Jordan: Welcome to week three of the world’s new normal. And you know what else is normal? I mean, aside from the fact that I, and probably you have barely left our houses. I don’t know about you, I haven’t worn a shirt with a collar on it in a long time and I really need a haircut. Besides all that, numbers are the new normal. They are my new normal, and Claire, you do our daily news updates, so I imagine numbers are just a huge part of your life right now.
Claire: Yep. I mean, I’m looking at new numbers every day, trying to figure out which ones are the most up to date. And not just here in Canada, but around the world. So those are changing fast. Um, how many new cases, how many that was compared to the day before, the week before even? And whatever numbers I tell you are most likely different within the hour. And I mean, I expect that timeframe to be shorter as we see more and more cases.
Jordan: And the weirdest thing about those numbers to me is that because there are so many of them and they’re all just about equally scary at this point, they’re becoming more abstract to me than they should be.I’m finding it, and I don’t know if this is true for you as well, but I’m finding it harder and harder to picture the reality that those numbers are supposed to describe to me.
Claire: That’s the interesting thing about numbers, you know, the bigger the number is, the more abstract it is. Like you said, it’s like our brains can’t comprehend those huge numbers. I mean, we see the number of people getting sick around the world, and you know, our first thought is, Holy crap, 707,000 people. Like that’s a lot of people. But I don’t think it’s until we see the images and have some sort of visual to accompany those big numbers that we’re really able to fully grasp what those numbers mean.
Jordan: Well, I don’t think it’s just a visual, and this is hopefully true for our listeners, I know it’s true for me and probably for you, is we’re storytellers. Humans do this. And for us, if we want to grapple with what those numbers really mean, we have to know the stories of a few people that are dealing with them every day. Or people that have been impacted by them. That’s why when we want to talk about what things look like in Canada and where we’re headed, we try to talk to someone who’s dealing with those numbers in, you know, ones and twos and threes, who’s dealing with the situation on the ground. And today’s guest is at the center of the crisis that the Canadian healthcare system is facing every day. And before we talk to him to get a picture of the reality of those numbers, Claire, you’re going to give us those numbers as of Sunday night.
Claire: Yeah, 6,200 we’re now above that for the number of cases in Canada, and most of those are in Quebec with over 2,800 cases there. Now, one of the biggest questions on everyone’s minds these days is how long will all of this physical distancing be in place? Right? When can I go back to my regular life? Well, Canada’s chief public health officer, Dr Theresa Tam, addressed this, saying, it is still too early to tell, but the impact of all the measures taken so far could become a bit more clear in the next few days.
News Clip: I think, because of the measures put in, you know, we have to see what will happen next. But at the same time, I have to say that together with the chief medical officers, we’re still thinking, well, what more can we do right now? Because you don’t– you still have to act pretty fast, even if your data has, you know, you’re still waiting for your data. But every day we’re thinking about, well, what more maybe we should be doing?
Claire: Now more locally in British Columbia, however, there is a report that says they have started to see a flattening of the curve. They are being cautiously optimistic though, and urging people to continue their physical distancing. And lastly, the federal government has announced additional funding. Seven and a half million dollars to kids help phone to provide mental health support for youth. Here’s Prime Minister Justin Trudeau.
News Clip: I know these past weeks have been tough. You haven’t seen your friends, you’re not able to go to school, you’ve been hunkered down with your parents, and you’re watching the world you know change radically. It’s a source of anxiety. It’s a source of tension. Maybe there’s extra tension in your family. But there are people who can help.
Claire: And the government is also giving $9 million through United Way Canada to help local organizations support seniors with services, including grocery delivery, medications, and check-ins.
Jordan: The most scared I’ve been, I think since this whole thing started was when the doctor who runs the intensive care unit at the hospital up the street from me talked to us and said this:
Michael: I am screaming from the mountain tops, ringing the alarm bell as loud as I can, because when I started working in the ICU in a couple of days, I may not come out for four months.
Jordan: Michael Warner described what his hospital could soon be facing in a way that, look, it left me staring at the screen of my computer for a few minutes after our conversation ended. But he also told us what he needed from the government, from the community around the hospital and from all of us. And that was more than a week ago now. So we wanted to check in and see what’s happening at that hospital and if they’re getting what they need. I’m Jordan Heath Rawlings and this is The Big Story. Dr. Michael Warner is the Medical Director of Critical Care at Michael Garron hospital in Toronto. He joins us again. Hi Dr. Warner.
Michael: Hi Jordan. How are you?
Jordan: I’m doing all right. As I asked you last time, the first question I want to ask is just, how are you? Is everybody all right there?
