“We’re seeing triple the number of Covid patients as we did in previous waves”: A Toronto General emergency doctor on what it’s like in the ER right now
Lucas Chartier is an ER physician and the deputy medical director of emergency medicine and site lead at Toronto General Hospital. Here, he discusses why younger, healthier Covid patients are showing up at the ER, how the hospital is navigating staffing shortages and how it’s bracing for the peak of the Omicron wave.
—As told to Haley Steinberg
“I’m a francophone, born and raised in Montreal. I completed med school at McGill, where I met my wife. We moved to Toronto in 2009 for our specialty training; she’s a general internal medicine specialist, and I work in emergency medicine. I later did a master’s of public health at Harvard and returned to Toronto to start the portfolio of quality and safety in the UHN emergency department. I’m also the regional lead for emergency medicine for Ontario Health Toronto. We coordinate care with stakeholders within and outside of the hospital, including EMS, police, mental health services and the shelter system.
“Every wave of the pandemic has brought its own set of surprises and challenges. Omicron is no different. What sets this wave apart from previous waves is the rapid speed at which it developed. It’s reminiscent of the first wave in March 2020 in many ways. With that first wave, we had the unfortunate luxury of seeing what was unfolding in Italy and in New York City, and we had a few weeks to brace for impact. The same thing happened with Omicron in South Africa.
“Still, this surge has come even faster and more abruptly than we anticipated. It didn’t help that it coincided with the holidays. It’s incredibly difficult to tell people who haven’t seen their loved ones in two years not to gather for the holidays. Now, we’re seeing the after-effects of those gatherings. When patients come into the ER with concerns that they may have Covid, I always ask about their exposure history. Many patients have said, “Well, I had a gathering over the holidays and a bunch of people I was with have tested positive.” Often, these patients are remorseful. With Omicron, we’re seeing entire families testing positive for Covid. As soon as you have one person in a closed circle, it’s usually just a matter of time before the rest of the group start exhibiting symptoms.
“We can’t control how many patients are going to come into the ER. The only thing that we can control is our preparedness. When bracing for this surge, we started to think about the flow of patients and how we could organize the ER to see as many of the sicker, more vulnerable patients as possible, in the safest way possible. With Covid patients, we have to account for things like physical distancing between patients and proper PPE. We had to plan for staffing shortages, knowing that we were going to lose nurses, physicians, allied health professionals, clerks and patient care assistants in large numbers.
“Staffing resources are worsening day by day. We’re not yet at the redeployment stage, but we’re working with a thin staff in the ER. We’re all picking up extra shifts to cover for colleagues who have had an exposure or are sick with Covid. There’s also a lot of shift trading to accommodate these absences. I’ll say to a colleague who has to isolate, “I’ll pick up your shift tomorrow, and you can pick up mine next week.” For physicians, there’s also an on-call system to fill in gaps. We’ve had to use this system much more frequently during this surge than we have in the past. It can be exhausting to feel like you’re always on call.
“When we get to the point where we’re unable to have the usual team provide care, we’ll have other providers with related expertise and experience cross-covering wherever needed. For instance, a rheumatologist might join the internal medicine team to help out.
“During Omicron, we’ve also had to figure out how to manage with reduced Covid testing capacity. The PCR and rapid antigen test systems are extremely overloaded, and we’ve had to prioritize the limited supply of tests for vulnerable patients—symptomatic patients, Indigenous patients, long-term care residents, health care workers and immunocompromised patients. But generally, every patient who truly needs a Covid test gets one in the ER. It’s hard to advise patients who are asymptomatic or mildly symptomatic and don’t require admission to the ER that they cannot receive testing, while still providing them care and reassurance. It’s never a pleasant conversation to have with patients—some are frustrated and disappointed. But it needs to happen for the hospital system to continue to function.
“We’re seeing an astoundingly large volume of Covid patients in the ER—around triple the number we saw in previous waves. We continue to see the usual ER patients: people with heart attacks, strokes, appendicitis, broken bones, cancer. But the number of patients coming in with Covid-related concerns has increased exponentially. This includes patients who are ill with Covid, patients for whom Covid is exacerbating an underlying medical condition, and patients who are concerned that they may have Covid and wish to be tested because of a high-risk exposure. It’s crushing to see the impact that this virus is having on so many lives. Even if the illness is milder, Covid prevents people from going to school or work, affecting their livelihoods, taking care of loved ones and other important responsibilities.
“A greater number of younger patients in their 20s and 30s are coming into the ER with Covid concerns. Some of them are coming because they need to notify an employer of their Covid status, or they want to know whether they should notify close contacts that they tested positive. Thankfully, many of them are vaccinated, which is the best defence against more severe illness. Even so, we’re seeing younger and healthier patients who feel truly awful with Covid. They have severe fevers, intense body aches and pains, headaches and fatigue. Sometimes these patients meet the criteria to be tested, but often we know even before the test result comes back that they likely have Covid.
“As a result of the significant strain on our system, these patients will often be discharged back to their homes. The other week, one of these young, healthy patients said to me, ‘What do you mean you’re discharging me, Doc? I feel like I’ve been hit by a bus.’ I had to explain to him that there wasn’t any treatment we needed to provide—no oxygen, no antibiotic. Even though his symptoms were severe, it wasn’t dangerous for him to be discharged and recover at home. The reality is that these patients will feel awful for a number of days while fighting this illness.
“We went into this wave with depleted human resources from nearly two years of Covid challenges, namely significant levels of burnout and decreased recruitment. I’m lucky to have a stable and supportive environment around me—my wife and children, as well as my circle of friends and family—some of whom I have only seen virtually over the past two years. In the few moments when I slow down and have too much time to think, I start doomscrolling and spiralling with concern about where we’re headed. But caring for patients and collaborating with other health care workers, knowing that we’re fighting this thing together, gives me a higher sense of purpose. I feel like I’m contributing to the shortening of this pandemic in some infinitesimal way. I know that I’m trying my darnedest, and that’s helped me avoid total burnout.
“Because of our staffing issues, we are in a more precarious position than we were two years ago. This wave has been especially tough for front-line health care workers who have given their all over the last two years, and were then asked to give even more over the holidays. Not only are they not able to see their loved ones, they’re working longer hours and picking up extra shifts.
“It’s been a discouraging start to 2022. So many of us just a few months—even weeks—ago were hoping that we had turned an important corner in the pandemic. We were thinking that we would be able to resume normal activities, normal life. But we’re back in a place that is very similar to where we were in the first wave, which has been extremely demoralizing for me personally, and for our teams that have been stretched thin for so long.
“My colleagues and I are suffering the same way that everyone else is. The other day I was trying to organize various activities and meetings while helping my two young children with virtual school. I’m not any different—we’re all experiencing some version of this. But it’s especially challenging for our staff members who can’t work from home and are constantly worried about their exposure in a high-risk environment. We now have good PPE and practices in place, but Omicron’s high transmissibility makes the situation so much riskier. The emotional and psychological tolls are much higher than they were during previous waves. But we’ll pull together as a team and do what we do best. We’ll learn from this wildly unpredictable situation, and I believe we’ll be better for it.”