“Nearly all of my patients are essential workers or related to one, and we have 28 more people waiting for an ICU bed”: A Q&A with Michael Warner, the Toronto ICU director who’s gone viral sharing his patients’ stories on Twitter
Michael Warner, the head of critical care at Michael Garron Hospital, has watched dozens of patients die since the start of the pandemic. Unwilling to see their deaths become statistics, he started sharing their stories on social media in hopes of influencing public policy and people’s behaviour. Now, he has a vast Twitter following and the ear of Doug Ford. We asked him what life is like inside the ICU during the third wave, how he rose to prominence and the toll the pandemic has taken.
What’s it like inside your ICU right now?
What we saw happening in New York and Italy before the first wave arrived in Canada—that’s what’s happening in Toronto right now. Cases are out of control. ICUs are overwhelmed. Inside my ICU, we have enough staff today for 14 patients, and 12 of them have Covid. Their average age is 58, and nearly all of them are essential workers or related to one. There are 28 more patients in the emergency department waiting for an ICU bed. To make room, we’ve cleared out our paediatric department and sent those patients to SickKids. We have ICU nurses working with non-ICU nurses because we’re so short-staffed. And there are only four of us ICU doctors. There has to be two of us on every day. So we’re working essentially nonstop.
What does that work entail?
My administrative duties have been nonstop since January 2020, creating protocols for everything: PPE, infection control, caring for Covid patients, admissions, how to connect with families over Zoom, visitor policies, drug rationing. Every day, no matter how full we are, I have requests to accept patients from other GTA hospitals. And then we have to make sure the ICU is adequately staffed with my colleagues who are completely burnt out. That’s over and above my actual clinical work. I’m on call 105 days a year, which translates to 24 hours a day for four- or five-day stints: examining patients, writing notes on them, doing procedures, communicating with their families, intubating them, palliating them if they’re dying.
You mentioned that your staff are burnt out. What has the last year been like for you and your team emotionally?
I don’t think I’ve really had the opportunity to pause and reflect on how this has affected me. I definitely know how it’s affected my family. Without the support of my wife, everything would have fallen apart. She has kept our family together. The partners and the families of health care workers bear the brunt of this. The challenge with Covid is that we live it at work and then when we’re at home, we’re still living that same despair and isolation. There is no break from Covid.
Beyond your work at Michael Garron Hospital, you also sit on the province’s Covid critical care table. What does that mean?
Our role is to make sure that we have oversight over the entire critical care system in Ontario and ensure that patients, no matter where they are in the province, have access to high-quality care. The fact that 20 patients a day move between ICUs is because of this table. The fact that ICUs generally have a good supply of drugs is because of this table. The critical care system works incredibly well, and I think at the end of the day that will be one of the good news stories of the pandemic. But our table is like all the other tables: we provide advice that gets sent up the food chain to cabinet and the premier, and they make the ultimate decisions.
Does it feel like they’re listening?
One of my biggest sources of frustration is when the government implements policies that have a negative effect on the pandemic, and when I know more people will fall ill and die because of those policies or because of decisions that weren’t made. That’s why I use my voice outside my hospital to try and change the trajectory of this thing, to hopefully protect more people. I’ve independently forged direct lines of communication with the premier and the mayor. They may not agree with everything I say, but at least they know exactly what I think. It’s empowering to be able to have some influence, because if there was nothing I could do outside of just caring for the patients that keep coming, I’d be very sad.
You recently had something of a victory: the province committed to administering vaccines in hard-hit neighbourhoods and specific workplaces, something you’ve advocated for. What was it like to hear that news?
When I heard the premier announce that he was going to be pivoting the vaccination strategy, I actually yelled out loud, “Yes!” I was so happy. I have to give the province credit for moving on this, but getting it done is all that matters to me. It’s execution time.
Some people have criticized the province for switching their vaccine strategy on the fly. Why do you think it was a good idea?
It’s been clear from the beginning of the pandemic that certain populations and certain areas of the GTA were most affected by Covid. In my observations on the front lines, it’s generally people who are of lower socioeconomic status, essential workers, racialized and marginalized individuals, many of whom we rely on to put food on our table, bring packages to our house and manufacture the goods that we use. I’ve leaned very hard on this when speaking with my connections, including the premier, to make clear that it is absolutely vital that these people, no matter their age, get access to vaccination.
