It’s been eight weeks since Marianne Gervais cancelled her family vacation to Florida due to COVID-19. As a nurse with Ottawa Public Health she understood the risks associated with travel and opted to stay home, despite protests from her three daughters. She knew her nursing skills would be in high demand as the health care system would need all hands on deck to navigate the uncharted territory of a global pandemic.
Since the arrival of COVID-19 in Ottawa, Marianne has been leading a team of nurses who check in with each resident who tests positive for COVID-19 to make sure they are getting the care they need.
Marianne, what have the last two months been like?
The whole experience has been incredibly intense. Right now, we’re seeing more positive cases among health care workers, since the province required all long-term care employees to be tested. Many of those positive cases showed no symptoms, which just goes to show how important it is to test broadly.
For the last four weeks, we have been following up daily with every resident that tests positive for COVID-19 or is presumed positive based on what we know about their exposure and symptoms. These follow-ups take a lot of staff hours, so we’ve restructured ourselves a bit to tackle this challenge.
Each lead nurse oversees a pod of four of five nurses. We also have crew members that help us, and they might work in a different pod day to day, depending on where the help is needed.
Are you getting support from the health sector more broadly?
Absolutely. Our public health nurses are such warriors, and we’ve developed a good system to support them. Our crew members come to us from all over the health sector: nursing students, medical students, nurses from the Children’s Hospital of Eastern Ontario, nurse practitioners, etc. We also have dentists helping, as well as staff from specialized health clinics who are available since their regular offices are closed. Collectively, they put in a huge number of hours. It goes a long way, especially when it comes to contact tracing positive cases.
You mentioned patients with COVID-19 receive a follow-up call each day. What are these calls like?
One of the difficult things about this virus is how unpredictable it is. We’ve seen cases where a patient feels unwell one day but is managing alright at home, and the next morning they take a turn for the worse and need to go to the hospital. Checking in daily lets us monitor closely for new or worsening symptoms.
Because follow-ups are done by phone, not in person, we have the same nurse call the same patient as much as possible. Each nurse becomes familiar with how their patients typically sound and they can hear it in their voice if they are sounding stronger each day. Or if they are taking a turn for the worse, that’s when we take action to help patients get additional care, which may include hospitalization.
How are people responding to the daily calls?
Most people appreciate that we’re checking in regularly. These patients are in quarantine for a minimum of 14 days. Some live alone. It can be lonely, so they like having the chance to chat with us.
I realize you speak with dozens of patients each week, but are there any that have made a big impression on you?
The details of the first few COVID-positive cases I dealt with are still so clear in my mind. One of my first patients was a woman with cancer.
This woman did everything right. She followed all the protocols to the letter, but because of her cancer she had a compromised immune system and she caught the virus. Having COVID-19 meant she had to stop chemo, yet she was always more concerned about the impact on others, like the family member who travelled from another city to help take care of her. I knew she felt guilty and worried that she may have spread the virus to someone else.
As nurses we are used to treating very sick patients, but the guilt we hear about from patients with COVID-19 is tough to witness. It’s one of the reasons I’m glad our follow ups are daily. It means we can check in on our patients’ mental health as well as their physical state.
What are the conversations like as people approach the end of their quarantine?
Pretty much everyone asks the same two questions: Am I now immune, and how can I help?
People are so eager to help once they’ve recovered. Canada Blood Services is participating in a national clinical trial to determine whether blood therapies could be a treatment option for patients with the virus, so that’s typically where we refer people.
In terms of immunity, we think there is a period of one to two years where people who have recovered are immune, but there is no guarantee. Even if you’ve had the virus, we still recommend that you follow physical distancing and hand washing guidelines.
Can you tell me a bit about what goes into contact tracing?
It was labour-intensive at the beginning. We were contact tracing before the stay-at-home orders were in place. At first it might have taken me three days to call all the contacts of one patient. Now that the number of contacts per patient is lower, I can get through three or four cases in a day, with crew members helping.
How do people react when they get that phone call? Are they alarmed to hear from you?
Less so now than people were at first, but people still ask who they were in contact with that has the virus, if they don’t already know. We sometimes get pushback when we explain that this is an anonymous process. But we point out that if the roles were reversed and they were the positive case, they would want us to respect their privacy.
What are things like at home?
I live in the rural east end with my husband and three daughters. My parents, brother and niece live with us as well, so social isolation is not an issue in my household! My parents help with the kids, and the girls love having their cousin around.
Being a nurse and working through this crisis offers a lot of perspective, so when I get home at the end of the day I know how lucky I am to have a large, supportive family there waiting for me.
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