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Vaccine relieving pandemic pressure at UHNBC

ER doctor pleads with community to remain vigilant as COVID case counts continues to rise in Northern Health region
28 ER doc Brian Hillhouse
Family doctor Brian Hillhouse and his health care colleagues at University Hospital of Northern B.C. have been put the test the past the 10 months dealing with the most deadly pandemic of the past century, which has forced the hospital staff to team up in a collective effort to fight the COVID-19 virus.

The arrival of the new year has been no cause for celebration for pandemic-weary medical staff at University Hospital of Northern B.C.

News cases of the killer virus continue to show up daily, stretching the ability of the largest hospital in the Northern Health region to treat sick people. As of Monday the hospital infectious disease unit was still at full capacity with 32 patients suffering COVID illness.

“Our numbers have been growing daily now,” said Dr. Brian Hillhouse, a family doctor who works in the hospital’s emergency department. “So everything’s full, the ICU and infectious disease unit and the COVID ward, formerly family medicine unit, are all at full capacity.

“It’s definitely on the uptake still. Northern Health hasn’t quite seen the flattening of the curve that the Lower Mainland has. Usually we’re a bit behind them, so it’s really encouraging that they’re seeing the curve flatten there and I suspect that we will see it shortly.”

As Northern Health’s medical lead of long-term care facilities, Hillhouse was encouraged by the arrival of the Pfizer vaccine on Dec. 22, a week earlier than anticipated, and it was used the following day on the 20 patients at Jubilee Lodge who did not already have COVID. One of the stipulations of the Pfizer contract was the super-chilled vaccine could not leave the hospital building, which prohibited many cities from getting the vaccine to care homes. But because Jubilee Lodge is attached to the main UHNBC building, patients there were given their shots  within a day of its arrival. 

Fourteen Jubilee patients died since the outbreak was declared Dec. 12 and 48 patients and 14 staff at the 66-bed facility tested positive. But Hillhouse says the vaccine has turned the tide for some of the northern B.C.’s  most vulnerable people.

“Now that we have vaccinated the long-term facilities, that is such a huge relief,” said Hillhouse. “Eighty per cent of the deaths are in long-term care facilities.

“On Dec. 27th, that was our last case in a resident off Jubilee.  I don’t know if you will see another case report like that, where you had such a high risk, with six cases a day converting positive, and all of sudden you vaccinate and it stops. It shows you the effectiveness of the vaccine.”

Over the next two months, with the Moderna vaccine supplies expected to arrive, Hillhouse says Northern Health plans to vaccinate everybody over the age of 80 as well as people in vulnerable living situations, such as homeless street people and group-home residents.

The majority of UHNBCs frontline staff have received the vaccine and Hillhouse says all long-term health care staff, even in Northern Health’s rural communities, are getting their shots.  UHNBC received 1,900 doses and Hillhouse has received  his first vaccination. The second dose is supposed to be administered within 32 days.

 “The vaccine rollout is really ramping up fast ,” said Hillhouse. “We’re currently vaccinating our rural communities in B.C. and we’ve vaccinated all of the long-term facilities now, which is huge. I think this topic of outbreaks in long-term care will be a thing of the past.” 

Adaptation has been key in keeping UHNBC functioning efficiently. When the pandemic was just beginning in March, Hillhouse was in on the military–style crisis planning meetings that involved the heads of medicine of all departments, public health officials and hospital administrators and it was determined that 26 was the maximum number of COVID patients the hospital could handle, using extreme measures.

“We’ve now had over 26 consistently for the last two months, with hardly a blip in our health care services,” said Hillhouse. “We’ve had to redesign the way the hospital works to handle that and still continue to provide normal care.”

In early December, the family medicine unit on the second floor was turned into the 21-bed infectious disease unit, with the other half of the floor devoted to the internal medicine unit, which is now used as the main medical ward in the hospital for patients with non-COVID conditions.

Hillhouse said COVID outbreaks at UHNBC have also occurred in the infectious disease unit, internal medicine unit, and rehabilitation, as well as Jubilee Lodge. Nineteen internal medicine patients and 12 staff (mostly nurses) tested positive and there were three patient deaths, while three patients have tested positive in the rehabilitation unit. The numbers for the infectious disease ward were not available. The worst rash of infections was at Jubilee, but there are now just two active cases (of the 531 total active cases as of Monday in Northern Health) and 32 patients are considered to have recovered.

Hospital staff shortages have been ongoing throughout the pandemic. Hillhouse was asked about reports of care-aid staff from Jubilee working their shifts with infected patients in the lodge, then taking overtime shifts that same day to work with non-infected patients in the short-staffed rehab unit, which is on the ground floor directly below Jubilee, and how that could possibly lead to cross-contamination.

