SUNDRE – The viral spread of seven different strains in the community could potentially culminate into one wave that ushers in a perfect storm that imperils the health-care system and threatens to overwhelm already-exhausted staff.
The situation prompted the Moose & Squirrel Medical Clinic to post on Dec. 6 a statement of caution to the public that included encouraging people to mask up in high-risk areas.
“Right now in Sundre, because we’re part of the TARRANT Sentinel program, I can tell you that we’ve got seven distinct viruses circulating,” said Dr. Michelle Warren, who alongside husband Dr. Rob Warren owns and operates the clinic.
“It’s unseasonal in that they’re all coming at the same time,” she said on Dec. 7 during a phone interview.
Among those strains are a resurgence of Influenza A, COVID-19, as well as respiratory syncytial virus, or RSV.
Although Alberta Health Services was unable to immediately provide specific statistic, a spokesperson confirmed emergency departments have in recent weeks experienced “an increase in patient volume, largely due to a surge in respiratory illnesses, higher-than-usual volumes of seriously ill patients, and increased staff vacancies and absences due to illness.”
By extension, wait-times have also increased and in some cases are too long, they said.
“Critically ill or injured patients will always be seen immediately. In Sundre, as in other emergency departments, wait times vary based on time of day, severity of patients and patient volumes.”
Steps can be taken to reduce the spread and alleviate the burden on hospitals and health-care staff.
Preventative measures like masks work
“The biggest thing that we’re seeing, is what they’ve seen in many places: is that wearing masks, staying home when you’re sick, social distancing (and) hand washing is very effective against spreading viral and bacterial infections,” said Warren.
Although the current past president of the Alberta Medical Association, Warren shared her insight specifically from her perspective as a physician with deep roots in Sundre and spoke with the Albertan on behalf of her clinic and the local medical community’s concerns.
Warren said public health measures put in place during the roughly two-year period to reduce the spread of COVID-19 had a drastic impact on other viruses that all but fell completely off the radar.
“We didn’t spread things around and so these are infections that we really didn’t see,” she said. “Everybody had a bit of a holiday from the usual winter maladies that we tend to get, so we’re all much more susceptible.”
Exacerbating the situation is those viruses returning with a vengeance now that health measures are lifted and many people have opted to throw caution to the wind.
“Now that people are back to just going to work when they’re sick, going to school when they’re sick, they’re not wearing masks when they’re in crowded areas, so they’re happily spreading the viruses around,” she said. “We’re seeing that people are getting sick with the common colds again.”
Patients are also coming in with ear infections and bacterial pneumonias that had scantly been seen over the past two years.
“People are not only just getting the cold, but because of the viruses that are circulating, we are seeing those secondary bacterial infections,” she said, adding children can be particularly susceptible.
Some children who come in sick even “need oxygen because a lot of these viruses are really irritating to the chest and they end up getting wheezy like our asthmatics do and end up needing some oxygen for a few days.”
Even in adults, the viral strains making their way around all have the potential to deliver a knock-out blow with symptoms such as a head or chest cold, sore throat, headache, sinus congestion and cough that can last seven to 10 days, she said.
“The cough can can linger up to three weeks,” she added. “And then meanwhile, you can be brewing your next virus.”
Recovering from the flu, for example, provides absolutely no immune system boost to defend against either a cold, COVID-19, or RSV, she said.
So the best course of action for anyone who would prefer not to be incapacitated for the better part of a week or two, is to simply take preventative measures.
And with low immunization rates for Influenza A throughout the province, physicians are also encouraging people to get not only their flu shot but also the bivalent COVID-19 booster, she said.
Choices have consequences
“For every decision we make, there’s consequences. What we are as physicians wanting patients to understand, is that if you are going to work when you’re sick or send your children to school sick, you’re spreading these viruses around and they will come home to roost,” she said.
“Where I think people get frustrated, is that they’re getting recurrent colds. And again, because we’re not doing anything preventative, and yet they’re frustrated that they’re picking up these viruses because there’s so many out there.”
While she couldn’t comment directly about the body of research indicating the damage sustained by internal organs gets incrementally worse upon recurring infections of COVID-19, Warren said time will certainly provide a clearer picture.
“And I think anecdotally, I’ve seen that as well. This is one of the reasons I really don’t want to get sick,” she said. “What I can say, is even in people who are otherwise healthy, long COVID really is an entity that we see and it is not something to be made light of.”
Some working-age individuals are finding themselves out of a job and struggling with daily tasks at home, she said.
“And we know from some of this research that long COVID actually does get worse the more infections that you have,” she said. “That’s the part that worries me a lot. We’ve seen chronic fatigue syndrome associated with other viruses that we know is a real thing; we know it’s been devastating to patients who have it.”
So although difficult to diagnose, that makes it no less real, she said.
“(COVID-19) is one of many viruses that has just proven to us how much we don’t know about human physiology and how delicate it really is, and how easily a virus can mess with things in a very long term sort of way.”
The solution, she said, is simple: wash your hands, stay home when sick, and wear a mask in crowded interior spaces. Those who can’t be bothered can expect to catch a bug, she said.
“You’ve made this choice, and now these are the consequences,” she said.
