COVID Hospitalization in Canada's Capital

Vanessa Large. Photo Tony Caldwell/Postmedia

"It was never peaceful. Everyone was very anxious. They all knew. The patients weren't naive, they knew they had COVID, and they knew coming in what was on the TV. 'OK, I'm not doing well and you're talking about ICU. Is this it? Is this where we're going'?"

"And unfortunately, the only answer was, 'We're going to ICU. They're going to do what they can to help  you and we're going to update your family."

"And sometimes we saw patients come back, and sometimes we didn't."

Vanessa Large, registered nurse, COVID Unit, The Ottawa Hospital

Dr.Samantha Halman . Photo Tony Caldwell/Postmedia

"They asked me that if it came to that and it looked like it was going to happen, the only thing they wanted from me was to make sure they weren't suffering, and I promised them we could do that."

"[Every  COVID death is different but all are memorable], We worry about the patients. We worry about them when we go home. We think about them."

"I've seen a lot of people die, and I have to be comfortable with death because it's part of my regular life. But the last six months have really struck with me. These are hard deaths. They're psychologically very hard."

"In many cases, outside this pandemic, I'm usually able to make sure the family is there and they're not alone and people are prepared. But with this, their family member wasn't sick two months ago. They didn't have cancer. They didn't have a terminal illness. They were playing hockey or they were out with their grandkids and all of a sudden, they're gone. And that's really hard to accept."

"Everybody thinks about the classic fever/shortness of breath/cough, but we've had quite a few people who have presented with gastrointestinal symptoms, like profound loss of appetite, diarrhea, nausea, vomiting. We've had quite a number of people presenting with near-fainting spells. We've ha people who have presented with strokes. We've had people come in with blood clots or pulmonary embolisms in their lungs or their legs. In older people, especially people from institutions, we've had people who have come in confused or with delirium."

"Anyone who comes in and we're thinking there's something that's off, all of these people are getting COVID swabbed. There's no real environment where you feel completely safe, because it can present as anything."

Dr.Samantha Halman, general internal medicine specialist, The Ottawa Hospital

The world has faced quite an upheaval in the last nine months; no less so the capital city of Canada and its leading hospital. The public is familiar with the results of announced lockdowns; social isolation, the urging of the medical community to remain alert and distanced, to wear masks and avoid crowds. And adjust to the social changes of lockdown where only those businesses considered crucial may remain open, and other shuttered temporarily -- or permanently. Children being home-schooled or subjected to remote-learning. People working from home, remotely. A sea change from normalcy.

And of course, for those not themselves affected by contracting COVID, or having someone in the family infected, there is the news and the daily case counts to keep the public informed and alert to the ongoing pandemic now resurgent, with a vengeance. From a toehold to a foothold to a complete invasion. And there are the hospital admissions, the transfer to intensive care, the deaths and the recoveries. Hospitals employ a variety of methods; supplemental oxygen, steroids and painkillers. And a lot of attentively quiet listening.

In Ottawa, Canada's capital alone, over 9,000 people were infected by COVID-19, more than half of those infected under age 40. But of the majority of the close to 400 deaths that ensued it was the elderly that carried the brunt of the living sacrifice. Three quarters of those in the elderly category were in their 80s and over, many suffering comorbidities exacerbating prognosis and ultimately outcome. It is interesting to compare illnesses and their death rates. According to Ottawa Public Health's mortality data from the most recent year where data is available, 2015, death from COVID ranks fourth.

Among the leading cause of death, ischemic heart disease led the peak death rate at 800, with dementia and Alzheimer's following at 662 deaths, lung cancer 413, and COVID following in fourth place of leading death counts in the city. Flu and pneumonia accounted for 155 death-responsibility. Although death from any cause is lamentable at the very least, heartbreaking at best for the families involved, COVID deaths prove to be quick and brutal. Someone will decide to go to hospital to find out what it is that appears off kilter with them. 

That shortness of breath is particularly worrisome and horribly uncomfortable. Two hours following admission supplemental oxygen is being administered, and the rate is progressively increased reflecting a steadily worsening condition. Breathing becomes rapid and shallow with 30 to 40 or more breaths per minute, yet failing to provide adequate oxygen. A switch follows from supplemental to high flow oxygen with the use of a breathing machine pumping pure oxygen. 

"Things are spinning out of control very quickly" says Dr.Halman. "It's very scary for patients because you go from coming in and being on two litres of oxygen to suddenly having 20 people thinking about how we're going to transport you safely across the hospital and down to the ICU and talking about putting you on a breathing machine when ten hours ago you weren't even short of breath." About one in five patients hospitalized with COVID required treatment in an intensive care unit, while the remainder had care in a regular COVID unit, many of whom improved to return home.

New development used blood thinners in treatment in reflection of some COVID patients becoming prone to blood clots. Decadron or dexamethasone representing a cortiscosteroid reducing inflammation, and antibiotics are also routinely administered. A dozen trial therapies are being tried out at the hospital including antiviral drugs like remdesivir and convalescent plasma. Patients are turned to lie on their stomachs to  help clear lungs. The most serious patients are placed on ventilators where an endotracheal tube running from mouth to lungs is inserted, the ventilator breathing for the patient.

Dr.Kwadwo Kyeremanteng (Kwadwo Kyeremanteng) jpg

"It's what we call invasive ventilation. It's uncomfortable, you need to be knocked out for it on sedatives and pain medications to tolerate it. People don't realize how difficult it is to be an ICU patient. We have a lot of PTSD, we have a lot of depression after with patients who survive it", explained Dr.Kwadwo Kyeremanteng, intensive care physician at The Ottawa Hospital. "The saddest part is seeing people die alone, which no one deserves, period. When you see someone who has been a good person and lived a good life and cared for their family, and they're dying surrounded by strangers in what look like haz-mat suits, everyone deserves better."