UP alumna Dr Amy Louise Collyer on the stressful cycle that has become the life of many healthcare workers as they fight to save the lives of their COVID-19 patients, worry about their own mental health and challenge misinformation.
It is 23:20, and the emergency bell begins to ring; it is high pitched and deafening. It signals that medical assistance is needed somewhere in the hospital, so I check the monitor: it's the COVID-ICU. That's my cue. I race to quickly dress in a new protective gown, hat and booties (if we are lucky to have all these things). I fumble to get my hands through the sleeves of the gown, and once I do, I sling my stethoscope around my neck, fit a visor, and start running. I press the first elevator. It has to come down from level 4, but I'm on the basement level, so I sprint and slam on the button of the other elevator around the corner – same thing. The alarm is still ringing; I take the stairs instead. Panting, heart racing and visor slightly misted, I arrive at the entrance doors of the ICU. I wave my access card and continue running. Blue-robed beings are shuffling. The ICU is heaving with multiple patients on ventilators or other machines that help people breathe. There is continuous beeping from all the different monitors in the room. I follow the sounds of commotion towards the bed where I am needed.
Nurses are circling a patient who is gasping, clammy, and barely holding onto life. One of the nurses states, "Day 33 of COVID-19 in ICU, on maximum treatment". She also rattles off the patient's chronic conditions and tells me about the sudden deterioration in the last few minutes. I check the pulse, airway and breathing. There is a faint pulse, and the oxygen supply is connected and running, but the patient is getting worse by the second. I phone the patient's physician, "Not for active resuscitation," I hear on the other end of the line (this happens when the prognosis is poor). We make the patient as comfortable as possible, given the situation. The gasping becomes less frequent, the effort to breathe decreases, and eventually, the patient dies. We call the undertakers, and I write the death certificate. I hope that COVID-19 viral particles haven't penetrated my personal protective equipment (PPE) somewhere along the way.
I retreat to the emergency unit to continue seeing new COVID-19 patients and other cases like heart attacks, strokes, and trauma. It's one of those busy nights where we have run out of space and have to hustle to find beds in other hospitals for our sick patients. It's also one of those nights where I keep hoping that when I blink my eyes and reopen them, it will already be the morning, so I can go home to carefully remove my work clothes and put them in a bag for washing, take a shower before interacting with others, and have a reprieve— some "normality"—before heading back to work to do it all again: to deal with the gasping, the death (of patients and colleagues), the disease complications, the heartbreak, the mourning families, the organising, and other struggles. A variation of this stressful cycle is the life of many healthcare workers at the moment. Granted, it is not always this busy and challenging. We see mild cases that we can send home, and we see patients who recover from being hospitalised. Still, we watch them return with impairments that they didn't have before, and we wonder how long it will be, if ever, that they will feel 100% themselves again.
Healthcare workers have had to deal with so much during this pandemic. Burnout and the development of mental health conditions have increased. Many of us have lost colleagues, many patients and loved ones. We are drowning, working in understaffed and under-resourced facilities that often run out of oxygen, PPE, and other essential equipment. In addition, we also have to deal with the exhausting effects of the infodemic of misinformation that challenges our chances of eliminating COVID-19 and only negatively impacts others. Each week there is a new story, a new conspiracy, and new people who deny the existence of this disease or spread misinformation (either intentionally or unknowingly) about the few options we do have to control things, like masks and vaccines. We wonder when this will all stop.
We understand that it's a confusing world out there. It's challenging to know what and whom to trust, especially when so many sources and people we look to for leadership start spreading anti-science and anti-vaccination rhetoric. That's why it is vital to find trustworthy sources, like university websites, scientific journals with high-impact factors (listen to health communicators who can translate and simplify this information), and non-profit health organisations.
Whilst it is essential to focus on treatments for COVID-19, many have been and are still being trialled, and we only have a few options so far that have shown effectiveness. Most of them are expensive and inaccessible to many. While research will continue to focus on that, prevention is still better than cure. We do know that the best way to control a viral pandemic is with layers of preventative measures that the community can take to help each other, such as masking and social distancing when in public; washing hands and staying home when we are sick (public health initiatives that we learnt in primary school) and vaccinating: no viral outbreak has ever ended through natural immunity alone.
The COVID-19 vaccine is the light at the end of the tunnel, an incredible example of the astounding progress that science and technology have made. It shows us what can be achieved when people work together for the good of all. Already, over 4 billion people worldwide have been vaccinated, and there have only been very few cases of side effects; there are more consequences if one has to endure COVID-19 itself. We also have a wealth of data showing remarkable benefits: it reduces one's chances of dying from COVID-19, minimises the possibility of one getting severe diseases, and helps prevent transmission to some degree, but this is still being studied. The COVID-19 vaccine is safe in breastfeeding, in those who are pregnant (after 14 weeks) and in those with chronic conditions. It is vital to vaccinate even if one has had COVID-19 before and is even fit and healthy. We only hope that in the future, vaccine access improves worldwide. Hopefully, more people will be exposed to evidence-based health communication that will encourage them to choose vaccination, a collective action to help save lives and curb this pandemic.
Dr Amy Louise Collyer is a University of Pretoria medical graduate. She works as an emergency doctor and spends her free time communicating health online.
This article first appeared on News24 on 6 September 2021.