Facing the pandemic as part of a pan-provincial team

“We had a difficult winter, we had a rough few months.
When the storms came in off the coast, it felt like they broke everything on us at once.
It’s easy enough to talk about Blitz spirit – when you’re not holding the roof up and knee deep in it.
The pictures and the papers got ruined by the rain, and we wondered if they’d ever get dry again…
But I don’t want spend the whole of my life indoors! Laying low, waiting on the next storm.
I don’t want to spend the whole of my life inside! I wanna step out, and face the sunshine.”
– “The Next Storm” by Frank Turner

When you are working in a smaller community in northern Canada, it can feel like nothing else in the world matters except the layer of ice on your car in the morning, and the list of patients waiting at the clinic if and when you make it there. Whispers of a new virus in Wuhan felt especially far away as I followed my wife around the province on her final year pharmacy school clinical rotations. For me, it was “business as usual” in early 2020 – packed clinic and emergency department waiting rooms, crowded inpatient wards, plentiful and underappreciated personal protective equipment.

At the end of February, we finished our time in Terrace and took a brief trip to Ontario to visit family. We didn’t realize it would be the last trip to see them for a while. When we returned to BC, we were noticing a lot more people wearing masks, and ominous messaging in the now increasingly empty airports.

And then, right as I was starting a locum in Salmon Arm, the horror of what was happening in Italy became widely known. Within days, my email inbox and twitter feed became flooded with SARS-CoV2 material. I felt that sensation of information overload that I hadn’t experienced since I finished my pre-clerkship med school years.

I continued to see patients in the clinic for the first week, but my schedule quickly became filled not with physical exams and face to face meetings, but with phone calls and carefully choreographed swabs. This was an uncomfortable shift, but as more stories poured out of Iran, Spain and the rest of Europe, and as the world shut down around us, it was clear this was all necessary. This is not a drill – this is the real deal.

Over the course of a few ER shifts, while I continued to see the belly pains, headaches, MI’s, sepsis and (likely not COVID, at the time) fever and coughs that form the bulk of emergency medicine, a transformation occurred both around and within me. I went from rarely needing to wear a surgical mask, to wearing one for all patient encounters. I started making phone calls to patients in our isolation rooms to avoid exposing myself and my nursing colleagues to a potentially COVID positive patient.

The collective problem solving and teamwork, always present in the department, took on a new life as we actively worked together to navigate once common procedures and assessments in the new “COVID Era” we were being dragged into against our will.

This wasn’t just happening in that small department in the Interior – as a locum physician plugged into four out of the five geographic health authorities (sorry, Island Health), I bore virtual witness to the province-wide response and reorganization of resources to face the threat of this new virus. It was at the same time impressive and terrifying. Charts slowly disappeared from the wards as long-term care patients were moved to more appropriate accommodations, and elective surgical patients did not have surgery.

I bore virtual witness to the province-wide response and reorganization of resources to face the threat of this new virus.

There was no peace to be found in being “under capacity” – we were making room for what was potentially to come. The ED, usually expecting a rush of patients over spring break, remained only eerily steady. In a community with many elderly individuals, it was like waiting for a tsunami to hit while we rushed to board up the windows. But by likely some mix of good public messaging, government and individual action, and luck, that rush never came while I was on duty. We used that time well, running simulations to prepare ourselves and the hospital for whatever came next.

By the end of March 2020, it wasn’t clear what the curve was going to look like in BC, but as I left Salmon Arm for my next long-planned locum in Northern BC, despite the fear of what could be coming, I felt hopeful and proud. Our provincial and regional leaders have stepped up, as has the public in adopting the new vocabulary and practice of social distancing and quarantine. New resources are being developed and expedited to help us in both our struggle to stem the tide of SARS-CoV-2, and to streamline our usual acute care work for the people of BC. Real-time virtual supports for both physicians and patients, once difficult to come by and sustain, are quickly becoming entrenched in the way we practice and experience medicine.

This is a defining moment for all practicing acute and primary care physicians and allied health care professionals. Though it can feel overwhelming, this is exactly what we trained for. The collective response I have been honored to bear witness to and engage in has been inspiring in its creativity, flexibility and courageousness. Never have we been united like this as a team of professionals around the province against a common challenge. I hope this experience – as painful as it is – will bring with it many unforeseen positive changes. There was a time before COVID, and there will be a time after COVID. Like everyone, I’m anxious about the stormy space in between, but I’m excited to eventually step out together into the sunshine of the latter.

This is a defining moment for all practicing acute and primary care physicians and allied health care professionals.

What has your experience been, during this time of rapid change in an already dynamic and difficult profession and specialty? Have you noticed any positive trends in medicine, your team, your region or the province in the last few weeks you hope will continue after this is done? How do you think your practice will be different once the acute threat of SARS-CoV-2 has been addressed?

Disclaimer: The views and opinions expressed in this blog post are those of the authors and do not necessarily reflect the official policy or position of the BC Emergency Medicine Network.