Dr. Susan Shaw is the chief medical officer for the Saskatchewan Health Authority. Since the COVID-19 pandemic hit Saskatchewan, Shaw has been vocal at press conferences and on social media about what individuals need to do to limit the spread of the virus and keep one another safe.
Global News interviewed Shaw on Thursday morning about surging COVID-19 cases and hospitalizations in Saskatchewan, health-care worker burnout and protests outside hospitals.
Q: Case records in Saskatchewan have been broken day after day after day. What does it look like for you on the front lines?
A: It’s extremely concerning because each of those cases is a person with a family and they now have a COVID infection and they don’t know what their future looks like, they hopefully will have a good recovery. They could end up with a syndrome that’s new to us called ‘long COVID.’ And what I fear is that they will need admission to hospital. They may need admission to the intensive care unit and they may die.
Q: You mentioned hospitals and the ICU. We know across the province, both are overwhelmed or nearly overwhelmed, yet we’re seeing people now gather outside of hospitals protesting not only masks and vaccines, but the existence of COVID. What is your message to those people?
A: COVID is incredibly real, and it’s all around us. It’s having a huge impact on our society and I think that is some of what we’re seeing with the demonstrations that are occurring. It’s heartbreaking, though, to know that we have a controllable, manageable, preventable disease, that we know how to do all of those things effectively. We have health-care workers who have committed so much of their hearts and their energy over the last 18 months to help people in need, and they continue to show up and do that every day. And we have demonstrations. Putting forward misinformation in such a heartbreaking way, and it’s hard to find the words to describe the impact on me as a person, but on us as a society as well.
Q: And your message to those people?
A: Please listen, get vaccinated, find better resources and supports to you. I think many people are actually not as resistant as perhaps those demonstrations may make us feel. I think most people just have good questions that they want answers or they just haven’t felt that COVID will impact them. Well, it may not impact them the way that it could, if you’re elderly or vulnerable or a child, however, it will impact someone that they love. So please get vaccinated. The minor inconvenience of wearing a mask is just that. It’s a minor inconvenience and it’s such a gift to each other. It protects me and protects you. It protects us.
Q: How do you deflect that anger and how do you focus through that to walk in through a hospital door and go back to work?
A: I don’t have a choice. I need to show up at work, the health-care workers that I work with don’t have a choice. The patients who need to come to the hospital to receive the care that they need for their health don’t have a choice. We have to come. Society has a choice.
I think we can have a better understanding of where protests or demonstrations are suitable and not suitable, and I’ve heard strong language on that. I think we could have action on that as well to ensure that hospitals, places of care are safe for care to happen. But it still impacts me.
One of the protests in Saskatoon was just (outside her office). I could see it. I could hear it. I could see that. And that was the point. That’s the whole point of the protest, isn’t it? But it was interfering with people arriving and leaving the hospital with their loved ones. It was interfering with very touching moments that I have the privilege of being able to observe out my window, where families say goodbye before someone goes in for treatment. That’s not right. But we still have to pick ourselves up and keep on going. Health care workers do not have a choice.
Q: Do you and all other front-line health-care workers have the support you need?
A: We’re doing our best to support one another, health-care workers, our community and I think we go through a lot of shared experiences. We’re relying on our families and our friends. I know my family and many of my colleagues’ families are worried and are supporting us and I appreciate that. I think we need more, though. I think we need more co-ordinated policy work in our province and across our country so that we have the controls that we need so that we’re not working so hard at the front line.
Q: What happens next, and will there be a fifth wave?
A: I can’t tell you, I really did not think we’d have a fourth wave. I think I’m not alone and many people thought that we wouldn’t have a third wave because, like I said, we have vaccines. We know how to control and prevent this. We have the skills. We have the resources. We’re a very fortunate country compared to many around the world. So I think we’re well situated to be able to prevent waves.
However, what happens next, I’m really worried. I think we’re going to see significant changes in the capacity of the Saskatchewan health-care system, hospitals and teams to be able to continue the full complement of health-care services that we are currently aiming to provide for both COVID and non-COVID care.
I worry that we’re going to have to go further into our critical care resource allocation framework, which is our ethics triage tool decision support system, and have to make, not that we want to, but that we’ll be forced into a situation, we’re actually having to choose who receives critical care, who receives end-of-life care, (and) who receives palliative care. I do not want to go there. We do not need to go there if we have the controls in place to prevent the spread of the disease.
Q: You’ve written about ‘compassion burnout.’ Can you tell me more about that and how you keep front-line health-care workers motivated 19 months and four waves into this pandemic?
A: It’s really hard for now, it’s a real phenomenon and it occurs in many situations, but one of the hallmarks is compassion fatigue, and it’s that losing your ability to have compassion or empathy for others. And that’s a risky thing for a health-care worker to have. I would not want to have my nurse or my physician or my therapist not care about me. That’s a hallmark of health-care workers, as we care about others and we want to do good. If I lose that, then I’m not as good at the bedside and I’m actually – the studies show I’m not as safe, so everybody should care. I make more errors. I don’t pay the same amount of attention. I’m exhausted.
So burnout is a real phenomenon that you should care about, whether or not you’re a health-care worker or you know a health-care worker. Health-care work is also incredibly meaningful, and so I think how we maintain our ability to keep showing up is by staying connected to our patients and understanding and really getting that small bits of joy even in the side and within tragedy, looking for them, supporting one another and talking about it. There are other strategies as well, but I am worried that the hours, the pace, the never-ending next admission with someone with life-threatening COVID adds up and it adds up over time. And we’re all human and we all have limits. So I’m really worried about what this is doing to me, and I’m really worried about what it’s doing to my colleagues.
Q: Some (health-care workers) have elected to leave the profession and now 19 months into this, and seeing a surge (in cases) do we still have enough doctors, enough nurses — if we ever had enough — to handle what’s coming and what you’re dealing with now?
A: I’m worried. I do know and we do know that people are choosing to leave their health-care profession for reasons that are right for them, and I don’t have any judgment there at all on people making the right decisions for them when it comes to working in health care right now.
I hope people stay, but even if everyone stays and I’m staying and most of my ICU team is staying, we still know from the projections and the trajectory that we’re on and the daily increasing numbers in cases … (and) people who are going to need care that we are at high risk of outstripping the number of health-care professionals that are trained, ready and able to do the work. We have lots of amazing people. We have lots of the right equipment and space. But the type of care that people need when they have severe COVID and are in an intensive care unit is incredibly specialized. And as much as we can try to expand that, it’s not going to be the same as usual times.
Q: Anything further you’d like to add?
Our health care system has been here for everyone throughout this, it looks different from March of 2020 to now. But right now we’re actually in I think one of the worst situations I could ever imagine. We have a disease that we know how to control and prevent. On top of that, we have an increasing highest number of people presenting for care that we have seen probably at any point of the pandemic. And I have no reason at this point to believe that those numbers are going to rapidly change in a good direction. I hope that they do. But that’s my job, isn’t to plan on hope. We’re actually having to talk about activating difficult decisions about who will get intensive care, who is going to have surgery, who is going to have the care that they’ve been waiting for. And that’s something that I never wanted to have to be part of. But that’s where we are.