COVID-19’s Impact on Health Care Workers — Andrea Sikora and Dr. Kim Spencer

Alex Maheux:

As the COVID-19 pandemic is rapidly evolving, the circumstances may have changed from the time this podcast is recorded and may not reflect the current environment.

Hi, and welcome to the CHIP: the Canadian Health Information Podcast. I’m your host, Alex Maheux. This show from the Canadian Institute for Health Information will give you an in-depth look at Canada’s health systems and talk to experts you can trust. If you’re interested in health policy, our health care systems and the work being done to keep Canadians healthy, this podcast is for you.

Today, we’re going to the front lines of COVID-19. CIHI has released numerous reports on health care workers during the pandemic, which have highlighted the daily risks they face. Data show there have been more than 92,000 cases among health care workers and at least 42 deaths. While those numbers have thankfully been declining, the fact is health care workers continue to put themselves at risk every single day. So, what’s it really like? We’re talking with Dr. Kim Spencer from Nova Scotia, a family medicine physician and assistant professor in family medicine at Dalhousie University. And we have Andrea Sikora, a respiratory therapist at St. Thomas Elgin General Hospital in the town she was born and raised. Let’s get to it.

Hi, Andrea and Kim. Thank you both for joining us on the CHIP today.

Andrea Sikora:

Hi, how are you?

Alex Maheux:

I’m good. How are you both doing?

Andrea Sikora:

I’m good.

Dr. Kim Spencer:

I’m great. Thanks, Alex.

Alex Maheux:

Kim, I’d like to start with you. Can you walk me through what the different phases of the pandemic have been like for you, perhaps from the initial shock and maybe panic of it to the different waves?

Dr. Kim Spencer:

I’m from Nova Scotia, and I work in rural Nova Scotia, so in general, Nova Scotia has done relatively well during the pandemic compared to other provinces in the country, of course. And I also sort of worked the pandemic with 2 different hats on. And one of those hats was in the emergency department as an emergency physician, and the other hat was family medicine. So, I also work as a family medicine doctor. And I think you kind of put it correctly. Beginning, there was that sort of shock and fear and the sort of foreboding, you know, watching the other countries going through the pandemic and just waiting for things to come and happen. And that initial stage was different in both the emergency department and family medicine. In emergency, it was always… it was a concern about logistics. You know, where are people going to go? Do we have enough PPE? What do we do for aerosolized-generating medical procedures? And I’m sure Andrea will be able to talk pretty significantly on that, being a respiratory therapist.

And there was just the constantly changing information day to day. You know, there was an overwhelming amount of emails and meetings and that sort of thing. So, that whole first wave, for us, or certainly the beginning of the first wave, was just waiting for things to happen. And then, all of a sudden, from the emergency perspective, the number of visits just dropped. People weren’t coming to the emergency department, and we just were like, “What is going on?” It wasn’t just the visits that maybe could have been done elsewhere; it was that there was less heart attacks, there was less car accidents, and of course they were trying to keep people off the roads and off their all-terrain vehicles and all that sort of stuff. But there was less other stuff, too, and it started to make us wonder, “Are people just staying home?” And for family medicine, it was sort of the opposite of that, where there was this mass panic where everyone was calling in and trying to get appointments to fill prescriptions so they could have prescriptions for the next year and wouldn’t have to go out of their houses. So, it was sort of 2 different experiences.

Alex Maheux:

Andrea, I want to ask you the same question, but obviously you’re coming at it from a bit of a different perspective. You’re a respiratory therapist, a field that many of us have learned a lot more about during COVID. What has your experience been in the last 15 months or so?

Andrea Sikora:

Initially, it was like, like Kim was saying, everyone was in shock. And then it was this mass workup to try to figure out, “How do we change everything we do on a daily basis and make it safe?” And there was this mass of 2 weeks at the very beginning, end of March going into April, where everyone in the hospital is just rapidly producing policies and procedures to protect us. And thank goodness we are in a small facility that, as groups, we were able to make the changes and set them in place, and that was that.

Alex Maheux:

Well, I was actually going to ask how both of your work has changed since before COVID. Obviously, we’re now used to things like masks, sanitization, distancing, but other than those, how have your jobs changed?

Dr. Kim Spencer:

Probably the biggest change in work, besides what you just mentioned, would have probably been the changes that happened in family medicine, because it’s obviously a community-based, you know, seeing of patients, et cetera, and the biggest change across the board and across the country was really the implementation of virtual care. And there are a lot of people in Nova Scotia, rural Nova Scotia, that don’t have internet access, like, they don’t have the ability to get reliable internet access, and a lot of them don’t computers, or a lot of them don’t know even how to really use that sort of platform because they’re just not really computer-savvy, and I get that. I’m not really technologically savvy myself, and so, it quickly changed to phone conversations, which, again, in certain times, has its challenges. You know, I have more than once — oh my gosh, so much  more than once — been like, “You’re breaking up! I can’t hear you! Can you walk towards your window?” You know, so that is sort of a daily occurrence, where even phone service in rural Nova Scotia can be a little bit shoddy at times.

