Inside a Toronto ICU: A second-wave revisit and what has changed in six months
TORONTO -- Raul Gonzalez is among those who are part of the second wave of COVID-19 patients at Toronto’s Humber River Hospital intensive care unit. But unlike many of those in the first wave, he is younger, just 46. He managed to avoid the ventilator, but remains on oxygen and is recovering.
“It is not easy. It is so hard,” Gonzalez said with emotion. “Keep physical distance and wear your mask … you can do a lot to prevent it.”
It has been six months since CTV News first visited the COVID-19 intensive care unit at Humber River, where doctors and nurses faced an unseen and unknown virus while grappling with fear and overwhelming hurdles.
Half a year later, as many regions in Canada cope with a second wave of illnesses, some of those early hurdles are gone. There is less anxiety, more calm and confidence, along with some encouraging news. But the fear is still there.
“Partly I think it’s because we're used to this. This is part of our new norm,” said critical care specialist Dr. Sanjay Manocha.
- Newsletter sign-up: Get The COVID-19 Brief sent to your inbox
Survival rates have improved and protective equipment -- once carefully doled out and counted due to shortages -- are no longer in short supply.
The faces of the patients have changed too since the first wave -- there are fewer patients from long-term care facilities. They are younger now, with doctors seeing more patients in their 40s, 50s, and 60s, coming in from the community. The youngest was a patient in their 20s.
“They’re the individuals who don’t have as many chronic illnesses, but they come in very sick and they need supportive interventions,” said Manocha.
“Thankfully (the second wave is) not as bad as we thought it would be, but we still don’t know … the numbers are climbing steadily.”
During a CTV News visit this week, there were 28 COVID-19 patients being treated. Nine of them were in ICU, with six on ventilators. In April, 45 COVID-19 patients were being cared for at the hospital, with 13 of them on ventilators -- the second largest number in the city at the time.
The staff at Humber were lucky -- none of the ICU team were infected by a patient during the first wave. And now, the team is more comfortable treating patients; they know the personal risks of infection are low when the right precautions are taken.
‘STILL THAT FEAR’
Ten months after Canada reported its first case, the medical and scientific community have learned a great deal about SARS-CoV-2, the virus that causes COVID-19, but there is still much that remains a mystery.
“I think we're still afraid. The reason why we're still afraid is because most people who get COVID have very mild symptoms. ... The problem is we don't know who gets really sick,” said Dr. Jamie Spiegelman, an internal medicine and critical care specialist at Humber.
One of the most encouraging trends in the second wave is the ICU survival rate. Here at Humber, the statistics show that death rates have dropped from between 15 per cent to as high as 50 per cent depending on the age and condition of the patient.
“I think it's because they're younger, and they can handle this and our support system is better. And, you know, there's some treatments out there that are having an impact,” said Manocha.
The steroids alone -- used to calm the inflammatory reaction that is often the real killer among infected patients -- have been shown to reduce deaths by 20 per cent.
They also know who needs a ventilator and who only needs oxygen.
“Some of them have underlying issues like diabetes. Some of them don’t even know they have underlying issues until they have COVID, right? So they have a few underlying issues like diabetes, hypertension,” said charge nurse Kimisha Marshall.
Yet some have no risks at all. Earlier this week, doctors at Humber had to send a previously healthy 45-year-old male to Toronto General to get extracorporeal membrane oxygenation -- essentially put on a life-support machine.
“It’s kind of random from our experience. So the fear is that you could get this virus and you could die from it,” said Spiegelman.
“We don't know who's going to die, who's going to live, and who's going to have very mild symptoms. So there's still that fear of a disease.”
The longer-term complications that many COVID-19 survivors suffer for weeks even months -- fatigue, breathing problems, neurological deficiencies, organ damage -- also remain a puzzle.
While front-line workers have been dealing with COVID-19 patients for more than half a year now, it does not come as a surprise to health-care providers that some people are tired -- even skeptical -- of the pandemic.
“Everyone has COVID burnout, everyone has COVID fatigue,” said Spiegelman, but he adds that getting back to normal is going to take time and patience.
“We just have to ... survive it and realize that it is going to have an effect on our personal life, our mental health. It is going to affect all of us. But at the end of the day, you know what? A year or two from now, we are going to go back to normal.”
Despite the positive trends and advances in treatments, health-care workers who face the disease every day worry that a new surge could change the picture.
“I know COVID is a very stressful situation. We're feeling it here as nurses because we are on the front line,” said Marshall, whose biggest fear is those who do not believe the disease is real. While the hospital has kept its staff safe, there is worry they can still get infected through the community.
“That's why I'm begging the community please … Wear your mask, social distance, stay home if you don’t have to go, please. Let's help each other and keep each other accountable. We're in it together.”