Follow up to my tweet on AB hospitals bursting at the seams....
Staffing. Or lack there of.
I was supposed to be off hospital administrative duties this week, and as the week as has gone on, it has been increasingly evident that there's no such thing as a break.
Not when, in one fail swoop, we will likely have 5 critical medical staff off for COVID and isolation, with a skeleton back up plan that will barely cover this gap.
At a time where concurrent to the staff shortages, we continue to see patient volumes that are untenable and 50-75% over our bed base.
At a time where we have to ADD teams of docs and allied health to deal with the volume, but cannot even staff our baseline teams.
At a time where I will now need to ask my weary colleagues to consider moving to a system that forces them to work an additional 18-24 hours on top of the 70 hours they work per week, just to cover the gaps.
This is utterly unsustainable. I don't know how we will make it through the next weeks. Like, actually do not know.
So when we talk about the effect of this wave on hospitalizations, please remember this context- that we are starting this wave so severely depleted, that whether we have 10 or 1000 COVID patients, the system is already broken beyond repair.
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In less than 10 hours today, I've had to counsel and guide 10 people who are either positive or close contacts to positive people. All in healthcare.
As someone who has been intimate with all things COVID since 2020, I'm no longer surprised when people come to me asking "should I test? Should I isolate? When do I go back to work?" The problem is none of our rules make sense anymore.
Both instinct and experience tell me that a close contact of a HIGHLY transmissible virus should stay at home. As @CMOH_Alberta said today, 1 in 3 people in #yeg and #yyc getting tested have COVID, and with testing access cut off we have no idea how many others have COVID.
And so it begins. The request to start back-up COVID planning. Overcapacity planning. Surge planning. The question lingering in the back of our minds "will this be the wave where we triage?"
There are many unknowns still with omicron, but what is a fact is that our healthcare system in AB is in such a precarious position that even a blip of a wave will bring it all crashing down.
We have not recovered from the fourth wave, and in many hospitals, we are still into surge ICU and medicine ward spaces. With staffing shortages plaguing the ability to get back to "normal activity."
21 months ago, I had no idea what to expect. I entered the battlefield, ready to fight, respond, create plans of action. No template. Just adrenaline, moral obligation, duty. /1
18 months ago, past the first wave, naively thinking that the "fall might be slightly busier."/2
13 months ago, I couldn't believe the death and devastation I was deep into. A record number of death certificates signed amongst our medicine COVID units in one day. And then breaking that record the next day. /3
One of the reasons COVID has affected physicians deeply (aside from the soul shattering moral injury, repeated trauma, and exhaustion-- since those aren't enough)- is because we are learning an entire pathogen and illness from scratch.
Only now are we starting to understand some of the inflammatory cascade that COVID causes and trying to target our therapies towards lessening this effect.
What we know even less about is long COVID. In early 2020, we thought we were going to see an incredible amount of pulmonary sequelae, lingering lung disease.
Long (but necessary) Thread on Hospitalizations: GIM (Internal Medicine) and ICU, and what it means to be "COVID Recovered"
We have gotten used to the slew of numbers thrown at us daily. Active cases. Deaths. ICU and hospitalizations. And over the last few weeks, we have seen a very slow decline in these numbers.
But I caution us all not to get excited or comfortable with these numbers. They do not tell the whole story.
612. The number of days since AB first declared Public Health State of Emergency due to COVID. On almost all of those days, I've woken up, checked the census of internal medicine and COVID patients in my hospital.
95 days. Roughly the number of days we have been in the 4th wave in AB. A wave that may have peaked, but now has plateaued into what we are calling at the hospital "the new normal."
150%. The amount each of my internal med docs have worked over the last 21 months, above their usual contractual obligations, in order to staff the COVID and internal med surge teams. (Should out to @BisonGIM - #TeamGIM)