Michael: I think every day poses new challenges and also new opportunities to come up with creative solutions for problems. But every day seems like the same day. There is no differentiation between a weekday and a weekend. You know, you still have three to five hours of Zoom teleconferences every day along with everyone’s patient care load. And everyone’s trying to plan for a situation that is evolving by the minute it seems.
Jordan: Well in that day to day at your hospital, I guess, or maybe even for other ICU doctors you talk to, what is your most pressing concern day to day at the moment?
Michael: So I’m in touch with all the other intensive curing it directors across the city, and to some extent across the province. And the pain point that we’re anticipating is, you know, in the not too distant future, not having enough ventilated beds, that means beds that can provide mechanical ventilation for patients that need it, in addition to the human resource challenges that we can foresee with respect to having enough doctors, nurses, respiratory therapists, et cetera. And then all the other equipment that needs to come with that bed with the ventilator, like monitors, IV pumps, in addition to the PPE concerns that we all have at the moment across the healthcare system. So it’s mainly a resource crunch. We’re concerned that there’ll be demand that we’re not able to meet in the foreseeable future.
Jordan: Can you give me a couple of examples of what you’ve seen in the past week that’s kind of reinforced that? How is it going at Michael Garren and particular, like on the ground? Do you have enough beds? Are you seeing ICU patients, et cetera?
Michael: So I’d say just about every intensive carrying unit of size in the province will have patients with COVID-19 on life support at the moment. Some areas are much more affected than others, but because this is a community based disease, the expectation is that in general, every hospital and every area will be affected in a similar way over time. We are planning to increase our ability to provide care to critically ill patients from, you know, from 19 beds to the 48 beds. But what we’ve realized is that even if we have the human resources, which are difficult to obtain, we may not have the necessary equipment to provide care to patients in those beds that we’ve created. Because you do need a monitor. You do need an IV. You do need a ventilator. And you all the ancillary equipment. So, and it’s unclear, I think for a lot of hospitals, when they will receive the equipment they need, to provide care to the increased number of patients, because everybody’s trying to acquire the same equipment, really, across North America and Europe right now. So the supply chain supply chain issue is one that’s a challenge for just about everybody, including the government, who I think are, you know, are doing their best to try and facilitate procurement. But it’s unclear exactly when we’ll get the equipment we need and if it’ll be in time to match the demand at that time.
Jordan: Well, when we talked to you a week and a half ago, you were really, really worried about exactly that, right? About, about the units being overwhelmed quickly and there not being enough resources. In the last 10 days or so, based on, you know, what you’ve seen in terms of the spread in patients coming in, are you more worried or, or less worried about how quickly that point is coming?
Michael: I’m definitely not less worried. There’s no real secret to this. Smart people with mathematical models to some degree can predict exactly when things are going to happen. That being said, you know, social distancing or physical distancing, which may be a more appropriate term now, is vitally important, remains vitally important. We cannot let up at all. In fact, we have to intensify our efforts because that still is a lever we can pull to try and reduce the risk of us having too many patients at once. I can say that if things go forward as they’ve been modelled to, we can all be anticipate, you know, when we’re going to run out of beds and that’s not in the too distant future. So, you know what I said a week and a half ago, and what I’m saying today are unfortunately quite similar. And that’s, we will not be able to care for everybody who needs it, unless the incidence and severity of COVID-19 within our population changes, or we get significantly more resources deployed quite quickly.
Jordan: One of the things that people were talking about online this weekend in Ontario in particular was. What seemed to be a sharp rise, not necessarily in cases, though those are increasing, but in terms of the number of people requiring ICU beds. It looked like that number was outpacing the rate of growth in general. Is that, is that what you’re seeing? Can you speak to that at all?
Michael: Well, it all depends on where we are on this curve in terms of patients requiring critical care and what the slope of that curve is going to be. But if they’re, you know, the number of patients who require ICU close to doubles each day, which it seems to have over the last few days, there’s only so many beds. The other thing to consider is that there’s a story to this disease in terms of, you know, how the symptoms present and when people get sick and we’re starting to learn from other jurisdictions the pattern. So the fact that a lot of people came back from March Break all at the same time means that in the next week or so, we’re going to see what the impact of that is on critical care resources. Because there’s the potential for people, unbeknownst to them who are carriers of COVID-19, either getting sick themselves or spreading it to others, who all become sick around the same three, four, five, six, seven day period of time. When I say sick, I mean sick in a way that requires ICU. I can’t tell what the future holds for us, but I know that we are preparing for a situation where we will not have enough resources, which I think is the best way to prepare given the circumstances.