You’ve also called for paid sick leave and paid time off for people to get vaccinated. Why are those essential?
Think about someone who lives paycheque to paycheque. If it’s the end of the month and they don’t have enough money to pay rent or put food on the table, they’re going to go to work, even if they feel sick or if they’re concerned about their safety. One of my patients was a woman in her mid-40s who acquired Covid from her husband, who was forced to go to work at a factory with a known Covid outbreak. He didn’t want to go, but he didn’t have any paid time off to protect himself. Everyone on his shift got one of the variants and he brought that home and infected his wife and his daughter.
His wife came into hospital and we had to intubate her. Her lungs completely failed, so I wanted to send her to Toronto General Hospital to be put on an ECMO machine. She was too sick to survive the transport, so the Toronto General team—two surgeons, two intensivists and a perfusionist—came to our hospital. I was at her bedside for 10 hours while we waited. It took three hours and 17 people to get her on the machine. Finally, she was sent to Toronto General, but she died the next day.
I will never forget that case. It was a completely preventable death. Her 18-year-old daughter no longer has a mother. It’s a tragedy. We need to afford people that basic human right to protect themselves, take time off to take a test, to get a vaccine if it’s made available to them and not have them lose money for prioritizing their personal safety. The premier has made paid sick leave a political issue. In fact, when I’ve talked about it with him, he thinks I’m talking about a political issue. But there’s nothing political about it.
Have any of your others patients’ stories stuck with you?
There was another case that was shocking in a different way. A young man in his early 30s transferred to our hospital from another hospital in crisis because they didn’t have any beds. He acquired Covid at his workplace. He was a back-office employee in the financial services industry, and he didn’t want to go to work because he shared an office with a person who did not follow public health measures or wear a mask. His coworker went to work with symptoms and gave my patient the B.1.1.7 variant. This young man with no pre-existing health conditions ended up intubated in the ICU. It took him three weeks to be well enough just to speak, but he still wasn’t healthy. All this because his boss wanted him to have face time at the office. Again, that’s preventable—not a death, thank goodness—but I don’t know what the future holds for this young man.
You’ve shared stories like these—as well as your opinions about what the province should do—on Twitter. Why take the time and energy to do that when you’re already so swamped?
None of this was planned. I started putting videos on Twitter and saying exactly what I think because I want to provide people with information that’s going to enable their decision-making. I want to turn numbers into real stories that can alter people’s behaviour. There’s a whole group of individuals who don’t think that this is real, that ICUs aren’t overwhelmed, that we’re just making this up. It’s important that I set the record straight so that people understand the severity of the situation, especially when communication from the government has been inconsistent at best. I don’t really understand what they’re saying half the time, and it’s hard for me to know how serious people should be taking this based on what they’re told by the premier and David Williams.
You’re not pulling any punches. Have you received any blowback—like, “Dr. Warner, you’ve got to shut up?”
Absolutely. If you’re going to put yourself out there, you have to be prepared to take hits from all sides. I’ve had to deal with ad hominem attacks, death threats, phone calls to my office telling me that people are going to get me, and a website completely dedicated to discrediting me personally and professionally. People have told me that they hope that I get Covid, and they’ve lied about me being paid by media and about me being part of Big Pharma. There’s no credibility to these things, but it’s really unfortunate when I just want people to stop dying.
My hospital has been incredibly supportive, though, and that’s part of why I’ve been able to be so forthright. They don’t necessarily endorse what I say, and they provide feedback when the government tells them they’re not happy with what I’m saying, but they have never told me to stop. And when I walk around the hospital, my colleagues tell me, “Dr. Warner, I saw you on TV. Thank you for standing up for us and protecting our patients.” They’re the ones who are actually doing the work, who are cleaning the rooms after the patient dies with Covid, who are taking the food to the people who can’t breathe, who are exposing themselves to risk every day. If I can have a small part in sharing the voice of the health care worker to the people who make decisions that affect our lives and the patients we serve, that’s important. I won’t stop until I have nothing left to say.