Risk mitigation
“I’m not saying you can’t go out to a movie and you can’t get on an airplane or travel,” she said.
“What I am saying is that when you’re in those higher-risk areas, we know masks do work; they do keep your germs to yourself. And the higher-quality masks protect you from the germs of others…when I’m in those high-risk activities, I do wear my mask.”
While Warren said she accepts the relatively low-level risk of going to a local restaurant in a booth that allows distancing from other patrons, she will mask up when flying to visit her daughter in N.B.
“I still test for COVID-19 before I go to see my loved ones that are at risk, because I know that I can be infectious before I have symptoms – even being fully vaccinated – and I don’t want to put my family at risk.”
She also confirmed when asked that their clinic maintains a masking policy that people for the most part understand.
“We do not want – ever – to put anybody intentionally at risk when we know there are (preventative measures),” she said.
“As a physician, I wear a mask sometimes it feels like 24 hours in a day. The tradeoff is I haven’t been sick,” she said. “And the one time I did get sick, I was not wearing my mask and I was in a high-risk environment; I let my guard down.”
Asked her thoughts on the government’s decision to ban mask mandates, she said, “They only work if they’re policed and enforced.”
And throughout the pandemic, it was clear mandates were barely enforced, she said.
Personal comfort versus collective health
“For some people in our society, it is more important that their personal comfort takes precedent over everything else,” she said. “And there are those in our society who will always put others first. And then everybody else is kind of somewhere in the middle.”
People should be able to choose, which is a good thing, she said.
“But then you also own the consequences of those actions.”
Aside from the personal consequence of potentially becoming really sick, there are other ripple effects from the choices people make that result in a faster spread, she said.
Only a small percentage of people who catch the flu will end up needing medical care, but even a small percentage ends up representing a large number of patients when there are so many cases cropping up, she said, adding that translates to longer wait times at emergency rooms, whether at the Myron Thompson Health Centre in Sundre or anywhere else in the province and even country.
Placing further strain on the system are instances when health-care staff themselves fall ill, leaving others scrambling to cover shifts.
“All of us are burning the candles on more than one end – we found ends we didn’t even know we had – to try to keep the hospital open,” she said.
At the Sundre hospital, a new computer program called Connect Care that’s being deployed province-wide to establish an electronic database among public hospital facilities for physicians to share patient health information, has also introduced a learning curve, she said.
While she feels the system will in the longer term prove beneficial by reducing duplication on the path to improving patient care, it in the short term does represent another demand on staff who already have their plates full. Although wait times vary substantially, she said patients who opt to go to Sundre’s emergency room could be waiting an hour or more.
"The people coming in are sicker"
Additionally, the facility tends to run at or close to capacity, especially during the winter. And it’s not just a matter of numbers, but rather how sick people are when they come in, she said.
“I think all of the physicians in Sundre that have been here over a period of time would agree, that the people coming in are sicker,” she said.
“I would say on my last shift, almost everybody was a Code 2 or 3,” she said, explaining that the most urgent rating is a Code 1.
“I think what we’re seeing is higher acuity,” she said.
Warren also reminds residents that the emergency room is not first-come, first-served.
“Part of the problem when you’re going to the emergency room to be seen, is we don’t see you in the order that you arrive,” she said, adding the sickest patients are seen first.
“If everybody coming in is sicker than you, you may potentially be there for a very long time.”
Of course that being said, she added physicians don’t want to discourage anyone who’s concerned about their health not to come in. But she suggested first calling a family doctor to conduct a virtual appointment and determine if they should be seen in person.
However, changes to how physicians are compensated means people who don’t have a family doctor can no longer walk in to the clinic.
“The way our clinic works, is we only can see those patients that we’ve taken on as a family physician because we’re not paid under the old fee-for-service system anymore, and it doesn’t really allow for a walk-in episodic care with patients that we aren’t going to see on a going-forward basis because we’re not paid that way anymore,” she said.
“So, that makes it more challenging. That means that these people who don’t have a family doctor in town, there isn’t a walk-in clinic. They can go to the emergency room, they can call the Greenwood (Family Physicians) clinic and see if one of their doctors is able to see them.”
Harassing health-care staff not OK
Further complicating matters is the ongoing uphill battle to attract new physicians to replace those who left. Public policy plays an important role toward that end, but so too does the community, she said, adding most patients are grateful for their doctors.
“But there are many patients out there that get angry at the system, angry at the delays, angry at the waits, and they do take it out on the frontline workers, whether it’s nurses or physicians. And that’s not OK,” she said.
“The government can do a lot to try and bring physicians into communities. But it’s on the community to keep them; and the communities can drive them away.”
Everyone just wants everything to get better; to get “our old world back,” she said, adding the challenge is how.
“And for some reason, health has become political; it’s political at the level of the patient, who views wearing a mask as a political statement, when it’s actually a public health statement.”
Among the discoveries of modern medicine dating back to the earlier days of surgeries was that patients are more likely to survive when the operating physician dons a mask, she said.
“But yet it’s become a political statement, which is really stupid,” she said, expressing concerns that said politicization could pave the way for a resurgence of once-eradicated viruses like measles, mumps and polio.
“Politicization of health care is one of the biggest victims (of the pandemic),” she said. “We’re going to see the consequences.”
