White Coat, Black Art·Q&A

'Running on fumes': Amid rising COVID cases, health workers struggle with fatigue, lack of support

Six months into the pandemic, a panel of health professionals talk about spikes in COVID cases, fatigue, and a public growing weary of restrictions.

‘There's more likelihood that you'd be criticized … for standing up for science,’ says doctor

For many health-care workers, it's been months working on the front lines and suiting up in personal protective equipment. (Evan Mitsui/CBC)

Health-care workers across Canada are bracing for a spike in hospitalizations as they watch the number of reported COVID-19 cases in many provinces rise. For many, it's been months working on the front lines, suiting up in personal protective equipment (PPE) and treating critically ill patients. Many are tired and as one U.S. doctor put it, they feel that they're "running on fumes." 

Earlier this month, Dr. Bernard Trappey, an internal medicine specialist in Minnesota, provided a personal account in the Journal of the American Medical Association, describing the deep fatigue that he and other health-care workers are experiencing

"Even frustration has given way to a bone-deep sense of weariness and resignation. I am running on fumes," he wrote.

The doctor's words struck a chord with other health-care workers, including Dr. Nathan Stall, a staff geriatrician at Sinai Health System in Toronto.

"We all feel like we're running on fumes," Stall told White Coat, Black Art.

"The COVID narrative and the COVID experience was very different than what we all had anticipated," said Stall, recalling what felt like a "call to arms" in March and April with people banging pots and pans on balconies and cheering front-line workers. 

But that's all gone, according to Stall, who said there's now a greater resistance in society towards some of the public health restrictions that will need to be  re-implemented. 

"There's not that sense ... that people are really behind us like before," added Stall. "There is that sense of resignation."

Burnout among health-care workers was echoed by Maureen Taylor, physician assistant in infectious diseases at Michael Garron Hospital.

"I've never wanted to apply that to me because … who isn't burned out?" 

Maureen Taylor, a physician assistant specializing in infectious diseases, has cared for COVID-19 patients at Michael Garron Hospital in Toronto. (Submitted by Maureen Taylor)

But she said she realized the toll it has taken on her personal life. 

"Even though I'm not taking it out on anybody at work, it may be that I'm using up all my empathy for the patients, and I don't have very much left for my friends and family."

Naheed Dosani, the medical director of Peel Region's COVID-19 homelessness response, recalled "so much uncertainty" in March. 

"We weren't sure if we had PPE ... it was very stressful. And I remember waking up my wife one morning before going to work and saying, 'Listen, I may get sick, like, I may not see you again. I know it sounds a little dramatic, but I love you,'" said Dosani.

"And I say the same thing with my parents and my friends. And that's really when it got real for me. And I know colleagues who work the front lines … at some point, come to a realization about this kind of conversation." 

Months into the pandemic, he says part of being a health worker is being an advocate and there's more pressure than ever. 

"There's more likelihood that you'd be criticized or even trashed online for standing up for science, for standing up for public health and what are the morally right things in creating change," said Dosani, citing how he used his social media platforms to talk about the impact of racism, particularly anti-Black racism, on COVID outcomes in communities.

Dr. Naheed Dosani says racism is having a disproportionate impact on people during COVID. (Evan Mitsui/CBC)

Stall, Taylor and Dosani joined Dr. Brian Goldman to talk more about the toll on health-care workers six months into the pandemic in Canada.

Here is part of their conversation.

How would you describe the overall wellness of [personal support workers and other health-care workers in long-term care] at this point in time as the numbers start to go up again?

Stall: There was this hyper-intense focus on long-term care in the spring, for good reason, because, you know, we had the national shame, really, of having the highest proportion of our country's COVID-19 deaths being in long-term care  —  around 80 per cent.  And so we had this lopsided response … it seems like back-to-school swept along and we've forgotten about long-term care again, but it's actually candidly brutal in the sector now in terms of morale.  

Outbreaks are starting again in homes, which is unsurprising once cases rise in the community. It only takes a matter of time before they penetrate into long-term care settings. Many of the issues that Naheed has raised around systemic inequity, particularly plagued personal support workers, which are overwhelmingly women of colour, underpaid, who have no hazard pay or sick pay. 

Dr. Nathan Stall, seen here in a Zoom interview with CBC, is a geriatrician at Sinai Health System in Toronto. (Zoom)

A lot of the pandemic dollars that were supposed to support our "heroic workforce," as our premier [Ontario Premier Doug Ford] described it, haven't been seen, and homes are understaffed. And I'm really fearful with cases rising now. It's only going to be a couple of weeks before we start to see devastation like we saw in the spring in our homes.

There's lots to be worried about here and I'm hearing that from all three of you.  As we head into the fall — the growing numbers of cases that we're seeing — I'm going to ask each of you in turn: Are there any sparks of light that keep you going? 

Stall: Over the summer ... thankfully it was a time when across the country where we really had success in flattening the curve. People were, you know, reemerging a little bit. Society was opening up. There was a lot of hope. But actually, that was the time when I felt the most profound burnout … Paradoxically in some way, the rise in the cases has, I'm not saying this is my light, but this is, I feel that call to action. 

Again I feel the engines revving up in terms of our health-care systems, in terms of the conversations people are having. So I know that health-care workers will rise to the call of duty if that's what's required in the fall and winter.

This is our calling, and for many of us this is a once in a lifetime or once in a career-defining moment. 

Dosani: The COVID-19 pandemic has a silver lining to it. It has brought social issues that are often thought to be separate from health care to the forefront of health care and public discourse in a way that I haven't seen in my lifetime. 

And I'm grateful that we're having conversations about paid sick leave. We're talking about migrant workers who work in rural farms. We're talking about the seniors in the long-term care crisis. We're talking about how to protect our children as they go back to school. We're talking about housing, the homeless, expanding financial relief, supporting people who use drugs with harm reduction and safe supply. And how racism is having a disproportionate impact on people during COVID. 

The views and experiences of people of colour have to be amplified in leadership roles, says Dr. Naheed Dosani 0:50

And these conversations while they existed before, they weren't happening in this way or at these volumes. And I think that that's something that we need to celebrate. We're working hard on our end and I'm asking government officials and policy-makers to please work hard and work smart on your end, to better understand people's vulnerabilities, and how those vulnerabilities shape people's circumstances so that as we move into the fall, and in the winter, we can we can support people from all walks of life because not everyone's experience is the same.

Taylor says we've learned more about managing COVID in the past six months. (Submitted by Maureen Taylor)

Taylor: We've learned a lot about how to manage this disease in the last six months. And so I feel in the second wave, we know we don't have to worry so much about "Do we have enough ventilators?"

And I think we know now that maybe there are a lot of people we don't have to intubate because other types of oxygenation like high-flow oxygen can help us bridge patients until they fight the infection off, and hopefully keep them from having to go on a ventilator. 

And that vaccine ... I truly believe a year from now, we will have an effective vaccine. It won't be a panacea. But I think there'll be something we can offer people. 

Q&A edited for length and clarity.
 

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