Sometimes it takes a team effort to stand up to a ruthless bully and that has certainly been the case within the walls of University Hospital of Northern B.C.
Doctors, nurses, respiratory therapists, pharmacists, cleaning and housekeeping staff, hospital administrators, lab and information technology specialists and communications staff have ganged up in the fight against the novel coronavirus and are winning that battle.
They have so far prevented any localized outbreaks.
“It’s really been a massive team effort,” said Dr. Marietjie (MJ) Slabbert, head of UHNBC’s critical care department and the regional medical lead for Northern Health critical care program.
“Never before since I’ve been in B.C. (four years) has there been so much collaboration between different departments and collaboration between administration and clinicians on a daily basis. People put small differences aside and really worked together trying to problem-solve.”
Staff at UHNBC, the referring hospital for northern B.C., have prepared for the worst after seeing hospitals in Italy, Spain and the United Kingdom inundated with critically-ill COVID-19 patients. That hasn’t happened in Canadian hospitals and B.C. has been one of the first provinces to flatten the curve. Northern B.C. has had just 60 confirmed cases and none of those patients have died from the virus.
“Our initial modeling and predictions were terrible; we were going to be completely overwhelmed and we have preparations in place for that, but we’ve been lucky so far,” said Slabbert.
“The initial concern was we were going to have the same type of surges they had in Hubei (province in China) and I think that made everybody quite on the edge, but also motivated to prepare for that. We feel we have processes in place and we’ve not been overwhelmed but we see how bad it is in the rest of the world. Some of my friends in the U.K., it’s hard for them to be positive when there’s 700 patients dying every day, it’s totally unheard of.”
As a specialist in anesthesiology and critical care, Slabbert met twice a week via teleconference with clinical and administrative ICU leaders from the five provincial health authorities to develop a COVID-19 strategy. Regional protocols were developed based on provincial, national and international advice.
UHNBC established a COVID-19 airway management team - seven anesthesiologists and the department heads of anesthesiology and ICU who serve as team coordinators - which stays in close communication with similar teams in other health regions. Ventilators were requested and moved to several Northern Health hospitals and respiratory therapists traveled to some of the smaller hospitals in the region to train nurses.
Very few physicians before the outbreak had ever been fit tested for N95 masks and nursing educators stepped up in a collective effort to train hospital staff how to manage all personal protection equipment (PPE).
As Northern Health’s triage intensivist, Slabbert coordinates the referrals and transfers of patients from other hospitals in the region and her airway management team is on-call and available at any time to intubate the sickest patients.
Since the pandemic began in mid-March, the team has been activated on average about three times per week and has intubated most of the patients who warranted the activation. UHNBC’s normal critical-care capacity is 10 patients and a second unit was prepared for COVID treatment which has an additional 15 beds. At no time during the pandemic has the COVID patient count reached double figures.
“If someone comes in to the hospital and is a suspected or confirmed case of COVID, the airway team actually gets activated to intubate the patient,” Slabbert said. “We’re trying to protect the rest of the health-care teams from the virus exposure and it’s working well.
“Not all patients come back positive (for COVID-19) but you can’t really wait initially to activate the team,” she said. “There are some patients who actually do better if you don’t intubate them, but it’s tough to know who those people are.”
Depending on how sick the patient is, the alternatives to intubation include high-flow nasal oxygen therapy or continuous positive airway pressure machines which present a higher risk of spreading airborne particles that can infect health-care workers.
“You weigh that up against early intubation of a patient (which keeps them unconscious under general anesthesia) and then have them in a closed circuit where they stay in minimal risk of exposure to the staff,” said Slabbert. “It’s not just the risk at the hospital, it’s the feeling that you might take it home to your family. I think that’s what’s making individuals very anxious.”
The uncertainty of not knowing if a patient has COVID-19 forces medical staff to suit up with full airborne PPE (N95 mask, gown, face shield, gloves). But a repurposed testing device brought to hospitals in Prince George, Fort St. John, and Terrace is producing much quicker point-of-care COVID-19 test results which can relieve Northern Health medical staff from that PPE discomfort.
The GeneXpert molecular diagnostic machine, which first gained acceptance in 2001 during a series of anthrax attacks in the U.S., can detect COVID-19 within hours of administering nasal swabs to patients. During the first five weeks of the pandemic, test swabs had to be sent from Prince George to Vancouver and it took four or five days for results. Now the tests are done at the hospital and the results are returned in two or three hours.
The reagent needed for the tests is in high demand so testing at UHNBC is done in three daily batches to ration the supply.
“It’s made a massive difference,” said Slabbert. “Now we maybe wear full PPE for half a day or three or four hours and you save on all that PPE.”
In response to the pandemic, Northern Health has made major strides using telehealth technology to provide virtual care for patients and connect doctors and nurses to enable sharing of information throughout the region.
Slabbert is part of a group of six B.C. intensive-care specialists called ROSe (Rural Outreach Support e-health), which for nearly three years has been helping rural clinicians deal with critically injured or ill patients and it has now turned its attention to providing COVID-19 advice.
A video app or phone call connects a rural doctor, nurse practitioner or any other health-care provider to an intensivist who volunteers on days-off to take the calls. Through a cell phone camera they can see the patient and view diagnostic images to offer their expert opinion and suggest instructions for treatment.
The fact there has not been a COVID-19 outbreak at UHNBC has decreased anxiety and improved the overall mood of hospital staff, according to Slabbert. Front-line workers have sufficient PPE supplies and are feeling less threatened while doing their jobs. But the risk remains until the pandemic is officially knocked out.
“As long as we all behave, hopefully we’ll just get through this,” said Slabbert.
“We’re all grateful we weren’t overwhelmed but we also know that we are in it for the long run. We sort of feel, we’ve probably got this, and we feel much better prepared.
“We’re not seeing a second COVID wave yet, because the restrictions have only been lifted on Tuesday, but what we are seeing after six weeks is a non-COVID surge of other people who have stayed home for six weeks and are now coming in quite unwell. We don’t want people who have chronic illnesses or very poor baseline health to not seek medical help in time.
“We all feel better prepared for what’s coming and we will stay vigilant. It’s easy to become blasé, but the virus is still out there, it’s not contained and there’s still no cure for it so it’s important to keep up that vigilance.”