How the Covid-19 pandemic has wreacked havoc for anaesthetists
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For the past three months, Dr Caroline Corbett has felt her days blurring into one in a “virally-induced time warp”.
“Realising it’s almost July when it seems time stopped and Covid-19 took over mid-March is quite surreal,” explains Corbett, who is in private practice in the Western Cape and is vice-president of the South African Society of Anaesthesiologists (Sasa).
Before the Covid-19 pandemic, her priorities were consistently defined both at work and home. But the virus has changed everything.
“Making time to pause and just eat a meal with family is so important now, especially as it’s very difficult to eat at work as we then need to remove all our personal protective equipment (PPE), sanitise appropriately, ensure we practise social distancing in a tearoom with limited space, and then use up another set of already scarce PPE to don appropriately to go back to treat patients.”
Like her, many of her colleagues rather don’t eat at work, conserving PPE and reducing the risk of infection.
“It’s undoubtedly a virally-induced time warp where we all wish for it to pass quickly, but are so desperate to make every moment count because the vulnerability of life is so starkly exposed every day. Unfortunately, the luxury that a large number of the population have is to be unaware of this, hence the lack of mask wearing and poor infection prevention practices we see often, as many just don’t believe that any of this is really happening.”
Anaesthetists are involved in the pandemic in different spheres.
“Some are on intubation teams where they are called to assist in the higher risk spaces of placing endotracheal tubes for patients so critically ill they require invasive ventilation. Others are joining physicians in ward rounds and contributing to the daily care of critically ill patients.”
Corbett is a member of the private practice business unit, Sasa Covid-19 working group and PPE work streams.
“We work as focused teams with the private and public sector equally represented, with one unified goal of ensuring no patient is left behind, and that clinicians and front-line workers are informed, equipped and supported.”
She is on an intubation call roster and is providing perioperative care for Covid-19-positive and negative patients who still need semi-urgent and urgent surgical care. Her days shift in 14-hour stretches, or if she is covering her ICU patients, being on call for a 24-hour period.
“The previous focus of work being a vocation that was about the human connection with a patient, sharing in their perioperative journey and being privileged enough to contribute to their overall achievement of well- being has been veiled in the shroud of Covid-19 and finding just that simple joy in the day is the challenge from a personal perspective, to be honest.
“That and the concern that I do not become a vector for the virus to my patient, my team and, of course, my family.”
One of her two daughters is a severe asthmatic and on immunotherapy. “She is considered higher risk. I have been extremely concerned about her since Covid-19 patients were first being diagnosed in SA. My greatest fear is still that I infect her myself.”
Corbett is vigilant in her basic principles of infection prevention and control at work. “Then I sanitise my hands and steering wheel in my car, keep all of my limited belongings in a paper bag in the boot of my car, and my cellphone in a ziplock bag.
“I only wear my own cotton surgical scrubs to work so they can tolerate a hot antibacterial wash. On arriving home I have had to ask the children not to rush to greet me and to steer clear until I have showered. All of my clothes are immediately removed and placed on a hot wash, my cellphone is sanitised with alcohol and my work shoes are left in the garage.
“I shower, wash my hair and usually apply cream to the bridge of my nose as the protective respirator has started to erode a pressure sore there - not uncommon with long durations of wearing them. Only then do I greet my family.”
South Africa is short of PPE, particularly the critically essential respirators for front-line workers exposed directly to high risk environments with Covid-19 patients.
“Without these respirators, front-line workers are at extremely high risk of contracting the virus, even with practising good infection prevention and control measures.
“We are also seeing a definitive and persistent regulatory lag or absence with both no testing or no regulatory certification provided for some respirators, and substandard unsafe respirators being supplied to staff.”
Corbett misses human interaction impaired by masks and visors and “just the ability to hold a patient’s hand to reassure them, hug a grieving family member, or not be able to communicate at all, in the case of many ventilated patients or critically ill ones.
“The inability for families to visit their loved ones is a significantly painful reality for all. I talk regularly to their families and enable video calling whenever possible, especially prior to intubating patients for Covid-19 and ensure that patients have at least some means of communication with their loved ones on what is, in many cases, a very long hospital stay.
“So much of recovery and well- being involves emotional and psychological health. Without the ability for patients to connect with their loved ones, they are significantly negatively impacted, as are we in being unable to reassure them just through basic communication and contact. We continue to just try our best.”
It’s easy to forget that despite the pandemic, health-care demands continue and patients still need surgery for cancers, injuries and births, for example.
“Over 85% of our population will not require Covid-19 care in hospital, but may still need to access urgent health care. I feel often quite desperate for these patients as many wait so long to seek care for fear of contracting Covid-19 that we have had patients arrive for resection [cutting out] of cancers only to find that the month or two that they waited to seek care rendered the tumour irresectable.
“The pandemic response and its urgency and all-encompassing demands have unfortunately usurped general patient care delivery in many instances and we need to try to refocus some energy on a more holistic approach to defending and enabling other essential health-care resources in the wake of our Covid-19 assault.”
Covid-19, Corbett says, is very clearly a defining pandemic from the perspective of life “before” and “after”.
"Every single aspect of our lives globally has been impacted by this but sadly not all will be fortunate enough to acclimatise to the new way of life ... This virus is so much more than a micro-organism that causes illness, it has created challenges and presented truths to our nation that long since required remedy and attention, and through the exposure of the system flaws it has been profoundly fuelled in its overall impact on society."
She says the incredible efforts and support of SASA from the start of the pandemic nationally "has been the reason I feel equipped to face all these challenges. We have been monitoring the situation globally for some time and already having discussions within SASA around what will be required of us, but the team effort of all of our members nationally has been truly humbling.
"Our CEO has worked alongside us in a non-clinical capacity 24/7, literally and figuratively fighting the fight! Our public and private sector clinicians have blended into a unified workforce that is clinician-focused, patient-centric and profession-guided and driven where every single aspect of the pandemic’s impact on healthcare and patients has been included in a response in some form.
"I am equally grateful to our fellow South African people - from the seamstresses who started making masks to the large corporates who donated PPE and funding, to every person who stays home and washes their hands – each one’s effort is cumulative in combatting the spread and empowering each other to get through this. I think in truth though, nothing can prepare any of us fully for the onslaught of physical, emotional, academic and professional challenges in which we have been immersed. But as South African trained clinicians, we have always been required to innovate, adapt, collaborate and lead – this has surely called for such skills."