So, I think that, for us, was like the biggest change. And also, just being able to try to do something virtually on the phone and trying to get people to explain the symptoms that they’re feeling and taking away the physical exam, which is obviously really important in a lot of cases. Of course, we didn’t do everything virtual. There’s obviously people that we had to see in the office; that never changed, and that didn’t change throughout the whole pandemic. But certainly, the implementation of virtual care was the biggest change that we had.

Alex Maheux:

Andrea, how about for you?

Andrea Sikora:

Initially, the biggest change was even just the process going in to work and the process coming home. So, before, you just grab your gear, grab a coffee and head in to work. Well, for the first month, I was afraid to even get takeout, to even get a coffee. So, I was like going on no caffeine, but you’re basically thinking, “I need to go to work and not contaminate my workplace.” So, you have travel clothes to work. You get to work, your hair is covered now, you’re wearing all your different clothes, your masks, your PPE, and then the way home, you have your other change of clothes on the way home, you come home, you shower, you decontaminate, none of your stuff comes in the house. Like, it’s just a longer process. A 12-hour shift is now a 13-hour shift, based on not even including travel; just like getting in and out of work, right? At work itself, like I said, it’s literally been everything we do. So, what we end up doing for the summer is we set up a tent outside, and we called it Code Yeti. And what happened is they would call us down, RT would come down, we have a Code Yeti, you grab your intubation stuff, you’d head outside, and the goal was to establish a close airway outside so that we could resume CPR as fast as possible, because we know CPR and defibrillation saves lives. But we have to close that airway.

I had one shift where it was actually an overlap of my husband who’s an emergency physician, too. We established airway, and the patient needed CPR, and he goes, “Hop on the stretcher!” And I’m like, “OK.” And I just jumped on the stretcher and surfed CPR through our small decontamination room, and I’m like, “What is going on?” I felt probably how paramedics feel, right? Like, we’re used to these walls that were so secure and safe, but to do stuff in the field is a whole…June bugs in your hair at night. Like, it was a whole other ball game. So, definitely everything we do changed.

Alex Maheux:

I want to ask you both: What would you say the biggest challenge was for you during the pandemic, both personally and professionally?

Andrea Sikora:

Being a parent of 4 kids, especially teenagers, has been a huge issue. So many arguments with the kids, and they’re just trying to understand. And unfortunately, our children are always annoyed by us, because we are the type of parents that you’re not allowed to go on a trampoline. You’re not allowed to go on an ATV. We see the worst of the worst, and our kids, whether it’s better or for worse, we just don’t allow them to do those things. And now, all those things they couldn’t do before, now it’s like, “We for sure aren’t going to let you do things, but we don’t really know why and don’t really have the background as to what’s going to happen if you do.” And we’ve kind of functioned in this mentality that there’s going to be some point one of us is going to get this, and this house is going to have to shut down. My oldest, who’s 16, I remember we were having fights over “can she do this, because this friend’s allowed to do that?” and me telling her no, and I said, “You know, I really wish this argument was about sex, drugs or alcohol, because there’s resources on that. There’s books on that, there’s resources. I can go look something up. I can talk to someone. I can parent you out of that.” I have no idea how to parent a teenager during a pandemic. And that was honestly the biggest personal issue, was trying to parent, when other people’s kids were allowed to do things, and we kept ours home.

Alex Maheux:

Mm-hmm. What about from a professional standpoint?

Andrea Sikora:

As much as I can say we made a lot of changes up front and were like, “This is on paper. This is going on,” there were still a lot of consensus issues. And rightly so, because you had CDC saying one thing, WHO saying one thing, and so you’re like, “What guidelines are we following?” So, it was constantly changing. So, professionally, it was very difficult, and it would be dependent on who you’re working with.

Dr. Kim Spencer:

I can’t even imagine how difficult it would be to parent teenagers in this. You know, I can remember back when I was a teenager, and the last thing I would have wanted to do is have someone say, “You know, you can’t do anything or see your friends.” I mean, it would just be the worst case scenario for a teenager. I, on the other hand, have 2 younger boys. Probably, our biggest challenge with them was getting the energy out, especially my 10-year-old who’s very into sports. You know, there was numerous times that I basically ran them around the house, literally around the house, and you had to do 10 laps before you were able to come back in. So, trying to get the energy out of little boys was definitely a challenge, for sure. So, the family perspective, I think being moms and all those moms across the country that had to work and try to look after kids that weren’t in school, I mean, that’s just an incredibly challenging situation. And dads of course were looking after their kids, as well. I didn’t not include them.

