Respiratory therapists may be the ‘best kept secret’ in the fight against coronavirus

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Alana Spicer has worked as a respiratory therapist at the IWK Health Centre in Halifax for more than 20 years. In all of her career, she’s never seen anything as intense as the novel coronavirus pandemic.

“The challenge of this new virus is no one is really sure [how it works],” Spicer said.

“In the first month, things were changing so rapidly — you would come to work and then the next day that policy that was written has been amended because someone has found new information.”

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Although things have “stabilized,” Spicer said there’s still a lot of uncertainty about the future.

“We’re as prepared as we can be and we feel confident in that,” she said. “It’s just the unknown.”

As a respiratory therapist, Spicer is a crucial part of the fight against COVID-19, an illness known to wreak havoc on a person’s lungs.

Photo courtesy of Alana Spicer. Photo courtesy of Alana Spicer

Severe cases of the coronavirus often require the use of a ventilator to deliver oxygen to the lungs, which helps the body function while underlying problems are addressed.

That’s where people like Spicer come in.

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In a severe case of COVID-19, the respiratory therapist would be responsible for “intubation, like inserting the breathing tube, ventilation [and] using the ventilator.”

How the coronavirus targets the lungs

Surviving COVID-19 depends on a patient’s lungs, according to experts like Zahid Butt, an assistant professor at the University of Waterloo in Ontario.

“The coronavirus is a respiratory virus [that] invades the respiratory system. Coronavirus can infect both the upper and lower respiratory tract,” he previously told Global News.

Butt, who specializes in infectious disease epidemiology, says a COVID-19 infection starts from the nose and then proceeds to the lungs.

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In most cases, the virus stays in the upper tract, which includes everything above the windpipe, Butt said. In those cases, symptoms can include a fever, cough or sore throat.

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For some people, if the infection isn’t considered severe, it hasn’t entered the lungs.

Butt says if the virus migrates to the lower tract, that’s when symptoms like shortness of breath can occur.

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“Once the virus reaches the lungs, it causes inflammation, which results in fluid accumulating in the lung and difficulty breathing,” he said.

“This fluid fills the lung’s air sacs… [then] blood oxygen levels fall below normal, a condition known as pneumonia.”

The air sacs are responsible for gas exchange, which is the process of breathing in oxygen and removing carbon dioxide.

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Since the novel coronavirus is highly contagious, respiratory therapists are some of the most at-risk health-care providers.

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“The insertion of the breathing tube is probably one of the most dangerous things, certainly for health-care providers in this pandemic,” Spicer said.

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“It’s an aerosolized procedure … so you’re worried about the transmission from patient to health-care provider.”

‘Best kept secret’

Unless you’ve been in intensive care before, it’s unlikely you know what a respiratory therapist does.

“We always kind of think of ourselves as the best-kept secret of health care,” Spicer said.

“We’re kind of, like, behind-the-scenes and you don’t know [about us] unless you’re in intensive care.”

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If you don’t know about respiratory therapists, you’re one of the lucky ones, said Michelle Stephens, a senior respiratory therapist at London Health Sciences Centre’s Victoria Hospital. 

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“When you need to see a respiratory therapist, you’re in acute distress,” she said.

“If you don’t know what we are, that means you’ve never been sick enough to need our help.”

It’s for that reason that Stephens considers respiratory therapists to “always be on the front lines” — not just during the pandemic. Photo courtesy of Michelle Stephens

“We’re essentially there to support anybody that’s in respiratory distress,” she said.

“It could be supporting them with supplemental oxygen therapy, it could be providing them breathing treatments. We have a large scope of practice.”

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How COVID-19 has changed things

A big chunk of Spicer’s days are spent practising COVID-19 simulations to ensure the IWK is prepared should there be an influx in patients with the virus.

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“On the east coast of Nova Scotia, we’re kind of the last people [in Canada] to be hit by the pandemic,” Spicer said.

“For us, the fortunate thing is that we’re keeping in touch with respiratory therapists across the country who are in the throes of this or who had to start dealing with this a month before we have.”

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The IWK has used knowledge passed along from other health-care experts on the front lines to create a Pandemic Response Unit (PRU) dedicated to providing care to COVID-19 cases.

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“They have the ability to provide intensive care … and all the things that go along with that,” she said.

“At this point, we’ve done a lot of simulation to make sure that when patients do come through, it’s the smoothest and safest [procedure] not just for the patients, but the providers, as well.”

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As a senior therapist, Stephens has also been heavily involved in preparing the hospital for the worst-case scenario.

“I’ve been helping with the onboarding of new staff, [which] we’re really tried to ramp up just in case we did have that surge,” she said.

“I’ve been providing more of an educator-type role.”

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One of the biggest and most difficult coronavirus-related changes for Spicer is remembering to protect herself before running to help others.

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“We’re so used to, if there’s a code blue (which indicates a life-threatening medical emergency), just running to the patient and starting the procedure,” Spicer said.

“Now, [COVID-19] is a very real risk to health-care providers as well. You have to protect yourself before you can help someone else.”

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

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— With files from Global News’ Olivia Bowden

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