How an ICU nurse is preparing for the Covid-19 crisis

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“I suspect all of our staff will get sick”: How an ICU nurse is preparing for the Covid-19 crisis

I work as an Intensive Care Unit nurse at a large hospital in the GTA. We have 30 beds, which is suitable for regular life, and we have a 1:1 nurse-patient ratio. That isn’t enough for what’s coming with coronavirus. But right now we’re just waiting. It’s eerie. I’ve never seen the hospital so dead in my entire life. There’s nobody there—no visitors, no extra staff. There’s a lot of anxiety and uncertainty about what we’re about to experience. I keep going to that worst-case scenario, and I’m mentally preparing myself for some fucked-up shit. I feel like one of those people nailing storm shutters to their windows before the hurricane comes ashore. I know it’s going to be devastating.

We haven’t had any patients who have tested positive for Covid-19 yet, but the visitor policy has already changed. Now each patient is only allowed one visitor per day, which seems to me like one too many. Everyone who comes into the hospital is a risk. But what if someone is dying? How can we prevent someone they love from coming to say goodbye? Do people need to die alone?

There are several critical care areas in the hospital: the ICU, the cardiac care unit and the operating rooms. The question facing us now is whether we have the resources available to accommodate a Covid-19 surge. All elective surgery and ambulatory care appointments have been cancelled in an effort to free up resources: critical care beds, physicians and nurses, personal protective equipment like masks and gloves. China provides us with our personal protective equipment, and we’ve already been told that we’re at critically low levels and there’s a global shortage. We need to do everything in our power not to waste it. 

We’re of course running short on N-95 respirator masks, and some people are even stealing them. One guy pretended to be an employee; a staffer stopped him leaving the the ICU with a box of N-95s, and he said he was taking them to another part of the hospital. The supply is so low now we’re locking them up in a cupboard. 

We don’t have enough beds in the ICU, but we can’t say no to anyone who needs our care. The same number of sick old ladies and attempted suicides and stabbing victims will come in, pandemic or not. The hospital’s response—to cancel elective surgeries, including most heart surgeries—will lighten the load. Critically ill Covid-19 patients will come to our unit first until we reach capacity. Non–critically ill Covid-19 patients will go to a different unit. We’ve been given no direction about making the kinds of decisions our colleagues in Italy have had to make: “wartime triage,” where you have to choose which Covid-19 patient—the 30-year-old, or the 60-year old—gets to go on the ventilator. How do we decide who gets the care? 

I don’t know how many ventilators we have. I believe we have enough for every bed in ICU, then some sort of reserve supply. But I honestly don’t know if we have enough for what could come. My gut tells me it’s not the ventilators that are the limiting factor—it’s the manpower. We don’t have enough critically trained nurses and doctors to do the job. Here’s the thing: you can’t just take anybody off the street and put them in my unit. They have to graduate, then go into critical-care training, which takes a year. Once they’ve been hired, there’s another year-long on-boarding process. And yet the government has asked our unit to prepare a plan to take care of 50 per cent more patients than we normally do, while also having 50 per cent fewer staff, with the assumption that half of us will be sick with Covid-19. You tell me how to do that math. If that happens, we’ll be completely overwhelmed. 

Our manager has told us that the higher-ups are working on a plan for that scenario, and they’re going to let us know in the coming days. I speculate that they’re going to bring in non–critical care practitioners to do some of the less urgent work. I bet we could bring those people up to speed in a week. 

Are we ready for this? We don’t have a choice. I think we’re going to bend really, really hard, but we aren’t going to break. I’ll be honest: I’m scared, though not for myself. On paper they’re telling us 50 per cent of the staff are going to get Covid-19, but I suspect it’s going to be all of us. Not all at the same time, but eventually, over the course of the outbreak. By August we will likely all have had it. And people will probably work sick because we don’t have a choice. Nurses and doctors are used to working sick. I suspect our hospital will turn a blind eye to it. Because what are you going to do when you’re in the middle of a hurricane?