Inside a Toronto ICU: What it takes to care for COVID-19's most critically ill
TORONTO -- The numbers of the COVID-19 story tell us one thing, but the experience of doctors and nurses caring for critically ill patients tell a much deeper tale.
The novel coronavirus SARS-CoV-2 is causing a dangerous pneumonia in some people it infects that behaves differently than any other respiratory disease. The many unknowns of COVID-19 make caring for the most severe cases incredibly complex and prospects for recovery less certain.
There are no approved drugs to treat the disease and a vaccine is at least a year away.
CTV News medical correspondent Avis Favaro and producer Elizabeth St. Philip were given a behind-closed-doors glimpse into what is involved in caring for patients at Humber River Hospital and some of the heroic efforts put forth to save them.
On this day, the hospital’s intensive care unit is caring for 13 COVID-19 patients on ventilators, the second-most in the city. They have the worst symptoms among 45 people being treated for the virus at Humber River.
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“This is not like a disease we have seen before,” said internal medicine specialist Dr. Jamie Spiegelman. He says COVID-19 does not behave like a regular pneumonia, making medical management “unpredictable and day by day we have to change what we do."
There are even signs the disease may be causing heart inflammation, kidney disease, blood clots and liver problems.
He says on top of that, he is fearful of getting the virus through treating patients and then bringing it home. Inserting a breathing tube into the airway, a procedure called intubation, is particularly risky.
“It is the first time I have been afraid of getting a disease from my patient.”
A paper published by the Intensive Care Society says it’s believed about five per cent of all COVID-19 patients will require mechanical ventilation on an intensive care unit.
‘IT’S REALLY SCARY’
A young man in the ICU is so sick his ventilator is turned to its highest setting.
“He was doing well and then his oxygen dropped,” said critical care specialist Dr. Keren (CRRT) Mandelzweig. Now the team is turning the young man on his stomach to improve the oxygen getting to his lungs and into his blood. It’s a technique called prone positioning and has been found to work well with COVID-19 patients.
But it is not an easy task.
Turning over a COVID-19 patient on a ventilator requires six people. It must be done slowly and carefully so breathing tubes don’t get disconnected, which would be dangerous for the patient, but also risk spreading the virus.
Turning two patients, along with dealing with all the gear and the careful disinfecting before and after, takes a full hour.
Mandelzweig describes the virus’s assault as “persistent” and says it really amounts to a waiting game.
“People are not getting better quickly, and they are on breathing machines for a very long time,” she said. “We don't have any treatments, all we can do is support the body with the machines we have and hope the body itself recovers from the disease."
Meanwhile, personal protective equipment for staff is both critical and in precious short supply.
“A gown, a mask, normally we would get it and throw it out,” said Mandelzweig, who is co-ordinating turning over this patient. “Now it is signed out like an opioid or fentanyl.”
Hospitals are also reporting shortages of sedatives, with COVID-19 patients requiring a lot of sedation to keep them calm and to prevent them from coughing -- a dangerous means of transmitting the virus to health-care workers -- during procedures.
Dr. Jason Cyr, an anesthesia specialist, says health-care teams are under-equipped right now in the face of a relentless battle against an invisible enemy.
“Some of us have moved away out of our homes, so it's the resolve, the human spirit is awesome. But this is scary. It's really scary.”
Nurse Sugandha Pandya, who is overseeing 32 COVID-19 patients, has one message: “Just please stay home and be safe and keep us safe.”
Outside the ICU, COVID-19 patients who are less severely ill are still closely watched in case stable breathing turns into a crisis. That can happen within seconds, says nurse Ayotunde Ajiboye.
“It is a deadly disease. I wouldn’t want anybody to have it. It is unpredictable.”
Floor staff hold daily meetings, updates on cases that are coming, and on supplies, that may or may not be coming. That stress, of not having adequate stocks of masks, gowns and gloves, weighs heavily on staff.
As does the reality that this battle is far from over and will result in casualties far beyond hospitals.
“You know the fact that only a tiny percentage of the population has had this at this point, so we're still looking at many months going on,” said Dr. Michael Gardam, chief of staff.
“The economic impact of that is going to be astounding.”
HOPING FOR A MIRACLE
Bruno Iozzo was a healthy 73-year-old before he developed a cough in late March. By the time he got to Humber River, he was gasping for breath.
He was one of the first COVID-19 patients admitted there, and he is still on a ventilator, three weeks later.
Dr. Sanjay Manocha says X-rays of Iozzo’s lungs show the toll the virus is taking. What should be black on the image is white and hazy, meaning his lungs are filled with fluid inflammation and can’t send enough oxygen into his blood.
It’s the “classic picture that we see of these corona pneumonias,” said Manocha. In Iozzo’s case, that has led to kidney failure and dialysis.
“We're learning as we go, because it's not the same and our approach is different for these patients compared to other patients who have pneumonia.”
ICU staff at Humber have yet to see any of their patients recover enough to go home.
Iozzo, who loves to play accordion and socialize with his buddies, used to own a construction firm and a vegetable farm in Newmarket. Though retired, he still likes to work in the family construction business his sons took over, says his daughter Gisella.
She says she now regrets that she didn’t take time off from work to go with her father on a vacation to Cuba in January.
“If anything, I just hope my dad would be one of those miracles that come out through this, and that this story shows the world there’s hope,” she said.
But she’s scared.
“I don’t know what will happen with my dad, and neither do the nurses and doctors,” Gisella wrote in an email to CTV News. “I can only go by what I do know, which is that they are trying everything they can to save him, and that my family and I are not alone in this horrific experience.”