Brothers in ERs living extremes of pandemic — in Victoria, in New York

Omar Ahmad says he only has to talk to his brother to know what people living on Vancouver Island have been spared. Ahmad, 46, is the Victoria-based department head of emergency and critical-care medicine for Island Health, while his brother Danish Ahmad, 36, who specializes in emergency and critical-care medicine, is at Mount Sinai Hospital in New York, which has been hit hard by the pandemic.

The two emergency physicians are living out the extremes of the global pandemic, one having just a handful of critical-care COVID-19 patients and the other forced regularly to have end-of-life conversations with patients.

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In a series of COVID-19 webinars hosted by emergency and critical-care specialists through UBC’s Faculty of Medicine, Danish Ahmad said his residents rotate between Mount Sinai Hospital and Elmhurst Hospital, the “epicentre of the epicentre” of the outbreak in New York City, where more than 26,000 COVID-19 deaths have been reported.

“It is honestly incredibly challenging, frustrating, and draining — both physically, between wearing the personal protective equipment, and also emotionally, where we’re constantly having these end-of-life discussions with patients on a day-to-day basis,” Danish Ahmad said. It’s hard to grasp the magnitude of what is happening, while everyone is just “heads down and pushing our way through.”

“I think in a couple years, we’ll all look back and be able to process this,” he said. “It has been striking the lengths we’ve gone to to take care of patients.”

Thousands of kilometres away, Omar Ahmad looks at an empty Gyro Park playground in Cadboro Bay and marvels at how timing, the community’s adherence to physical distancing, and good planning have helped Vancouver Island to avoid the worst of the pandemic.

Omar said his brother’s insights have helped him prepare for what Victoria could be up against. “There was a lot more learning coming from his direction than vice-versa, for sure,” he said.

Based on the experiences in China, Italy, New York and Vancouver, Victoria physicians were bracing for the worst, he said. “We were expecting that wave to hit, so hearing from Danish frequently was very educational.”

Through the University of B.C. webinars, Danish’s experiences helped inform Omar’s decision-making, as well as the decision-making of many across the province, Omar said.

With his own years of experience with other diseases, Omar tempered early enthusiasm about new drugs and therapies for COVID-19. “I’ve seen other diseases, maybe not a pandemic like this, where there’s a lot of interest in a particular drug or a therapy and everybody jumps on the bandwagon and then lo and behold, a year later or six months later, you realize it didn’t actually work or there’s better studies.”

Sometimes, Omar would just give his brother an ear. “He would call me up and talk about some pretty horrendous cases, some pretty tough end-of-life discussions he had, and some touching moments.

“It’s a tough go at the best of times in emergent and critical care, and so we’re always there for each other.”

Typically, tough cases come a few times a week or a month, but during the pandemic, “cases were hitting him hard three, four times a day. He’d be talking about seeing somebody on the floor that’s alive and well and then four hours later they’re dead.”

The Ahmad brothers are the sons of Nafees Ahmad, from New Delhi, India, and his wife, Zeenat Ahmad, from Karachi, Pakistan, who moved to Canada via England in the early 1970s. A naval architect and engineer, Nafees moved the family first to Toronto, then to Sidney, where he worked for B.C. Ferries, and to Ottawa, where he worked for the coast guard.

In 1992, Nafees accepted an offer to run a cruise line headquartered in Miami, where he was followed three years later by his wife and son Danish. Sister Hana, who was studying law at the University of Ottawa, and Omar, who was at the same university pre-med, stayed in Canada.

In the United States, Danish followed in his big brother’s footsteps, studying medicine in Florida, then doing his residency in New York, where he was certified in emergency medicine, internal medicine and critical care.

As a physician, Omar said he can’t deny wanting to be in the eye of the storm with his brother, helping and learning, but as a department head in Victoria, he’s grateful that Island hospitals and health-care workers weren’t overwhelmed and the death toll has remained low.

Omar Ahmad said he almost feels sheepish that he’s only dealt with two of the six COVID-19 cases to come through his intensive care unit.

COVID-19 planning on the Island started in earnest in February, he said. By the time the provincial state of emergency was announced on March 18, everyone was in high gear, working together across the province. Five days a week, there were early-morning conference calls across the five health regions.

“The collaboration and concern for everyone was just incredible,” he said.

