'Lapping at our shores': Small and remote hospitals anxiously await a COVID-19 influx
ER doctors tell The Current that testing, protective equipment stocks of concern in some regions
While ER doctors in small and remote hospitals across Canada say they're ready for COVID-19 patients, they are anxiously awaiting the influx already seen in larger centres.
"We are all kind of a little on tenterhooks, a little restless, waiting for what we know is coming." said Dr. Lois Bowden, head of Valley Regional Hospital's emergency department in Kentville, N.S.
As of Friday, more than 12,000 COVID-19 cases have been confirmed across Canada.
The Current spoke with emergency department doctors in three provinces. While they believe they're prepared for a deluge of cases, they worry about the impact COVID-19 will have on their facilities and staff.
"We are also in that lull and quiet before the storm where we do feel the storm lapping at our shores," said Mark Gracia, an ER physician at Penticton Regional Hospital in B.C.
"We are getting [a] trickling in of numerous highly-suspected COVID patients. And we're not yet at the phase where we're having to ventilate a lot of patients, but that is around the corner."
Long waits for test results
Chief among their concerns are personal protective equipment (PPE) stocks, including masks, and for some, the delay in having patients tested for coronavirus.
Dr. Sean Moore, chief of emergency services for Lake of the Woods District Hospital in Kenora, Ont., near the Manitoba border, says that it takes between seven and 14 days to receive a patient's results from the Toronto-based lab.
"So we have no idea if we are seeing COVID patients or not," he told The Current's Matt Galloway.
Mona Nemer, Canada's chief science adviser, was critical of Ontario's testing levels Thursday.
"I am a little bit preoccupied by the situation in Ontario because we should be doing more testing in Ontario," she told Radio-Canada.
"I hope they're going to be able to ramp this up."
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While Moore's hospital currently has the necessary stock of PPE, he worries that unless production from medical supply companies — and others contracted by the federal government — increase, it could quickly dwindle.
"In speaking with my colleagues down in southern Ontario and Quebec, who are due to run out very shortly, we can only hope that the supply chain is in place soon enough," he said.
'We have access to one N95' per shift
Gracia, whose hospital is about 250 kilometres east of Vancouver, echoed Moore's concerns, adding that masks at his hospital are being rationed and staff are looking for ways to reuse them.
"When we come on shift, we are given one surgical mask and we have access to one N95 [mask]," he said.
"We're going to start collecting the masks at the end of the day and ... try to see if we can bake them at low temperature to kill off the virus so that we can actually re-use the masks and not run critically low."
Surgical masks and N95 respirators are designed to be used only once, then discarded.
In an email statement, B.C.'s Interior Health Authority told The Current that PPE stocks are being assessed by the province, and that stock is available for distribution to facilities across the province.
Interior Health also acknowledged that disposable N95 masks are being collected from the region's largest acute care sites, then sterilized, in an effort to assess "opportunities to preserve critical PPE supply levels" as part of a "provincial initiative for emergency backup supply to regular inventory."
In a Facebook post last month, Gracia also urged those worried that they may be infected with COVID-19 to "not rush to get tested."
He says some patients have gone to local emergency rooms asking for tests, despite being told by the provincial telehealth service that testing was unnecessary.
He added that the test may produce a false negative.
"If I went to a grocery store and the scanner was wrong on every fourth or fifth item that I was putting through into my bag, I would definitely not trust the scanner."
Gracia worries that those false negative tests might encourage people to prematurely end isolation and inadvertently spread the disease.
At Valley Regional, Bowden says that she has fewer concerns about PPE stocks and test results. In an email sent to staff, a photo shows a fully-stocked warehouse, she said.
Test results have also been available within 12 to 14 hours.
In an effort to protect patients without COVID-19, Bowden and her team have taken what she describes as a multi-door approach to isolating suspected and confirmed COVID-19 patients.
"If you walk into our emergency department this morning, there is a spotter at the door — a nurse with a mask. She will ask you a couple of screening questions," Bowden explained.
From there, those with symptoms unrelated to coronavirus enter through one entrance, while those with COVID-19 symptoms are segmented in two separate areas, including to a designated "COVID ward," depending on whether the patient has a confirmed diagnosis.
Bowden says the planning led by the Nova Scotia Health Authority around the coronavirus pandemic has been unprecedented.
"It's been an activity schedule of preparedness and organization that I have not seen before in a career spanning several years," she said.
Written by Jason Vermes. Produced by Suzanne Dufresne, Anne Penman and Mary-Catherine McIntosh.