Jordan: Do you find yourself looking hard at the actual numbers that are reported every day about number of tests still pending, number of positive tests, et cetera, et cetera? Or is that noise and you’re just dealing with what’s in front of you? How do you guys tackle that?
Michael: I mean, there’s so much information and you know, sometimes I’ll get the same email from seven different sources because everyone’s really working hard to try and get their head around this. I think you can have the macro view or the micro view. It depends what I’m doing. You know, I just spent five days working in the ICU and to be honest with you, Jordan, I spent most of my time looking at the list of patients in the emergency department and seeing if there was a patient in what we call resuscitation room number one. That’s the room where we put patients who require negative pressure, isolation patients who are suspected to have COVID-19. I would check that link 20 times a day just to see whether the patient was coming who was going to need my services. So that’s my micro view. And then the macro view, I sit at the provincial table, so I have an idea of what’s going on in the rest of the province. And I know that there are other hospitals that are hit much harder than we are at Michael Garren. But I also know that, you know, the situation I had last week, and the situation to date today at my hospital, couldn’t be more different. So I think you can only–
Jordan: How so? Can you elaborate?
Michael: I don’t want to speak about specific patients, but let’s just say we’ve been more affected today than we were when I was in the ICU the last five days. And that means tomorrow I could have more patients, and the next day, you know, be out of resources. So things can happen that quickly, which is why paying attention to yesterday’s data doesn’t really affect what I’m going to do because I’m planning for what’s going to happen two weeks from now already, which is what I have to do. We have to plans for what’s happening two weeks from now, four weeks from now. Four months from now, really, today. There’s a multi-pronged approach to that, you know. The people who sit at the highest table need to start thinking about field hospitals. They need to think about unconventional ways to ventilate people when we run out of ventilators. They need to think about how to make sure health care workers are hydrated and fed. They need to think about how we make sure people continue to physical distance, even if things seem to be getting better two months from now. I think about all those things, but my scope of thought changes depending on what I’m doing at the moment.
Jordan: Well, the last time we talked, one of the things we talked about was what people can do and how seriously they were taking the orders to physically distance. How seriously they were taking a government mandated self-isolation. Do you get the sense over the last a week or so, that we’ve actually seen an uptick in that message getting through in terms of general behaviour?
Michael: You know, it’s actually hard for me to know because I physical distance maximumly. I mean, I literally haven’t seen anybody except for my immediate family and the people I work with for three weeks. I haven’t left my house except to play basketball with my kids in the driveway. I think that on social media, it’s becoming a societal norm to stay away from each other, which I think is good. But there’s still people who try to create exceptions in their own mind about what is okay and what isn’t okay. For example, getting together with people who are allegedly also self-isolating or physical distancing. So if they’re physical distancing and I’m doing the same thing, well then, isn’t it okay if we get together? And the truth is no, it’s not okay. The safest number is still one in terms of being with other people. I think the government of Ontario has now recommended five people. I think last time we spoke it was less than 50. And I still feel that the right message needs to be one, other than your immediate family. So we’re getting there, but I’m not sure if people entirely get it completely. And I have to decide where I’m going to focus my efforts. But the community in general, I think, is really stepping up to the plate in terms of thinking about healthcare workers, thinking about their employees and the people who are less fortunate than them, who may not, who may be completely socially isolated. We’ve had a huge response to our community drive for personal protective equipment, which you may get to. And now I’m trying to focus on how to make sure that health care workers have adequate food and hydration once we really get in the trenches and are wearing PPE, you know, 12 hours a day straight, not able to eat. You know, what does that look like? How do we make sure healthcare workers don’t get sick? Just by being overworked and not fed.
Jordan: What kinds of stuff, and I’ll ask you about the PPE drive in a minute, but what kinds of other stuff have you seen that that’s made any kind of difference to you guys? You know, we’ve, we’ve seen videos of people clapping and singing for healthcare workers. I’ve noticed like messages in chalk on the sidewalk, that kind of stuff. Are you getting that from the community?
Michael: I think about my kind of close circle friends and family, and I think the check-in texts, the messages to my wife, you know, can we get you anything, cause we know Michael’s working, those things really make a difference. Even the humorous texts I get from my good friends that I grew up with, just to add a little bit of levity. I think that for other people, knowing that there’s solidarity among the community can be helpful. I have to be honest, I’m focused so much on what’s going on that I can’t really look outwards. But I think that if people are driving home and they see something that means to them, that people are thinking about what they’re going through, that probably helps them get through the day. Cause it is hard. And I think it’s hard for everybody, but it’s really hard when you’re essentially leaving your safe place, which is your home and going to the war zone, which is the hospital, and you don’t know what it’s going to be like. And then you have to go home again and think about what that means for the people that you’re returning to. So I think that, whether it’s social media or things people put on their houses or messages, I think it all helps to make people feel like they’re not forgotten and that, you know, their work is valued. I think those messages can help sustain us as we continue to work through this difficult time.
