Maureen Taylor is a physician assistant in infectious diseases at Michael Garron Hospital in Toronto.
I have lost track of how many patients I’ve cared for who were infected with COVID-19, but now it’s in the dozens. Our hospital started to see admissions the week of March 16th, just as the provincial government announced a shut-down of non-essential businesses, and the federal government enacted wider travel restrictions. Over the last 5 weeks, I feel that I have witnessed the arc of the narrative of this pandemic through my patients. Although this is not scientific, and can’t be generalized beyond my hospital, this is my coronavirus experience.
Week 1
The first patients in mid-March were the travellers. There were a couple of cruise ship returnees. There were a few who’d just returned from vacations or business trips to hotspots like Spain and the UK. A couple were people who hadn’t travelled, but close family members had. I have no idea about the personal wealth or education of these people, but clearly they had financial resources.
Week 2
The next wave of patients indicated community spread of COVID-19. I saw essential workers from bakeries and grocery stores. Airport limousine or taxi drivers who just laughed when I asked if they remembered passengers who were coughing. Duh. There were one or two patients who insisted their only contact beyond their home was to go grocery shopping. This was before retail outlets imposed limits on the number of shoppers entering stores at a time.
Week 3
By the beginning of April, there were no more patients with a link to travel, but there was now a definite trend in the socioeconomic background of our COVID patients, which continues to the present. Very few of them speak English as their first language. They are often from multigenerational families, living in small apartments within apartment tower complexes. There is usually someone in the household who is still going to work, sometimes in a healthcare facility. But it is often the grandparents who are sick enough to need to be hospitalized.
Weeks 4 and 5
As has been reported in the US and elsewhere, COVID-19 is disproportionately affecting marginalized and disadvantaged communities. It is not clear whether public health authorities in Canada are even collecting these data on COVID-19 patients, but this is consistent with my COVID patient arc. I am now seeing patients from homeless and refugee shelters who are COVID-19 positive but thankfully showing very few symptoms. But they need to stay in hospital because they simply have nowhere else to go. The City of Toronto is now finding hotel rooms for this patient population where they can remain for the entirety of their self-quarantine before returning, I assume, to their shelter. My patients are nervous about that return because they know that shelter outbreaks are not under control in Toronto. I try to reassure them that having had COVID-19 should give them at least temporary immunity. At least most experts believe that’s the case.
Final Thoughts
I do wonder whether governments and public health have done enough to communicate, in multiple languages, the importance of social distancing, hand hygiene within households, and other protective strategies. Have they reached out on the social media platforms and community newspapers that my patients are more likely to rely on for news about the pandemic?
One population that I haven’t seen in huge numbers yet are residents from nursing homes. This is a surprise to me, because I know some of the long term care homes in our hospital’s catchment area have COVID-19 outbreaks. I credit the diligent work of our hospital’s ID/geriatrics teams who reached out weeks ago to provide these facilities with on-site expertise, personal protective equipment for staff, and assistance with discussions around end of life goals of care in the event the resident becomes gravely ill with COVID-19.
I don’t know where the arc of this narrative is headed in the next few weeks. Ideally, I’d like to have so few new admissions for COVID that I’m back to more mundane infections like diabetic foot ulcers. Something I never thought I’d hear myself say.