“Right off the beginning, in March, there was a single-site order in the long-term facilities because they don’t have that ability to reach out to other work forces for casual (shifts),” said Hillhouse. “You can’t go from an infected area into other areas.

“Jubilee has been short-staffed all year, even before the pandemic, and as a result they didn’t have all the beds filled and that’s been an ongoing battle with all the nursing homes with staffing.”

Nurses with critical-care backgrounds who either retired or moved into management have volunteered to returned to their jobs to help the hospital deal with the crisis and Hillhouse says that has helped alleviate some of the shortages.

The sickest COVID patients at UHNBC are in the intensive care and infectious disease units. As of the start of this week, five people are on ventilators in ICU and eight are in the infectious ward. ICU capacity has been doubled in Prince George with two intensive care specialists and a team of ICU nurses on duty at all times. Each ICU/IDU doctor works 12-hour shift and also has to deal with non-COVID critical-care patients. UHNBC has a pool of about 10 ICU specialists, some of whom are locums who come in from other cities.

Much has been learned about COVID strategies and best practices for hospitals in the 10 months since the COVID pandemic took hold in March. One example of that evolution is intubation procedures. Initially, intubation was recommended for treating the sickest patients struggling to breath properly and that demand led to a worldwide shortage of ventilators. But through trial and error, doctors have shied away from intubation, a process which uses drugs to paralyze the breathing muscles of an unconscious patient to allow a machine to do the job of the lungs.

“In March, when this was brand-new to us, there was definitely a drive to early intubation and early aggressive critical care,” said Hillhouse. “We’re still doing critical care but intubation and ventilators are the last resort now.  There are long-term harms with the ventilators.

“ICU is no picnic, it’s hard on the body. There’s always huge long-term implications, there’s lung disease, there’s infections, there’s vascular problems, there’s post-traumatic stress. Ten per cent of people with a COVID infection will have long-term complications.”

Because COVID is a respiratory disease, demand for oxygen has skyrocketed. The problem is, the hospital building was not designed for it and the plumbing and piping infrastructure is not sufficient to deal with crush and UHNBC staff have had to utilize bottled oxygen.

Diagnostic procedures such as ultrasound, endoscopy, colonoscopy, mammography and MRI tests have been interrupted by COVID and the hospital has postponed elective surgeries but not to the same extent lately as early in the pandemic, when businesses were locked down across the province and those screenings came to a virtual standstill.

“We’ve been very careful not to stop, like we did earlier in March, when there was a complete shutdown of everything elective,” said Hillhouse. “That had a huge impact. That was because we didn’t have the resources, we didn’t have the PPE or the training and we didn’t know where things were going. We didn’t even have (COVID) testing and now the healthcare system has ample testing and resources and is now ready to face it.”

Hillhouse, a 43-year-old Prince George native who graduated from the Northern Medical Program in 2008, is a father of three and there’s not a working day that goes by when he doesn’t think about what he might be bringing home to his family, and he knows his health care colleagues are thinking the same thing.

“You put your cellphone in a plastic bag and every time you take off your mask and shield you’re trained to know that’s where your weakness is and you could contaminate yourself when you take your stuff off,” he said. “Every time you wash your hands you think you’re washing off COVID and the thought haunts you throughout every action.

“It’s been a huge relief for the frontline health care staff have all been offered the vaccine now. You can just  see the elation and their spirits rise when they get the phone call that they know they can book their appointments. It’s a small celebration for the health care community.”

The effort to defeat COVID has had at least one positive effect – it has united health care professionals into a team trying to achieve the same objective .

“Now, basically, we’re in wartime and if anything it’s brought the medical community together and kind of revitalized us,” said Hillhouse. “There are lot more interactions, a lot more meetings and planning and a lot more working with administration. I’ve been practicing for over 10 years and only rarely would ever see an administrator or manager  and now every day I’m on the phone with them. Instead of all clawing at the resources and fighting for our piece, now it’s everyone together in a common battle.”

Part of Hillhouse’s job as doctor is to phone family members often with bad news about their loved ones. He’s had to tell people their mother or father have died or that they won’t be able to visit somebody they love, and in the case of a nursing home resident that separation has lasted the better part of a year. But throughout the pandemic he’s never felt unappreciated.

“Despite all these tragedies, the community has been so understanding and so supportive, always thanking us as for the work we’re doing, it’s really heartwarming and I’m really proud of our community in how resilient we are in being able to manage this” he said. “We’ve had less resources and less access to things and yet we’ve been doing really well with this.

“We’re not out of the woods yet. It’s soon, and we can see the end of it, but we’re depending on people to take it seriously right to the end.”