A glimpse inside the ER during the pandemic's 3rd wave

As Ontario's hospitals prepare for the possibility of triaging life-saving care in the eventCOVID-19 cases further overwhelm resources, one Ottawa doctor saysshe's not emotionally prepared to make such choices.

"I don't think any of us thought we would need to make these decisions when we entered medicine," said Dr. Justine Amaro, an emergency room physician at The Ottawa Hospital.

Amaro saida sense of "foreboding" has blanketed the emergency room as she and her colleagues watch hospitals in the Greater Toronto Area (GTA) exceed their capacity to care for critically ill patients.

As of Saturday, there were approximately 100 patients on ventilators in intensive care wards across the nation's capital, according to Dr.David Neilipovitz, head of critical careat The Ottawa Hospital and is also leading the critical care effort in eastern Ontario.

Of those patients, more than halfarepeople who've been diagnosed with COVID-19,Neilipovitztold CBC. Three out of four COVID-19 patients are on ventilators, he added.

There has been a slight plateau of some key COVID-19 indicators in the city, however, and on Saturday, Ottawa Public Health reported thelowest one-day case total in more than three weeks.

• COVID-19 case drop could be short-lived if not careful, experts warn

The Ottawa Hospital also said in mid-April that it was not close to deciding who gets life-saving care.

But if the availability ofICU beds or staffing reaches a critical point, doctors will follow a provincial triage protocol based on mortality risk.

Critically ill patients who have the best chance of survival one year later would be prioritized under the protocol.

Changing concerns in ER

When COVID-19 first arrived, Amaro said there was a lot of fear aspeople didn't know how it spread or how dangerous it was. At the time, hospital staff were primarily worried about shortages in personal protective equipment.

In fact, ER visits declinedduring those early days a sharp contrast to what's happening now.

By last fall,Amaro said she started to notice a new trend: more patients coming in with late stages of diseases, suggesting they had put off seeking medical attention.

Amarosaid she sawpatients come in who'd already had heart attacks andstrokes, as well as people withmetastatic cancers that had spread. In one case, sherecalled a patient going into septic shock due to a gall bladder infection.

"He was dying of a life-threatening problem that, had he presented himself earlier, it could have been dealt with," said Amaro.

Parents,front-line workers among younger ER patients

In the past two weeks, Amarosaid she's seen a greater number of patients in their 20s, 30s and 40s with COVID-19.

• Ontario's 3rd wave of COVID-19 could hit younger adults harder. Here's why

Sometimes, entire families or multiple members of a family are infected. In one case, Amarorecalled two parents who were both admitted to hospital with no one to take care of their young children.

The doctor said she's also seen cases where grandparents are filling in the child-care void.

"I've also had patients where a parent is too sick to go home but they choose to leave the hospital and go home anyway because they have no other option," said Amaro.

Among Amaro's younger patients are essential front-line workers, some ofwhom do not have the option to stay home. They also include people without paid sick leavewho live in crowded spaces with large families.

'A huge toll'

Amaro said she's still haunted by one "heartbreaking case" involving one of her older patients.

"I've literally sat with an elderly person who has begged me to please provide them with medical assistance in dying, because they would rather die than continue living in an isolated way," she recalled.

Emergency rooms filled with patients experiencing mental health problems, doctor says

3 years ago

Duration 1:11

Dr. Justine Amaro, an emergency room physician at The Ottawa Hospital, says more people, including elderly residents, are experiencing mental health crises during the pandemic due to continuing social isolation.

"It breaks my heart to watch people literally feeling they would rather end their life than they would continue to live on in a way where they are alone."

In the 17 years she's worked in emergency medicine, Amaro saidshe's never seen so many patients suffering from deteriorating mental health.

"The social isolation," she said, "has taken a huge toll on all of us."