Fourth wave sees burned out doctors, ‘record numbers’ of patients and nursing shortage in Hamilton hospitals

A year and a half into the pandemic, emergency department doctors are exhausted, frustrated and worried. Hospitals are filling up and there are fewer nurses to care for them. Doctors are burned out and cases are still rising just as schools reopen and the colder weather arrives.

The vaccine can help relieve much of the pressure on the health-care system - but not everyone is taking it.

Dr. Simerpreet Sandhanwalia still gets emotional talking about what it's like working on the front lines with COVID-19 patients.

The emergency department physician at Hamilton Health Sciences (HHS) remembers at the beginning, she'd put her N95 mask in a paper bag at the end of her shift to reuse because equipment was in short supply. Her biggest fear was bringing the virus home to her family.

I said to my husband, if something happens, these are my passwords," Sandhanwalia said through tears.

In January, her family did end up getting COVID - not necessarily through Sandhanwalia's work, she said, but it was a very scary" experience nonetheless seeing how the virus affected her son and mother.

During shifts in the emergency room, it was hard to see the virus take so many lives. Sandhanwalia spoke to grieving families and then had to move on to the next patient.

This happened during wave one, wave two, wave three, now we're in wave four," she said. Everyone is so resilient, but everyone is very tired and everyone is burned out."

Now in the fourth wave, she and other doctors are seeing young people, from roughly 20 to their 50s, with no underlying health issues, getting quite sick with COVID-19 and struggling to breathe."

Everyone that's sick that I'm seeing is unvaccinated," Sandhanwalia said. They are regretful."

In Hamilton, the city still has a way to go before it reaches its goal of fully vaccinating 90 per cent of those eligible.

Making matters worse is while there are fewer COVID-19 patients in hospitals compared to the third wave, there are more patients overall.

Dr. Greg Rutledge, chief of emergency medicine at St. Joseph's Healthcare Hamilton, said the hallmark of the fourth wave is without question ... the sheer volume of patients."

Previously postponed procedures are currently underway, which might account for part of the volume, doctors say. But the full picture is likely more complicated.

I don't think we fully understand where the higher volume has come from," Rutledge said, noting the trend is being seen provincially. All of our doctors are coming in early and nurses are staying late."

The record numbers" - about five per cent higher than pre-pandemic volumes - come as hospitals battle a critical nursing shortage.

HHS, like other hospitals in Ontario and nationally, is experiencing ongoing staffing shortages that have been exacerbated by the pandemic," said an email from spokesperson Wendy Stewart. Though she couldn't provide exact numbers, Stewart said the number of vacancies at HHS reached a high of almost 300 for nurses alone during the pandemic.

The demand for nurses is massive and the pool is stretched thin."

Many of them left due to burnout, Sandhanwalia said.

(Both HHS and St. Joe's are holding virtual career fairs for nursing jobs in the fall. For HHS, details are at hamiltonhealthsciences.ca/careers/nursing.)

High patient volumes means that many admitted patients are in emergency beds waiting to move to other wards. Because those beds are filling up, emergency wait times are longer.

The backlog just trickles down and then you start getting surgeries cancelled because how are they supposed to do surgeries if there's no beds?" Sandhanwalia said.

With hospital staff stretched to the limit for so long, St. Joe's Dr. Conor Lavelle said it's frustrating" to see people not take the vaccine.

The emergency department physician has seen fully vaccinated COVID patients in hospital: The people who are vaccinated are still able to get COVID just the same way that someone who's on birth control is still able to get pregnant."

But how many of them has he admitted to ICU?

None," Lavelle said. Zero."

Most of the patients he's seen are unvaccinated because of misinformation and fear. But by the time Lavelle sees them, they've developed severe COVID and want to get the vaccine to cure them.

That ship has sailed," he tells them, because the vaccine can prevent the virus, not cure it. Once someone gets COVID, they have to first recover and be stable enough to get the injection.

For those who face barriers to getting vaccines but don't have the virus, Rutledge said public health is working to start offering shots in the emergency department.

Heading into the fall, Sandhanwalia fears the situation will get worse as people move indoors for the colder weather. But she's not giving up.

She says tailored outreach" is important to reach diverse populations. As part of the South Asian COVID Task Force, she helped provide health information and debunk myths in different languages during the pandemic.

She saw firsthand what happens when barriers are removed. After a new testing centre in Brampton had few visitors, Sandhanwalia made a video with her mom in Punjabi to explain how people could book an appointment. A colleague also made a PowerPoint in Punjabi.

In 48 hours, Peel Region was booked until the following week."

The task force co-founded the national This is Our Shot campaign, with FAQs in more than 30 languages and prizes for getting vaccinated. The campaign also worked with Arkells to produce a commercial.

The doctors agree that vaccination will go a long way in the fight against the virus.

For every person that doesn't get vaccinated or doesn't respect the lockdown rules, there's somebody else out there who's suffering," Lavelle said. It's almost like a civic duty to protect one another."

Maria Iqbal is a Hamilton-based reporter at The Spectator covering aging. Reach her via email: miqbal@thespec.com.