that you're treating people with, and surgeries and things that are upcoming … any effect on those at this point because of our case count in the hospital? 

To the best of my knowledge, the hospital currently has not had to start deferring surgeries. 

Certainly, there is a backlog that we're still trying to wade through in terms of medical imaging and other procedures that were put on hold in the pandemic. And that's something that we've seen, you know, across Canada and most recently in Alberta, is that we're unfortunately having to delay procedures as a result of the pandemic. 

It really can't be overstated how sad that is for individuals who are waiting for potentially life saving treatments. Like, if you need a colonoscopy for colon cancer screening and it's delayed by six months, and it turns out that that's positive and we could have done something about it, I mean, that's devastating. 

But not just life saving stuff. Imagine you need to wait for a knee replacement and you're in pain every day. You can't walk and that gets deferred. The impact the pandemic is having not just on COVID-related cases, but on people waiting for procedures, is really sad and unfortunate. 

Fortunately, we are not, to the best of my knowledge, in that position right now, though of course it is a fluid situation, so things change. We're getting daily updates on the status of the hospital, how full it is, so I'll continue to watch and see how we go from that perspective. 

What do you say to people who are listening right now who are not vaccinated?

Please get vaccinated. I have no ulterior motive. I'm not part of a conspiracy. All I really want to do is show you the information and help you make a choice that may wind up saving your life. 

I've been in situations where I've talked to people who have COVID, who are unvaccinated, and every single one of them as they sit there on oxygen struggling to breathe, says, 'Is it too late for me to get the vaccine right now?' And that's … it's just incredibly sad to be in that situation and so I'd like to not have to do it any more. 

If you're listening and if you're unvaccinated, go online. Sam Harris has a podcast, which I think is excellent, where he discusses... the vaccine. It's excellent. I would encourage people, if you're on the fence, to sit and listen to that.

Feel free to go and have a conversation with your health care provider about it — though if you're coming in for an argument, please don't do that. If you just want to convince me that the vaccine is bad, I'm less interested. 

But if you have actual questions that you don't understand how it works, come ask. I'm happy to answer those questions and happy to try and help allay some of your concerns. 

But really, I think the important message here is just please go get vaccinated.

With files from Elyn Jones and Jane Sponagle

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