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IN IT TOGETHER: Caring for critically ill patients during the pandemic

Posted Jun 1st, 2020

IN IT TOGETHER: Caring for critically ill patients during the pandemic

This is a series of stories profiling members of the Niagara Health team and the work they are doing as part of our response to the COVID-19 pandemic. Meet Dr. Ryan D’Sa, Chief of Critical Care for Niagara Health.

Dr. Ryan D’Sa is quick to respond when asked to describe the work of the Niagara Health team during the pandemic.

“The team has buckled down and performed their jobs admirably in what is a challenging time,” says Dr. D’Sa, Niagara Health’s Chief of Critical Care. “Every member of our multidisciplinary team, from physicians, to nurses, to respiratory therapists, to cleaners and all other support staff, has had an important role in our response to the pandemic and our preparedness. This is our calling, to care for and help people.”

Dr. D’Sa is part of the team caring for our sickest patients in the Intensive Care Unit (ICU).

A significant focus of our pandemic planning was preparing for a potential large increase in the number of patients requiring a critical level of care in the ICU.  The St. Catharines ICU, which was designated as the unit to care for critically ill COVID-19 patients, was divided into multiple sections – to create safe places to care for patients with the virus and for non-COVID patients.

Some patients who had been in the ICU were safely moved to clinical units at our Greater Niagara General and Welland sites.

Additional spaces in other areas of our sites were identified so they could be altered to provide a critical level of care, like people requiring a ventilator to help them breathe, if we experienced a surge in patients. Our team collaborated with other regional hospitals on planning and sharing of resources. We also provided training to some nurses who do not work in the ICU on caring for critically ill patients, and we introduced enhanced infection control measures on the ICU to ensure patient, staff and physician safety.

Dr. D’Sa joined Niagara Health in 2011 as an Intensivist and two years later became Chief of Critical Care. He was training as a Fellow in the United Kingdom before coming to Canada, and like others, had colleagues abroad who were sharing what was happening on COVID units in other countries and how their staff were protecting themselves in the midst of the pandemic.

Describe your role in preparing for the pandemic?

There has been a great deal of planning to ensure preparedness for every stage associated with the pandemic. We’ve extended the capacity of the ICU, examined the impact the disease would have on our patients and staff, and how would we manage if varying degrees of staff were lost to illness or isolation. We worked on preparedness for a major surge of patients, which fortunately we have not seen so far.

What have you found to be most challenging during the pandemic?

The biggest difference has been donning and doffing personal protective equipment (PPE). Approximately 15 to 20 minutes is added to every patient we see. It is particularly important that the removal of the PPE be done properly. We usually run our ICUs at capacity, and although there are fewer patients at this time, the amount of work is still the same. Also, procedures that generate aerosols (intubating, bronchoscopy, CPR) can be worrisome for some staff. It has become increasingly important to show leadership, demonstrate good technique to other staff and support them.

What is it like dealing with a virus that is new and unknown?

Medicine can be likened to pattern recognition. When a patient comes into the hospital, they have certain patterns of problems, symptoms and signs. The whole picture may not be evident, but as a physician you try to draw the whole picture in your mind based on part of the puzzle that you see and have put together. We were always taught to think broadly about a person’s condition and not rule things out. Yes, COVID-19 is a new disease and it’s an infectious disease. The question is then, what does it do when it infects the patient and how infectious is it? We do have structures in place to look at how we deal with infectious diseases. The issue is, it is so early on and we are such an informed society that we all want to be at a stage where we come to the conclusion of this disease and we have a vaccine that can prevent people from getting it and we have a treatment, like an anti-viral, that can supress symptoms in people. That will take time. What we can provide now is supportive care to treat and manage the symptoms. While it is known to impact the lungs, we’ve also seen where it causes thrombosis (blood clots), affects the heart and other areas of the body. We don’t know all of the effects of this disease because it’s so early. We will continue to learn more.

What is a learning you’ve gained from the pandemic?

One learning has been the importance of people heeding the advice of public health officials, which has made the biggest difference reducing the spread of the virus. The history of medicine was one of my favourite subjects when I was in medical school. I remember reading about the Black Plague (in the mid-1300s) and the management of it. At that time, you didn’t have medical care as we do today, and it was managed non-medically. It was managed primarily by quarantine efforts and public health measures. If you reflect on the number of COVID-19 cases in Canada, and you compare them with other parts of the world, our public health measures have been key to helping us to flatten the curve. The efforts by the public health officials to educate people to stay home as much as possible and to practice physical distancing have allowed us to keep the number of patients requiring hospitalization to a manageable level so that hospitals are not overburdened. It does make me very happy to know we have not had a surge in patients. I thank the government for instituting these public health measures, and we all need to continue to be vigilant and follow these measures.

How has the pandemic impacted you personally?

I have been working until early hours of the morning to get up to speed with information being published worldwide, synthesizing this, and integrating it into our approach. I’m separated, but have a beautiful five-year-old daughter, Charlotte. She is in Senior Kindergarten and we have to keep up with her schoolwork alongside her incredible teachers. When I work on the COVID unit, I won’t look after Charlotte and I make sure I keep my distance for at least 48 hours afterwards to ensure I’m symptom free and not ill. When I reflect, it is easy to get caught up with the pandemic.  At the end of the day, we are all doing this for our families, for our children, and for the world to carry on. Charlotte reminds me of that when I spend time with her or FaceTime her. That’s why we are all in this - we are working hard to ensure tomorrow is a better day than today.

Click on the In It Together button below to read more stories about our team.

Niagara Health System