From the front lines of a pandemic

By Dr. Susy Hota

I think if you asked most people on the frontline of this pandemic, they would tell you it’s hard to find the time or energy for reflection. It’s been a year since the WHO declared the COVID-19 pandemic and we’re still in the middle of it.  It’s tough to accept because every single one of us is longing for life before the mass quarantine, the deaths, the masks, and the end of everything that signified our usual lives.

Every time we hear  transmission rates have gone down,  hospitals are slightly less full, and  the government is considering yet another re-opening plan, we assume we are winning this fight. The public wants to believe we are winning this fight. Here’s the thing though, it’s been a year and the fight keeps changing. We didn’t know anything last March – we were working in the dark, and the stories out of China initially, and then Europe and then New York just across the border, were frightening. In some countries in Europe and in the United States there were concerns over sufficient supply of PPE for the health-care workers and fear that there weren’t enough ventilators for the most seriously ill patients. We were staring into the abyss.

A year later, there was palpable relief when vaccines were produced in a period of time unheard of in modern medicine.  It was a light at the end of this long and dark tunnel. However, months later, we are struggling  to effectively deploy stuttering supplies of the vaccines, at the same time that new variants are causing great concern. Should our kids be in school? How will we help small businesses? What about those without secure housing? How do we protect our elderly in long-term care? And of course, how do we support our staff, family and friends to continue pushing through the pandemic and adhering to infection control measures?

Like virtually everyone else I know, these are the questions that keep me awake at night. As the medical director of UHN’s Infection Prevention and Control team, I can say we are old pros at managing infectious diseases. The IPAC team has handled countless outbreaks of respiratory infections, provided guidance as UHN became the national repatriation site for Ebola in  2014 and I can honestly say we handle this stuff well. But none of the previous outbreaks or pandemics hit us this hard, or for this long. Every single day we are dealing with something new and the way we respond has to change in order to keep up. It’s a whole new world.

Every member of our IPAC team has been working day and night to ensure units have what they need to be safe. Surveillance and reporting of COVID-19 cases during and outside of outbreaks, and contact tracing exposed individuals so that isolation and testing can be employed to limit transmission are labour-intensive but critical. These actions don’t respect the boundaries of a work-day – they bleed into nights, weekends and holidays. The IPAC team is also put in the position of having to be the bearer of bad news to their friends and colleagues in order to keep them safe. COVID-19 steals joy in so many ways. For health-care workers who are awfully tired and still working so hard, it’s a terrible thing to have to tell them, you can’t sit and take a break with a friend. You can’t share a treat that might lift your spirits. Everyone has to be superhuman in their vigilance. I find all of that enormously challenging because I know what toll this pandemic is taking on everyone.

Perhaps the most emotionally difficult part of this experience has been our work with  long-term care homes. In the spring of 2020, UHN was assigned responsibility  to support IPAC for 13 long term care centres, five retirement homes, and 30 congregate care settings. Having no prior experience with LTC, the experience has been eye-opening on many fronts. There was little in the way of IPAC infrastructure and training in the homes. We had to work on building capacity while guiding them through some of the most challenging outbreaks I have ever seen. It was heartbreaking. It’s intense, 24/7 work that requires constant pivoting. Eventually we are going to have to stop treating this as an emergency and figure out how to live with COVID-19 long term. Perhaps we’re not quite ready for that conversation yet because the pandemic still feels very active and volatile, but we’re going to have to get there. And I know we can. I have watched health-care workers do the most incredible things this past year. Fighting for their patients, even as they fight fear for themselves. Holding hands while people took their last breath. Ensuring loved ones knew they weren’t alone. Working together as a team to inspire each other and get through another really hard day.

This has been the toughest professional challenge of my life, and truthfully I just want it to be over. But even on the bleakest days I am reminded of how lucky I am. I have an incredible husband, beautiful and resilient children, and colleagues I would never trade. There are few silver linings in all this, but I try and remember to be grateful for all of them.

Throughout this experience I have been reminded at almost every turn, of how committed, and professional our health-care workers have been, and continue to be. We will get through to the other side of this, because of them.

Dr. Susy Hota is Medical Director, Infection Prevention and Control (IPAC), University Health Network.