The Sunday Magazine

Conflict-zone doctor predicts 'terrifying times,' due to lack of resources to fight COVID-19

The demands and conditions that Canada's hospitals and health care providers are going to face in the weeks and months ahead will be entirely new territory, according to Halifax physician Dr. Sundeep Chohan. Dr. Chohan has many years of experience in the field of catastrophe medicine, having worked in conflict zones and natural disasters. He argues that the medical response to COVID-19 will call for the skills and approach required in a war zone or humanitarian crisis rather than in conventional modern medicine.
Dr. Sundeep Chohan standing in the interrogations room used for filming SAS: Who Dares Wins in Morocco Series 3. (Submitted by Dr. Sundeep Chohan)

Canadians are used to having a healthcare system that is dedicated to keeping patients alive. But if doctors and nurses run out of the resources they need to help victims of the COVID-19 pandemic, they will no longer be able meet those expectations.

(Submitted by Dr. Sundeep Chohan)

"If you look at how things are changing and the exponential growth of this disease, I think we will probably hit a point whereby difficult decisions are going to be made over the coming, I would say, two weeks," said Dr. Sundeep Chohan, in conversation with the host of The Sunday Edition, Michael Enright.

Dr. Chohan moved to Canada last year to become a family doctor in Halifax. He was formally trained in the U.K. in disaster and catastrophe medicine. It is a specialty that has taken him to war zones, as well as countries around the world that have faced humanitarian crises, natural disasters and medical epidemics — such as cholera and leprosy. 

Any doctor, at any time, could be called upon in a disaster, says Dr. Chohan, as happened in New Orleans during Hurricane Katrina, when adequate resources were not available to deal with medical needs.

Now that medical staff are being put forward into the front lines without equipment, they have to make choices based on duty, based on availability, based on risk.- Dr. Sundeep Chohan

"If you look at the COVID-19 disease, the trajectory is becoming exponential. So what's happening is that the numbers every day are growing at such a fast rate, and that is overwhelming medical resources. So you could say, actually, that it is going to become a catastrophe with the passage of time," said Dr. Chohan.

When that happens, he says the standard of care we are used to will have to change.

"You're forced to practise in ways that are substandard or not ideal," he said, noting that economics or the availability of equipment become factors in patient care. 

"So the big problem, obviously, at the moment is a lack of personal protective equipment for staff. And if you look at the figures that are coming out of Italy at the moment, about eight or 10 per cent of the infections there were medical staff," Dr. Chohan said. "Now that medical staff are being put forward into the front lines without equipment, they have to make choices based on duty, based on availability, based on risk. These are going to be very difficult decisions in the coming few weeks and months."

Dr. Chohan said he feared in January that COVID-19 could become a pandemic, when he observed the actions of authorities in China, as "disproportionate for what they were saying is a very simple, straightforward influenza or pneumonia-type illness."

I think for doctors on the frontline, for patients and for their families, these are going to be quite terrifying times because, essentially, doctors are going to be forced to make decisions that normally in the Western world we don't do.- Dr. Sundeep Chohan

He expects Canadians will be traumatized when COVID-19 hits its peak in this country.

"I think for doctors on the frontline, for patients and for their families, these are going to be quite terrifying times because, essentially, doctors are going to be forced to make decisions that normally in the Western world we don't do," he said. "Pretty much all costs and all resources are put into sustaining life."

Instead, Dr. Chohan says, doctors may have to decide who will have access to a ventilator and who won't. As a result, some patients will die. 

"It's going to be very difficult for doctors who are not used to that environment and have not seen that level of death, but also who have not had to make those very, very difficult choices. And I think this will be something that comes to haunt them for many, many years," Dr. Chohan said. "I speak as someone who has seen probably over a thousand dead in the field, and it does haunt you."

Dr. Sundeep Chohan at a front line clinic during a war crimes investigations in Goma, Democratic Republic of Congo. (Submitted by Dr. Sundeep Chohan)

He says Post-Traumatic Stress Syndrome (PTSD) is more prevalent in medicine than people realize, and that events like this will induce it.

"I think PTSD, probably the big elephant in the room for medicine, is something that's not discussed," he said. 

Doctors may appear to be fine when they make a clinical decision about patient care, but "the problem is going to be when they look at someone and it reminds them of their grandfather or their grandmother or their father or mother or brother or sister, and then suddenly you have that connection. That is when they're going to start having problems."

It's inevitable that it will pass, and it's just going to be a very difficult three or four months.- Dr. Sundeep Chohan

Medical staff will also have to communicate with family members in these traumatic situations.

"If you're a relative of a loved one on a ventilator, you want to be sure in your mind that everything possible was done. Now you tell me, as a relative, how you're going to feel being on the other side of that conversation whereby doctors are saying, 'Well, it's not a huge amount of improvement, we have limited resources, and we want to allocate a ventilator to someone else,'" said Dr. Chohan. He expects many doctors and families will be having these conversations across North America. 

Despite the challenges ahead, he remains optimistic because of the trajectory of COVID-19 he has seen in other countries.

"If you look at, say, South Korea and you look at Singapore, they have managed to control it through social distancing and their ensuring contact tracing," said Dr. Chohan. "This is a disease that can be controlled…It's inevitable that it will pass, and it's just going to be a very difficult three or four months, whilst the medical community works on the best medical care available."

I think this is an opportunity for us to look at what's ahead…and say, 'Never again.'- Dr. Sundeep Chohan

He also sees our experience with COVID-19 as an opportunity to create a medical system that will be better prepared for a future pandemic, which he believes will be inevitable. 

"One of the things I've noticed in Canada since my time here is that we have five million people without a family physician. You can imagine what state of mind they're in at the moment not having access to medical care, right in the middle of a pretty horrific pandemic. Maybe it's time we looked at reinvesting in primary care," Dr. Chohan said. "I think this is an opportunity for us to look at what's ahead…and say, 'Never again.'"

Click 'listen' above to hear the full interview.

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