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What you need to know about COVID-19: September 23, 2020
As an ear, nose and throat (ENT) doctor and surgeon, Magdalena Kujath knows how important it is to respond quickly in a crisis, especially when airways are concerned.
It is part of their training and regular practice, as an acute medical emergency can have them reshuffle their weekday or even leisure time at home in an instant.
The difference with this pandemic, however, says the Kentville, N.S. doctor, is that these changes are drawn out over months as opposed to hours, and the manner in which they can respond is ever changing as they have to balance new concerns for personal and public safety.
“This sustained sense of urgency doesn’t allow us to recalibrate and find a new routine,” says Kujath.
Further complicating matters, ENTs work in the upper airway, which COVID-19 affects, and knowledge about appropriate protective equipment for their procedures is ever evolving.
“What we do is the same but the how is changing,” she says.
As with most doctors, this level of energy and frenzy has been ongoing since the state of emergency was declared in March and it is finally easing up, she says. And, like other healthcare professionals, they are figuring out their new normal.
Plenty of precautions
Krissy Dooling, a physiotherapist at Riverside Therapeutics in St. John’s, N.L., went back to work seeing patients in early May and returned full-time in early June. She says she felt very nervous and cautious about returning to work.
“I wanted to make sure I was following the guidelines exactly to minimize any risk to my patients, my family and myself,” she says.
Now, after two months and dwindling cases of COVID-19, Dooling says her anxiety has reduced.
“At the clinic, we are in the new routine now, and we have a system in place to ensure all areas are clean and sanitized and all patients are protected. I feel good knowing our staff have been educated about PPE (personal protective equipment), sanitization and reducing their own risk and the risk to our patients,” she says.
Healthcare professionals, like surgeons, already work in very high standards of hygiene and disinfection, says Kujath, so they only had to make small modifications to their physical spacing, cleaning protocols and scheduling of patients.
Likewise, Jennifer Williams Saklofske, an audiologist with The Hearing Boutique in Kentville, N.S., says in terms of infection control, they already had strict procedures in place. Because she works in close proximity to patients, she now wears gloves, masks and goggles whenever she comes in physical contact with a patient.
This clinic has also installed plexiglass dividers at their desks.
“As we work with hearing impaired individuals, it is paramount that when speaking, our faces and mouths are visible for visual cues to understand speech,” adds Williams Saklofske.
“To avoid potentially transferring the virus through touch, I am using the plexiglass divider as an ‘invisible line’ and ever time I cross it, in either direction, I sanitize my hands.”
Corena Hughes, a physiotherapist with Body Works, a multidisciplinary clinic in Charlottetown, P.E.I., says their clinic is also focusing on washing and sanitizing surfaces between each patient and encouraging patients to physically distance once in the clinic.
Hughes says they are slowing patient caseloads and seeing fewer patients because they need 10 minutes between sanitizing touched surfaces before the next patient can touch the surface.
“Physical changes we have made to the clinic include having a plexiglass wrapped around our front desk area and removing our chairs from our waiting room and having patients wait alone in rooms in the clinic to see their provider,” says Hughes.
At Dooling’s clinic, staff began by seeing one patient at a time, then sanitizing every surface and piece of equipment after use. Paperwork was completed online to minimize time spent at the clinic and as much information and treatment was done over virtual platforms as possible.
“When we opened in early June, we ensured our waiting area respected the social distancing with chairs six feet apart,” says Dooling. “We removed any magazines and promotional material from our waiting areas and attempted to stagger client appointments as not to have more than one individual in the waiting area at a time.”
Although necessary, changes to the workplace and workflow are not always easy.
Kujath says, even for her profession, the stringent measures of sanitization are magnified. The extreme precautions she’s used to from the operating room are now extended to her office practice and even into her personal life. In a way, she says, she is living in the sterile-conscious environment of the operating theatre all day – and it’s become the norm for the public as well.
“Even for a surgeon, this is an exhausting experience; as rewarding as we find our jobs, and as comfortable as we are maneuvering in that shielded, sterile environment, we do like to leave the operating room and enjoy the freedom of the ‘outside world’ from time to time,” she says.
The biggest change, or challenge, that Kujath sees is the nature of her interactions with patients. There is still a lot of fear in the community and some people are wary of venturing out even to see their doctors, she says.
“The prescribed physical distancing and protective gear has me wearing a mask so patients can only see the upper half of my smile from six feet away, hearing-impaired patients have added frustrations with comprehension as they can no longer benefit from lip-reading, and with my paediatric patients, high-fives and stickers have been cut out of my routine,” says Kujath.
Kujath did manage to turn one challenge into a chance for creative problem solving.
“I saw a patient mid-pandemic with sudden onset nerve hearing loss,” she says.
“This is an urgent situation and we cannot afford delays as there is only a small window of time in which to rescue the hearing and prevent irreversible damage.”
Normally, this diagnosis is made and monitored through treatment with an audiogram – a formal hearing test - which was not available because of nationwide shutdown of these services.
“In lieu of a formal hearing test, I pulled out my tuning forks and conducted a cursory hearing screen, using historical methods from the dawn of electricity and era of Beethoven,” she says.
“Happily, based on my diagnosis, the patient was able to receive appropriate treatment and had full recovery of her hearing.”
Slowly, services are returning, and practitioners are returning to a more normal flow.
Through it all - and all the changes - Hughes says patients have been incredible.
“They are very kind to each other, very understanding if they have had to wait longer for their appointment and very compliant once in the clinic to wash their hands and physically distance,” she says.
“I have been impressed with everyone's ability to come in for their appointment and follow the protocols.”
COVID-19 has been a learning curve to incorporate these changes and it has added a cost to their daily operations, Williams Saklofske says, but they are now used to this new workflow.
“We are ready to stay the course or pivot operations if needed,” she adds.