CANADA’S EMERGENCY-DEPARTMENT DOCTORS ARE FEELING LEFT IN THE DARK ABOUT HOW EXACTLY TO CONFRONT THE COVID-19 CHALLENGE, BLAMING WHAT ONE CALLS A ‘VOID IN COMMUNICATION.’
Confusion about protocols across the country
TORONTO • They’re manning the trenches in an increasingly difficult struggle to fend off the COVID-19 pandemic.
But Canada’s emergency department doctors are often left in the dark about how exactly to confront the challenge, receiving conflicting advice from government and hospital employers, some of them warned Sunday.
One emergency physician has just published a starkly worded opinion piece about what he called the “void in communication” over how health care workers in Ontario should protect themselves and their patients.
A spokesman for the emergency doctors’ national group says it’s a problem across the country — a “desultory and tentative” approach by government that leaves health workers and hospitals largely on their own.
“They’ve seriously let us down,” said Dr. Alan Drummond of the Canadian Association of Emergency Physicians. “We are getting mixed messaging with regards to screening, we have had decidedly mixed messaging with respect to what’s required for personal-protective equipment … There is confusion at the ground level with all of these things.”
Though patients are being encouraged to stay away from hospital emergency departments if possible until the outbreak is under control, many with symptoms of what could be the novel coronavirus are, in fact, showing up at the wards.
Drummond said people have been referred to his emergency department in Perth, Ont., by the local paramedic service and employers. Dr. Bill Cherniak of the Markham Stouffville Hospital north of Toronto says his ward has been doing 10 or more COVID-19 tests a shift.
But physicians and nurses are receiving fuzzy signals about their approach to the disease, as fears grow that the epidemic could soon get far worse in Canada, said Dr. Blair Bigham, a fifth-year emergency-medicine resident in Hamilton. His opinion article in the Medical Post says doctors are getting the runaround and “vastly different” advice from the authorities.
“Doctors all over Ontario are just totally confused about what public health wants us to do,” said Bigham in an interview.
A physician friend in Eastern Ontario, for instance, was told she had to self-isolate at home for two weeks after returning recently from a trip to the U.S. She had an appointment to carry out a medically assisted death and was forced to find a different physician to fill in for her on the sensitive assignment, said Bigham.
But another MD friend, working in southwestern Ontario, was told after making extensive inquiries that he could, in fact, show up at work after coming back from the United States.
At a separate hospital, the intensive-care unit said travelling physicians could return to work immediately, while the emergency department said they had to stay home, said Bigham.
Doctors in Alberta and B.C., meanwhile, have been told they definitely have to self-quarantine at home following a foreign trip, said Cherniak.
Another area of confusion surrounds the personal protective equipment doctors and nurses wear when dealing with potential COVID-19 patients.
Bigham said emergency doctors at a Hamilton hospital recently got a memo they interpreted to mean that if they encountered a patient who might have the virus, even if they were wearing personal protective equipment, they had go into home isolation. Which could deplete the ranks of such health workers rapidly, he noted.
There has also been conflicting advice about what type of masks to wear when, for instance, administering a coronavirus test. Until a few days ago, Public Health Ontario was recommending health workers don N95 respirators — snugly fitting masks that provide optimal protection — while the Public Health Agency of Canada and other provinces said looser-fitting surgical masks were sufficient.
Ontario recently changed its advice to mirror the others. And yet, noted Bigham, the Centers for Disease Control in the U.S. is still recommending N95 masks for health professionals dealing with possible COVID-19 patients.
Cherniak was among numerous doctors and other medical workers who retweeted a Twitter post from Bigham about his commentary, saying “Truer words never wrote. It’s really a mess.”
But in an interview he said he believes that public health officials are doing the best they can.