Why we need to ‘learn to live’ with COVID-19, according to doctors and immunocompromised patients

Echoing through the halls of the emergency department in Toronto’s Humber River Hospital, a man can be heard shouting obscenities at his doctor. The patient was brought to hospital by police after he was arrested for threatening to blow up a nearby shopping plaza.

The bomb he claimed to have hidden under his shirt turned out to be an empty lunch bag. The patient has a history of psychosis and substance abuse.

“The number of cases that are presenting with this level of agitation has increased substantially,” said Dr. Leon Rivlin, the medical director and chief of the emergency department.

Rivlin and his colleagues measure the pandemic not only by the number of cases and hospitalizations, but also by who walks through their emergency department entrance every day.

These days, their most pressing concern isn’t COVID-19 per se, but rather the fallout from two years of pandemic lockdowns, including a significant spike in the number of patients suffering mental and emotional distress.

“The pandemic creates this general sense of anxiety. And then when you add pre-existing disease, whether it’s psychosis or depression, then it only amplifies it. And so that’s what we’re seeing a lot of here,” Rivlin explained while typing the patient’s details into his computer.

The man is eventually given medication and transferred to the hospital’s mental health department.

Rivlin is one of a growing number of health-care professionals who are now echoing calls made for months by politicians, protesters and business owners about the need to “learn to live” with COVID-19, without imposing another round of harsh restrictions and lockdowns.

“Learning to live with it is what we as a health-care community, and as a general community, need to be prepared to do,” Rivlin said.

“COVID is always going to be there. This year we had Omicron, last year we had Delta; what is it going to be next year and how are we going to respond to it? We need to have a broader strategic plan that’s more than the reactive plan that we currently have.”

In addition to a spike in cases of depression, anxiety, alcohol and addiction, staff are also seeing more patients like Anna Mazzocco. She has diabetes and was experiencing pain in her right big toe. Her family doctor’s office has been offering appointments by phone during the pandemic — by the time she finally came to hospital to actually see a doctor, the infection in her toe had spread to her kidneys.

“I consider myself a COVID victim because a doctor may have been able to identify it if he had seen it or ran some tests,” she told Global News from her hospital bed.

“The infection has spread and shut down my kidneys. So dialysis is now possibly a life-changing thing.”

Rivlin said “access to care is definitely limited when your doctor’s offices are less available to see.”

“We decrease the disease burden of COVID in the community, but we increase the disease burden of other regular diseases, which aren’t managed.”

The main goal of the pandemic restrictions is to reduce the burden on hospitals, and intensive care units in particular. But in the ICU at Humber River Hospital, the COVID-19 caseload is now manageable, according to critical care specialist Dr. Jamie Spiegelman.

“We’re really only seeing critical illness in two types of patients, them being the unvaccinated patients and the immunocompromised patients,” Spiegelman said.

But what happens if we see a new variant, another wave, and hospitalizations rise once again?

The challenge facing public health officials, according to oncologist Dr. Gautam Sudan, is how to avoid another lockdown while also protecting the most vulnerable. Sudan works in the hospital’s cancer ward, which is full of patients who are immunocompromised and highly vulnerable to COVID-19.

He said the fifth wave has witnessed an explosion of cancer patients with Omicron, which causes further complications and delays for their treatment.

“With any cancer patient who is on chemotherapy, their immune system is not strong enough to tolerate, and some of them won’t tolerate COVID,” he said. “I know we had a few patients who had passed away from COVID who were quite healthy and doing well on treatment.”

And for Sudan, that risk hits close to home. In 2017, his mother, Neelam, was diagnosed with cancer. They live in the same house but when the pandemic hit they kept their distance for many months.

Neelam is now fully vaccinated against COVID-19 and cancer-free, though she’s still receiving chemotherapy, which weakens her immune system.

She said she’ll continue wearing a mask and avoiding crowds indefinitely. She’s planning to skip a family wedding next month.

“I do go out now, but I’m very careful, not like before (the pandemic),” she said. “And I’m scared, too. I don’t want to end up in the hospital, that’s what scares me. If I end up in hospital, I won’t be coming back.”

Despite the risks, she and her son support removing pandemic restrictions, so long as our hospitals can cope.

“The new reality is that COVID is here to stay,” Sudan said, seated next to his mother on the couch in their Brampton living room. “Just be mindful of all the people who are not as healthy as you. You don’t know who is immunocompromised, and so do your part and get vaccinated.”

Just before Christmas, one of Sudan’s cancer patients, Danielle Cameron, caught COVID-19. The married mother of three young children was diagnosed with Stage 4 inflammatory breast cancer in December 2019 and spent much of the pandemic hunkering down indoors.

Cameron is fully vaccinated but said catching COVID-19 in December was scary and meant she had to temporarily delay her cancer treatments. Fortunately, she was able to recover at home.

“It was awful. But we survived,” she said. “We took precautions, we did all the things we were told we were supposed to do, and we got over it. And hopefully we never have to get it again.”

After two years of pandemic lockdowns and living in fear, Cameron is done hiding at home. She attends her children’s hockey games, cheering through her mask from the stands, and the family is now planning to take a long-delayed holiday to the Dominican Republic in March.

“It’s been two years of being on edge and not knowing what to expect and being scared and fear-mongering. And I think people need to just enjoy their lives. Life is short. Pandemic or no pandemic, we still have to make memories and enjoy our life. We just have to be smart about it and be safe.”