Jordan: Tell me about the actual physical stuff people have done. Tell me about the PPE drive and what the response was and how it started.
Michael: So it started, I’ve kind of lost track of time, but I think it’s been about a week, actually. A week ago one of my very good friends, who stood up for me at my wedding, and I were talking about, you know, the issue with PPE, and the fact that we didn’t feel that the needs were going to be matched in a timely manner by the government, despite, you know, what they said they were going to order, which was great, but we felt that, you know, there’s PPE in the community, people want to do something, so let’s make it easier for them to do it. So he and I built a website called the PPEdrive.com we got through all the administrative red tape in my hospital, which was essentially non-existent. They said, sure, we’ll collect it here, we’ll clean it here, we’ll store it here. You build the website, we’ll make it happen. So that’ll happened really overnight one night, we built the websites, got the URL, et cetera. And then over the past week we had over 250 individuals or businesses donate like hundreds of thousands of items of PPE. I’m not exaggerating, with more coming. We’ve actually extended the drive for another week, and more importantly, we built the site so that other hospitals and healthcare institutions can add onto our website with our own community drive. So we had, I believe we have eight other hospitals in Ontario who have attached themselves to the PPE drive and are able to procure PPE from their community. So this is a community effort. We’ve also been able to generate a lot of ideas about how to make PPE and unconventional ways. So we have guidelines for people who do 3D printing. We’ve also pivoted to demonstrate to people how they can create masks, not so much for healthcare workers, but for visitors to hospitals and also for patients once they leave hospital. We’ve been able to find corporate sponsorship to go and pick up PPE from people who can’t make it to the hospital. And the outpouring of interest from the community is really unrelenting. So we have a whole technical team. We have people from Twitter helping us, and the hospital foundation, really leading the charge. So I couldn’t be more proud of, you know, the East Toronto community and all the people who have contributed from beyond our local area.
Jordan: I saw a picture of, I think it was you standing in front of all the shelves that people had brought in and it was amazing. It was really something that I needed to see. And so, thank you for starting that and for providing a model that other hospitals can use to let the community pitch in. Because that’s my last question is just, I’m still in the same place that a lot of people were when they heard you last week, which is I want to do something. I don’t have any PPE in my house, but I want to do something. What can I do?
Michael: So if you, if you go to the website, there’s a link for how to, you know, how to make a mask. If you happen to be handy in that respect. Please physical distance, just please listen to me. Support the people who are working in healthcare. Just check in with them. And then the people who are being left behind, either financially or socially by this new world that we live in, I think that helps a lot. And wash your hands. I mean, all these little, they seem like little things, but they make a material difference and how bad this is going to be. It doesn’t have to be big. Just do something small and do it consistently. And then, you know what, if you are a business owner, if you have means, and if you can help people, if you own a restaurant, if you have links to manufacturers, if you’re a 3D printer, if you’re a distiller who can make alcohol hand sanitizer for the community, so all the community hand sanitizer can come to the hospital, come to the website, send us a message, we’ll get you hooked up. We’ll figure out a way for you to be deployed in a way to help. Not just us, but everybody. So the opportunities are limitless. And if it’s, you know, an elderly lady who has a needle thread making one mask, that makes a difference, the scale doesn’t matter.
Jordan: And the website is the PPEdrive.com and all the instructions are there.
Michael: Absolutely correct. Yeah.
Jordan: Thank you so much for taking the time, Dr. Warner, and good luck with what you’re facing this week.
Michael: Okay. All the best. Have a good day.
Jordan: Dr. Michael Warner is the Medical Director of Critical Care at Michael Garron Hospital. And that was The Big Story. We are covering this story because it is the only story every single day now. Sometimes it will be horrifying. Sometimes it will be hopeful. But we’ll be here with you as it develops. If you’d like to tell us what you’re up to, you can record a voice memo on your phone or record a video and send it to firstname.lastname@example.org. You can find all of our other reporting on this subject at thebigstorypodcast.ca. You can find us as always on Twitter if you just want to talk at @thebigstoryFPN. If you’re enjoying or at least finding it useful, what we’ve been doing through this crisis, you can go to your favourite podcast player and leave us a rating. Leave us a review. It helps us know that what we’re doing matters. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.
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