I think one of the professional challenges, from an office-based perspective was family medicine sometimes is not about just fixing a medical problem; it’s a lot about empathy. And it was very difficult to…You know, you don’t realize how much you use your body language and your facial expressions to convey that you care about what somebody’s saying. And not being able to do that and have to try to use your voice to convey that sort of empathy only was really difficult. And some days, you’ve maybe done it OK, and other days, I’m sure I missed the mark. It was a work in progress. That’s for sure.

Andrea Sikora:

Well, it’s interesting that you say, “Use your facial expressions and your body language to convey empathy.” However, if it was person, you’d be covered in PPE, and imagine these people that are end-of-life or the last time that they are talking before they get put on a ventilator, and all they’re seeing is people covered in 2 layers of everything. You can hold a hand. They don’t know what’s going on underneath there, right? It’s got to be absolutely terrifying for them. So, to be able to support patients is very difficult in person also, because it’s very difficult to spend the time for them to see your facial expressions, too, right?

Alex Maheux:

Mm-hmm. What’s it like being on the flip side, not being the patient but being the caregiver who’s covered in PPE trying to comfort someone?

Andrea Sikora:

You know, I had a patient last night, and she’s an exacerbation of COPD. It’s not even COVID; I’ve got to put her on a mask that’s blowing air into her, and all they can kind of do is just sit and have a natural conversation and try and get her and hold her hand, “Do you need warm blankets?” The little things, I feel like I do try and do that, because I think my mom instincts also come out, and especially with little kids, I get a little bit more cuddly with them too, but I do try to make people feel as if they know that we care.

Dr. Kim Spencer:

I agree, Andrea. I guess the other challenge for patients that maybe we haven’t mentioned yet is there is, at least in Nova Scotia, there was restrictions on who could come in to the hospital, right? So, they don’t even have, or on some occasions, anyway, don’t have a support person there or anyone else, so all they’re seeing is the health care workers. And that’s really scary when you’re critically unwell.

Andrea Sikora:

We tried our best to, before we would paralyze people and sedate people and put them on a breathing machine, that if they had an opportunity to FaceTime their family, then we would do that for them, or the first time they woke up off a ventilator, got extubated, the breathing tube out, we have tried as a facility to do that. I unfortunately had a friend I grew up with, her mom, because she was on non-invasive ventilation, which is the worst aerosolized-generating machine you can use. There was absolutely no family in there, and that poor woman did not want to be resuscitated, and died of COVID, and she died with absolutely no family with her. She was like in her late sixties. It was just absolutely sad. Once I found out who she was, it obviously hit me a lot more, but no family at all.

Alex Maheux:

I can’t imagine how challenging it’s been for both of you. And we know that burnout in health care providers was an issue even before the pandemic. It’s been widely reported that this has only increased in the last 15 months. I’m wondering if either of you have witnessed or experienced this yourself.

Andrea Sikora:

So, what people also forget is that, even when we were having COVID numbers, the rest of it still happens. We’re in a community hospital. We still have to run Code Pinks. We still have high-risk deliveries. We still have the amount of overdoses, obviously, this year, has gone through the roof. We still have traumas, and I have days where, in a community hospital, I had to intubate 3 people, and it was happening shift after shift, and I said to my husband, “I’m going to break down.” And he said, “I’ve never heard you say that ever. Ever, ever, ever.” I don’t know if it even had to do with COVID, but it was just that the restrictions also that you put on yourself to perform these procedures, everything takes so much longer getting ready for them. Now, you’re in rooms; you can’t go in and out of a room. You’re there; you’re there for 3 hours in your PPE, waiting to get someone to the ICU. And I had a breaking point, but I think it was like September or October; it wasn’t even in the middle of a wave. But resiliency, and you keep going, right? What choice do you have?

Dr. Kim Spencer:

When you run on adrenaline, you can do anything. And maybe almost what, Andrea, you’re talking about is like, once that moment that you slow down, you start to realize what you’ve just done for the last 6 or 7 months, right. So, it does make me wonder, when this all ends, what’s going to come out in the wash on the other side. Certainly, for myself, as I mentioned in the beginning, I started this pandemic doing 2 jobs, and in December of last year, frankly just because I felt like I was working too much, and the amount of work that we were doing on top of work was sort of overwhelming, I decided to take a break from doing emergency medicine for a period of time. And it wasn’t so much I was burnt out; I was just tired. I think I recognized that you’re walking down that path to, “Hey, what’s 3 months going to look like from now if I feel like this today?” So, I can definitely see that, when the dust settles, we may be into a situation where a lot of people’s adrenaline is going to slow down, and everything else that people have been putting off to the side so they can basically get through this year and a half to however long it’s going to be is really going to come to the surface, and that really might tell the story of what’s in our future.

