A Toronto doctor describes working on the front lines of the COVID-19 pandemic
Dr. Naheed Dosani says patients and health-care workers are exhibiting incredible kindness and patience
Dr. Naheed Dosani is usually a palliative care doctor. But this week, he's been working on the front lines of the COVID-19 crisis, helping people get tested for the disease caused by the coronavirus spreading rapidly around the world.
The Toronto doctor spent Mondayat the William Osler Health System COVID-19 assessment centre located at Peel Memorial Hospital in Brampton, Ont., and says what he saw on the ground gave him hope.
There were 648 confirmed or presumptive cases of COVID-19 in Canada as of Wednesday afternoon, with nine deaths. Presumptive cases are those who tested positive at the local level, but whose results have not yet been confirmed at the National Microbiology Laboratory in Winnipeg.
Dosani spoke to As It Happens host Carol Off about the work happening on the front lines. Here is part of their conversation.
Can you describe the testing facility at your hospital? Just give us a sense of the atmosphere there.
The experience that I had working on the front lines at the William Osler Health System COVID-19 Assessment Centre was a combination of a lot of hard work in the background — people working tirelessly, spending hours to create, basically, in a very short amount of time, one of the region's first assessment centres. And so it felt like an honour and a privilege, actually, to be on the front lines.
The second observation was the way that there is this amazing sense of community on the front lines. I, myself, am a palliative care doctor, actually. So definitely working in a different space. And beside me was a nurse from the emergency department, our clerical staff from mental health, and our housekeeping working from the medicine staff.
So we normally don't work on the front lines together, but we are coming together around the pandemic. And it was truly a unique experience in that way.
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Are you seeing anything that can be improved? I mean, the criticisms [we've heard] is that there's too many people turning up in emergency wards looking for testing. There's too many people that are jamming and bottlenecking systems. Do you think you've got a model here that can actually get people tested pretty fast?
I can appreciate that with changing information ... it can sometimes cause confusion. But having worked on the front lines at the assessment centre in Brampton, Ontario, I had a unique perspective to see how it works.
And I have to say, all the way from the public messaging that's gone out from our colleagues ... to triage, to filtering into the assessment centre, to assessment of the criteria and testing or not testing, and then even counselling, I saw a very streamlined and very efficient and effective approach, which was respectful of people's emotions during this time, and yet getting the job done, meeting people's needs when they need it.
I was just blown away at how people were so kind to us, because they could see that we were working very hard. - Dr. Naheed Dosani
We're hearing ... [from] people [who are] very nervous, concerned about their health for obvious reasons. And so as people arrive at the centre, at this facility, are they calm? Are they anxious about what they're confronting?
You see a wide array of emotions, without a doubt, when people get to the centre.
We had a woman with a child who was very overwhelmed with some of the information she had read online and seen in the media. And when she was being assessed, she broke down crying. And normally, you know, as a palliative care doctor, or any clinician in any field … we would get close. We would counsel. But this is a pandemic. You can't do that.
And what was so amazing was to see how the team — the nurses, the staff — kind of still kept their infection protocols, so we were all gowned up and wearing our masks, but we all rallied to connect with this person, this woman who was crying and overwhelmed, and provided emotional support.
Another vignette that stuck out for me was the idea that ... I lost track of how many people were actually asking me, "Hey, doctor, I know you're working at the centre and you're here to treat me and assess me, but are you OK?"
I was just blown away at how people were so kind to us, because they could see that we were working very hard. It was very busy and so we saw a wide array of emotion in that way, and we saw a lot of care as well.
Of course, everybody wants to know if they've got it, even if they haven't got symptoms. So what happens when people arrive? You know that if you're not showing symptoms, they don't test you. It's not effective. So what kind of reaction do you get from people when you turn them away?
Self-referral is appropriate to show up. We do have health-care worker referral as well. Currently, the criteria is for people who are experiencing symptoms of an upper-respiratory tract infection, or flu-like symptoms, and any of the following:
- Temperature greater than 38 C.
- Individuals who are immuno-compromised, or who may have, for example, cancer or advanced kidney disease.
- Age over 60.
- Pregnant people.
- Health-care workers working on the front lines.
- And folks who have been in touch with someone who is [a] probable or confirmed diagnosis.
We saw 198 individuals on that shift, and 124 received testing. When people didn't receive testing, I have to say, people were grateful. They were respectful. They were understanding that there may not be enough test kits for everyone at this time and that we have to heed public health advice on who gets the testing.
How quickly do they get results from the test?
What we were counselling people is that the results would be out within 48 hours, and a public health official would call them to provide further advice.
As they are awaiting the test results, should they be telling anybody they have come in contact with, tell a workplace if they've been there, that this is going on? Or is it too early before you know the test results?
Absolutely, it's very important in that time period to let ... people in your circle know and let your workplace know so that other individuals can also be assessed as well.
You said that there was not enough test kits at this point. And that's a great concern, isn't it? Because we heard from [Tedros Adhanom], the head of the World Health Organization, this week. He said: "You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don't know who is infected. We have a simple message for all countries: test, test, test." And we're seeing that in South Korea, where there's 270,000 people who have been tested. Other places where it's less. In Canada, we have ... just shy of 900 tests ... per million of people [according to the National Post]. That's high, but not as high as perhaps other countries are doing. Do you think that that's a problem?
I should note while I'm not a public health specialist or infectious disease specialist, my experience working on the front lines at our assessment centre at William Osler Health System was that we definitely had enough tests for the individuals who were meeting criteria as set out by our public health experts.
You're normally a palliative care doctor. So you, all of you, you're just recruited to do this extraordinary need to have people tested. And I wonder, though, what happens to the people, the patients who need you. Are you pulled in two directions knowing as you have these other people who are probably hoping you come back soon?
Most definitely. You know, there is a great need on the front lines everywhere because of COVID-19, not just in the assessment centres. I'm so grateful to work with an excellent team that has agreed to cover some of my outpatient home visit follow-ups and some of my work in local hospice, and even my clinics, so that I can go and contribute.
So it definitely takes that community, and while not everyone who is supporting the COVID effort is working in the assessment centres, I think everyone in health care — no matter what background or discipline you're working in — everyone is chipping in and doing their part, even if it means covering for a colleague.
Written by Sheena Goodyear. Interview produced by Chloe-Shantz Hilkes and Morgan Passi. Q&A has been edited for length and clarity.