Island Health, following the lead of provincial health officer Dr. Bonnie Henry and B.C. Health Minister Adrian Dix, made plans for a worst-case scenario, using modelling by the B.C. Centre of Disease Control based on experiences in China and Italy.

B.C. physicians also learned from Quebec and Ontario, where people were returning home sick from international travel during an earlier spring-break holiday.

By early March, physicians in Island Health were also watching hospital admissions in the Lower Mainland.

Province-wide school closures, travel bans and physical-distancing orders helped to reduce new cases.

More than 30,000 non-urgent elective surgeries were cancelled or left unscheduled so about 4,000 hospital beds would be ready for a possible surge in COVID-19 cases. On Thursday, the province began rescheduling those surgeries and diagnostic and screening procedures.

“We were ready to go, we were ready to save lives and do what we needed to do, for sure,” said Omar Ahmad.

Hospital administrators and department heads planned for ventilators, personal protective equipment, the re-deployment of nurses and doctors, the recruitment of retired nurses and physicians, and serving remote and rural areas.

“Everyone stepped up,” he said. “We were just so prepared and our staff, emergency docs, ICU docs, administrators, everyone just working like crazy, but at the end of the day, our numbers are extremely, extremely low.

“We feel like our public got on top of it, that people heeded the public-health warnings.”

Royal Jubilee Hospital has seen few COVID-19 patients admitted to the intensive care unit, he said, and “every single one of them except for one has done very well.”

“We haven’t seen here, firsthand, all those other complications. Most people are presenting fairly typically for the most part. We haven’t seen those crazy sort of cases that my brother has seen in New York.”

“The numbers they’ve seen, of course, are astronomical. They have seen the blood clotting. They have seen the unexpected neurological syndromes. They’ve seen all the usual stuff. They’re seeing the person just walking down the street who unfortunately gets hit by a car, has no complaints of COVID-19 and they do the work-up on them to find that this patient with no symptoms has COVID.”

Danish has also seen patients with silent hypoxia — dubbed “happy hypoxia” — to describe people whose blood oxygen saturation levels should cause them to be incoherent and their lung condition should see them gasping for air, but instead their symptoms appear mild. By the time they realize they are sick, they are gravely ill.

The mortality rate in B.C. at about 14 per cent is “surprisingly low” compared to other parts of the world, which saw a 40 to 50 per cent mortality rate in their ICUs, said Omar Ahmad. Of the 127 people who have died of COVID-19 in B.C., five have been within the Island Health region.

Omar said the first day coming in contact with the virus was daunting.

He was working in the emergency department when a stable patient with underlying health problems who had been handed over to him began to worsen. He soon required life support.

“In the middle of all this, it dawned on me maybe this is COVID.”

All the simulations and practice kicked into gear. He suited up and limited those in the negative-pressure room to only himself and respiratory therapist Dave Oh as they put the patient on life support. In a non-COVID-19 situation, there could be up to five in the room.

Afterwards, he showered, “which is very unusual.”

“When I went home I was worried. It was late shift and it was 3 a.m. in the morning, so I slept in a separate room away from my family that night and I didn’t really interact with them until the COVID [test] came back negative the next day,” said Omar, who is married to Dr. Leah MacDonald, a palliative-care physician and Island Health executive medical director. He is the father of three.

He praised the bravery of allied health professionals — respiratory therapists, nurses, housekeepers — who despite the “horrors” they had heard about in Italy and other parts of the world, did their jobs “humbly” and gave the “great care and love” they always do.

“People were like: ‘How can we help? This is our job, this is what we do,” said Omar. “Everyone just rose to the occasion.”

He said he and his colleagues are heartened by the cheers that ring out from communities every evening at 7 p.m.

“I don’t think we are worthy of all the clapping and support that happens at 7 o’clock, but at the same time, I think what it’s turned into is, I believe, the communities are also clapping for each other, not just health-care workers, but everyone.”

While this first wave of the pandemic has come with a lot of dread, it has also filled him with hope, he said.

“With the incredible social distancing we’ve done, we just haven’t seen that primary surge and I feel quite confident that if we continue to self-isolate for a period longer and get our number low, I think if we do have a secondary surge, the work we’re doing now will allow us time to deal with it quite effectively without being overwhelmed.

“We just need to hold the course.”

ceharnett@timescolonist.com

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