Kitchener ICU doctor says it could take a year to catch up on missed surgeries, appointments from COVID-19

From the outside looking in, it appeared hospitals in Waterloo region weathered COVID-19 fairly well.

While the public knew about some issues — such as outbreaks at local hospitals and surgeries cancelled — behind the scenes, there were concerns the hospitals could run out of space to treat everyone, says Dr. Rob Chernish.

Chernish is a respirologist and critical care physician at St. Mary's General Hospital in Kitchener. He also consults at Grand River Hospital and has an outpatient practice.

He spoke with CBC Kitchener-Waterloo's Craig Norris, host of The Morning Edition, about what was happening behind the scenes of the second wave of the virus in Waterloo region and what he predicts the next year will be like as the health-care system catches up with surgeries and appointments that had to be put on hold.

The following interview has been edited for length and clarity.

Craig Norris: During a recent regional COVID-19 media briefing, you said three emotions stand out for you as you look at the past year: Denial, fear and frustration. Let's start with the denial and fear that you felt. 

Dr. Rob Chernish: Those emotions are now a year old. I should put that caveat in. But certainly the fear was what we were seeing at that time a year ago today in China. We'd heard some things, but it was being a bit glossed over, if you will. 

But then when Italy happened and New York City happened, we saw the magnitude of what this virus could do. Then there came some real fear. 

And then, you know, we started to see patients showing up in our own hospitals. We were pretty afraid at that point, yeah. 

The denial was the initial emotion ...  that this is actually going to happen and so we got over that when it actually started to happen. 

The frustration part was when we were caught with a lack of [personal protective equipment or PPE] is really the hallmark of the first wave was. We just weren't prepared and we were really shocked to see our supply lines were so limited in how we could actually acquire it. 

And that's been a recurring theme actually throughout the pandemic. I mean, we see it even today on the second wave when if you don't make the vaccine, you're going to be standing in line and you'd be subject to protectionist policies of other countries. 

Norris: What was it like? I mean, there was the supply of PPE, but there was also the space in hospitals. What was it like to have to find new spaces for these COVID patients? 

Chernish: Absolutely. So I think what people may or may not know is that before there was ever COVID, we would run our hospitals and 85 to 90 per cent capacity. We were stretched pretty thin and previous governments had always clawed back so we were working harder with fewer people. 

So we were in really no shape to weather a pandemic. It's like we've been beaten up for years and then thrown in the toughest fight of our lives. 

Norris: In late January and early February this year, there was a peak in cases. Hospitals in the region weren't taking in new patients from other parts of the province, surgeries were shut down. Now, that's what we hear. And we sort of gloss over that, right? We go, 'Oh, that's terrible.' But take us behind the scenes. What was happening? 

Chernish: The second wave, even though we had prepared and we had our surge policies in place and we knew what we wanted to do, the numbers were extreme. 

And when people come in for COVID-related problems to hospital, especially in the ICU, they tend to stay a long time. The shortest amount of time I had somebody on a ventilator was about three days, but the longest was many months. 

So when they come in, they stay in those beds and you can't use them for anything else. I think what we had to do every morning - and I'm about to do this afternoon - is have a series of meetings where we try to plan: What are we going to do with that next patient that comes in,  where are we going to put them? Is it in our hospital or are we going to have to start sharing? 

By that I mean, we have a network with Grand River Hospital, our sister hospital, so they would give us patients, we would give them patients based on bed availability, but also we'd reach out to places like Guelph General Hospital or Cambridge Memorial. 

You may have heard in the news that the Grand River Hospital took patients from Toronto. I personally had to send people from St. Mary's to London for help during the worst of it because there was no place to put people. 

So you're doing all this administrative work while you're still trying to care for the people who are here. 

That period was quite difficult, but on a positive note, I am pleased with how the last … couple of weeks have been going. Things are a little bit better. 

I'm in the intensive care unit this week and I'm pleased with what I'm seeing. And that's a testament to the people in the community doing what's right with social distancing, gatherings being limited, hand hygiene, mask wearing and getting the vaccine when it's their turn. 

Norris: So the denial, the fear in the frustration, what are you feeling today? Is there a glimmer of optimism? 

Chernish: I don't want to come across as Mr. Negativity. Now I would have to say I'm hopeful.

I'm very aware of the variants of concern and what they could do. But I'm optimistic. I look to countries like the U.K. who, I mean, the dominant strain was the U.K. variant and they've only vaccinated about a third of their population, plus some natural infection and their numbers have come way down. 

So I want to believe that these next few months, if we just drive a little bit harder to the finish line, so to speak, and I hope it's the finish line, that it's going to be a lot better and we're not going to have to shut down services and can actually come roaring back. 

Norris: What are concerns around post-COVID burnout because there's so much catching up to do? 

Chernish: Well, it's obviously a concern for many, many physicians and certainly many nurses are tired. It's been a long year. 

But I know that if we can just put COVID behind us, we're going to see a lot of motivated people. Some people were looking for work during the pandemic year because their programs were shut down. 

There's going to be some time for catching up and relaxing and licking our wounds, so to speak. But I think that enough people are ready to catch up but it's going to be a long struggle. There's no question. You had a piece earlier today demonstrating the burnout in nurses. It's a real problem. 

Norris: And is there any sense of how long it will take to eliminate this backlog? 

Chernish: You know, people are being coy with numbers. I could tell you that here at St. Mary's, we're definitely trying to increase our diagnostics for running our CT machine, I believe, around the clock now, trying get caught up. 

We're going in on weekends and doing respiratory testing, I believe other cardiac diagnostics as well. 

We're trying and I think we're going to try to get the ORs (operating rooms) up and running closer to the end of the month and hopefully even above capacity for a while. I'm guessing it's going to take the better part of this year, maybe into next year.