How an infection control practitioner is adjusting to the second wave

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“It’s like finishing a marathon, then getting told to run another one”: How an infection control practitioner is adjusting to the second wave

“I’ve seen the anti-mask protesters in the news. My first response is frustration, because that kind of behaviour puts us all at risk”

Lauren Parsons is an infection control practitioner at Toronto’s Mount Sinai Hospital. Over the last six months, she’s worked with doctors, nurses and patients to detect cases, manage treatment and control the spread of Covid-19. Now, as Ontario enters a second wave, she describes what life is like on the front lines.

-As told to Alex McClintock

Infection control practitioners are hospital workers who are experts in stopping the spread of infectious diseases. It’s a highly specialized job. I’ve previously worked at Trillium Health and Michael Garron Hospital, and in October last year I started in the Women’s and Infants’ Unit at Mount Sinai.

At a meeting just after Christmas, one of our team members brought up this new respiratory illness in China called coronavirus. By January, everyone knew that it was going to be something big. From February, we infection control practitioners were on call around the clock, working seven days a week. None of us really had any time to be scared or anxious or emotional, we were just so busy. We were getting calls in the middle of the night, talking about every single patient who was suspected to have Covid and how to manage them. That became unsustainable once community transmission became more widespread, but even so there were times when I was up most of the night and had to go into work the next day.

The neonatal intensive care unit and the emergency department are my responsibility. We had to put in place procedures so that every person who came into the emergency department was screened. First by a security person for obvious symptoms, then by health care workers who would check temperature and take histories. If the patient was from a long-term care home or the shelter system, then they might meet the criteria for testing right away; others might get a test later. If someone couldn’t wear a mask because of a mental heath issue or some other reason, we would put them in a separate area, either a cordoned off part of the emergency ward or a private room.

All of our admissions are put on what we call “additional precautions” or “droplet contact precautions.” That means staff have to wear PPE: masks, face shields, gloves and gowns. Those precautions last until they’re assessed by me or another infection control practitioner. If they have a negative test or we believe they don’t have significant risk factors, we may say that those precautions are no longer necessary.

The difficult situation is when we have unexpected Covid positive results: patients who don’t meet any of the symptom criteria and are from a low risk group, but their mandatory pre-operation test comes back positive. That’s a risk because the scenario everybody wants to avoid is an outbreak in the hospital. It keeps us up at night. More than one hospital-acquired case could shut everything down for two weeks. Thankfully we haven’t had that yet. Our strong adherence to the procedures we’ve put in place helps, but there’s a big element of luck, too. There are other facilities that have had outbreaks and I don’t think they could have done much more to prevent them.

I spend mornings at my desk managing which patients are where, and my afternoons are usually full of meetings with multidisciplinary groups. Coming up with rules and processes can be quite complex, because there are a lot of competing priorities to balance. Obviously we need to reduce the risk of infection, but there are other things to consider, too: patients’ health might be affected if they can’t have loved ones or carers visit. We make those decisions with input from doctors, managers and medical ethicists. For example, in my portfolio we often deal with high-risk pregnancies where we know babies are likely to end up in the neonatal intensive care unit. Obviously you want the primary caregivers to be there, but in the context of Covid, that’s difficult. I remember having to speak to a couple who were about to receive a diagnosis for their newborn and both wanted to be there. That required me and the physician to grant an exception. We had to balance the emotional impact on the parents with the risk that they could potentially infect other patients. Then I had to screen them and instruct them on how to wear the proper PPE. I think they appreciated it in the end, because they felt less anxious going in, knowing they were keeping other people safe.

I’ve seen a few people posting conspiracies about how Covid is fake or caused by 5G towers on Facebook, and I’ve seen the anti-mask protesters in the news. My first response is just frustration, because it puts us all at risk. You think I want to be working weekends like this? But humans aren’t very good at change and I recognize they’re experiencing this in a completely different way than I am.

 

 

It’s been a funny time for someone with my background. I’m the person my friends and family turn to for information. It’s like a teeter-totter where I think I’m talking about Covid too much, but then somebody else brings it up and I feel like I don’t want to talk about it anymore.

When case numbers started to go down, I got a week off and I went up to my family’s cottage in Muskoka. I don’t really know where the time went, but it was fantastic to get a breather. That’s the best thing about being up there: I can do whatever I want, whether it’s wake surfing, or reading a book all day or playing cornhole into the wee hours.

I needed that, because now positive tests are rising again. We expected it, but we didn’t know when it would start. It feels a bit like finishing your first marathon, then having someone tell you that you have to run another one.

Right now we’re at capacity, but we’ve learned a lot about the virus over the last six months, which helps. Access to the hospital is now fully restricted. And we have a better idea of how long patients are infectious, so we don’t necessarily have to keep them in private rooms for as long. That’s good because it helps us free up beds: the thing we really want to avoid is hallway medicine, because with a respiratory disease like Covid that makes an outbreak more likely.

I think things are going to be OK within the hospital, but it’s starting to look like a crisis out in the community. I’ve been surprised by how quickly the situation has worsened, and now that the community spread is wider and there’s less contact tracing, anybody can have the virus. Right now it’s mostly a younger demographic that’s affected, but if they start passing it on to their older relatives then we’re going to be hit hard.

The thing is, we’re not going to solve this inside the hospital. Over the past few weeks, I’ve tried to be understanding when I saw people inside restaurants and bars. We all have Covid fatigue. But at some point soon people are going to have to pull together and take this seriously. The messaging has been a little confused, but in the end it’s simple: if we all stay home for two weeks—or at least those who can stay home do so—we’ll beat this thing.

It’s going to be a challenge, and I’m going to be busy, but we did well the first time round, and we can do it again.