'We're in war times:' Hamilton's frontline healthcare workers brace for COVID-19 surge

Dr. Greg Rutledge is not a soldier but he is at war.

"We're in war times, in war against a virus," he said.

The chief of the St. Joseph's Healthcare Hamilton emergency department and a physician in the unit, Rutledge and other frontline workers across the city are facing an invisible enemy in COVID-19 — a virus that can't be seen until it's too late.

They know it's here, but don't know exactly how close. They know what it is, but don't exactly know how to stop it.

"You have all these undertones of 'What is on my body, am I clean, how can I make sure I'm not bringing that home, how can I make sure from one patient to the next that I'm not carrying that with me?' " Rutledge said.

A surge of infected people are expected to hit hospitals across Ontario hard — so hard, the worst case scenario predicts there won't be enough resources to treat them all.

Healthcare workers will be the primary line of defence against the novel coronavirus, but they are running out of resources for themselves, with no medicine to help them.

It will lead to desperate decisions and irrevocable consequences, the success of which will only be known in the aftermath of the pandemic, which could last two years.

"People feel it when you come in," Rutledge said.

The calm before the storm

Rutledge spends time in the war room with supervisors and directors mapping out their next move as the virus spreads. But he's also in the trenches with nurses, physicians, social workers, X-ray technicians, administrators and others who  treat patients.

"The biggest fear, as we've had this run-up for so long, is that we've forgotten something, that we're not prepared for something and sometimes you don't know that until you get in the fight and it really starts to unfold," Rutledge said. 

Right now, the atmosphere in the hospital is eerie. Rutledge said it's the calm before the storm, with 30 to 40 per cent fewer patients than normal. 

Still, workers are taking all the precautions they can. 

When they start their 12 hour shifts, they go through a screening test. Most bring separate bags for clothes or scrubs and smaller bags for their phones. When they leave work, they change outfits again and immediately shower before washing their clothes. 

Some have cut their hair to avoid the virus clinging to longer strands. Others are living away from their families.

There's no word on exactly how many patients will arrive and how many beds and ventilators they will need.

Rutledge admitted the amount of cleaning and precautions each day will slow down their response time, but he thinks they won't run out of resources. 

St. Joe's has also launched a new program to provide virtual care to long-term patients, sparing the use of personal protective equipment, which Rutledge said, is not in short supply.

'It's here, it's landed, we're in it now'

But the people meant to protect the public aren't immune — COVID-19 is already beyond enemy lines.

Three healthcare workers at St. Joe's Special Care Nursery tested positive for the virus.

"I wouldn't doubt there are people who come to work scared," Rutledge said.

"It's here, it's landed, we're in it now … we are at risk."

Frontline healthcare workers could also burn out.

They likely won't get a chance to eat during their shifts and are always on high alert, even after they leave.

"It's been a very odd time because it's been six weeks of this build-up and yet here we sit with still small numbers and so you're almost fatigued from the work up to it," Rutledge said.

"Then you realize that, actually the worst is yet to come and we need to be prepared for that and keep our wits with us as we get ready for what will likely be worse than what we've had so far."

If the surge barrels toward Hamilton at full force, the crew of roughly 30 people per shift will be forced to evolve and adapt.

"As we look at this explode, the shifts really just become a number at that point. The start time would be the same roughly, but your end time really ends when there's other support there who can tap out and the place is reasonably under control," Rutledge said.

The limits of a shift will likely be "off the table" when the wave of patients come in, leading the hospital to consider a model that lists who is available to work a shift and how many days in a row they worked. The plan will allow them to optimize staff while still giving them rest to avoid any medical mistakes or oversights with PPE use.

What will be left when it's over?

An influx of patients may also pose ethical dilemmas if there aren't enough beds or ventilators. 

Frontline healthcare workers will have to begin choosing between lives, scrutinizing over which patient will get resources and which will have to wait.

They may also have to watch people die — a lack of any medical solutions has disarmed nurses and doctors, leaving them almost as helpless as their patients.

"The larger conversation of what the economy looks like and what does everything look like after this, that's a big worry of ours, what does the healthcare workforce look like during it and on the other end of it?"