Alex Maheux:

Mm-hmm. I guess just to elaborate a little bit more on that, I’m sure a lot of health care workers have been running, like you said, on adrenaline and coffee for quite a while. What do you think the long-term mental health impact of the pandemic is going to be on you and your colleagues?

Dr. Kim Spencer:

We don’t know what’s going to happen until it’s all over and the dust settles. But physicians, respiratory therapists, nurses, physiotherapists, every person that works in health care, has been through a situation that, unless you had worked obviously in the SARS outbreak or what have you, but no one had worked in anything like this. This was not something that I think any of us signed up for, and the health care professionals are humans, and there’s bound to be some sort of fallout from the things that people have done, have seen and have had to deal with in the last year.

Alex Maheux:

I want to approach a bit of a more hopeful topic. We know vaccination efforts have greatly increased in the last few months, and we’re hearing that this is thankfully having an impact on the rates of cases and also extreme cases. Do you feel comfortable sharing with us if you’ve chosen to be vaccinated, and if so, do you feel more safe now?

Dr. Kim Spencer:

Yes, I have been doubly vaccinated. We actually had what we call a phase zero approach for anyone that was working in the hospitals starting in January of this year, and I have to say that, especially the 10 days after the second vaccine sort of picture was a huge weight that was lifted off my shoulders, that fear of bringing sickness home to your family, and God forbid something happen to them. You know, I know they’re not 100 percent perfect, but it was just such a huge weight lifted off my shoulders. I mean, it was a very, very happy day for me.

Andrea Sikora:

So, I’m double vaccinated also, received my first short in the beginning of January and was able to get my second dose before they kind of put everything on hold and prolonged us. So, that was also my husband and I, he was also double vaccinated within days of myself. Do I feel any safer? I honestly don’t look at myself as a vaccinated person. Until my entire family is double vaccinated, then I will see myself as a vaccinated person. It has not changed one thing I do professionally. Nothing has changed from what I do. I don’t even picture myself like that. I now…Thankfully, my 2 oldest girls have one shot each, so we’re getting there, but until we’re all done, it hasn’t changed me too much.

Alex Maheux:

Looking past COVID and the pandemic and all the associated restrictions, what do you think that we’ve learned that will help us in the long run?

Andrea Sikora:

The sad thing that I hope we would have learned is better ventilation. However, I really don’t think anyone’s acknowledging that still, and there’s a lot of people who are not acknowledging this and making the changes, and you’d think that that would have been something that was done, especially within the schools. We’re 15 months in, guys, and we still haven’t made much change.

Dr. Kim Spencer:

I would hope that, from a country perspective, you know, we all start thinking about the importance of having our own manufacturing for things like something like a vaccine or what have you. You know, we obviously had to rely on other countries to get the vaccines that we have here, and at the beginning it was a little bit precarious. Just a little bit more disaster planning in advance probably would have been hopefully a good thing to learn from this, and hopefully we have that, to have backup plans for God forbid if something like this happens in the future. From a family perspective, I’m incredibly impressed how well a five-year-old can wash her hands, which she certainly couldn’t do before the pandemic. So, that just goes to show that you can teach good hand washing to children.

Alex Maheux:

Surgeons in the making.

Dr. Kim Spencer:

Yeah, exactly.

Alex Maheux:

Well, thank you both for joining us on the CHIP today. I will steal some of the words I’ve used throughout the podcast. Thank you for your strength, your empathy, your resiliency throughout this all, and thank you for sharing your personal experiences with us. It was lovely to talk to you.

Andrea Sikora:

Thanks for having us.

Dr. Kim Spencer:

Thanks so much. I appreciate it, Alex.

Alex Maheux:

Thanks for listening. We hope you enjoyed this episode. Check in next time when we bring you more valuable health perspectives and continue to chip away at health care topics that matter to you.

If you want to learn more about CIHI, visit our website: cihi.ca. That’s C-I-H-I-dot-C-A. If you like what you heard, subscribe where you find your podcasts and leave us a review and give us a follow on social media.

This episode was produced by Jonathan Kuehlein, with research from Amie Chant, Marissa Duncan, Shraddha Sankhe and Ramon Syyap. And a special thanks to Tracey Fisher and Dina Gordon. I’m Alex Maheux. Thanks for tuning in to the Canadian Health Information Podcast. Talk to you next time.

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