This is episode deals with the emotions, issues of trying to open up the economy, returning to a "new normal," and what we can do to feel more secure currently and in the future.
(This is the core of the transcript from the podcast. The Intro has been removed and some areas improved for reading ease.)
Lalit:
Welcome to The Introverted Doctor podcast. This episode is an unexpected one because we're going to talk about COVID anxiety, returning back to work. I have Dr. Jobin Varughese. He's the Chief Medical Officer of a longterm care home. He's also a family physician and a site director at McMaster Family medicine. He comes with a tremendous wealth of experience and knowledge, and I really would like folks to listen to where this conversation goes because I think it's important. I was not expecting to do this episode this week. Welcome, Dr. Varughese.
Dr. Jobin Varughese:
Thank you so much. It's been a pleasure speaking with you. I mean, you and I have had the conversations over the years since you had the podcast, and I've been an avid listener of the podcast for a while, so it's a, it's a pleasure to be on.
Lalit:
It's great to have you. One thing I forgot to mention is that you're also part of the William Osler Health System. You and your group of people do exceptional work. Now let's talk about your experience as a physician, a chief medical officer, and working in long term care homes because you've had the army come in and step in. I think you've had more experiences than probably many family physicians or even in the emergency room. Can you talk to that?
We had the army come in because we had a severe issue with a staff shortage...we had many staff who actually contracted COVID ...some had symptoms; some stated that their symptoms were present. Others stated that they were just not able to work. They were feeling too anxious.
Dr. Jobin Varughese:
Yeah, absolutely. I mean, I think there's a couple of points on that. One is that our home actually we, I, was working as medical director, and we recognized around March that it was pretty clear that we needed to start keeping a steel ring around long term cares. It became very clear we needed to keep one physician per home so that we didn't risk cross-contaminating. I was working with the administration very closely as a medical director to try and see if we can ensure that we have the least amount of risk to our patients.
And so we set up screening. We had a plexiglass screen back in early March. We were talking about doing active screening at that time. We were starting universal masking way before it became the huge we were doing a lot of different things that were extremely preventative.
However,the virus came into our home. It came very quickly, and it actually went through the home very quickly. We had many cases I believe up to 50 in the end, of 120 bed home. And we, unfortunately, have lost some of our patients to COVID. We had the army come in because we had a severe issue with a staff shortage. So we had many staff who actually contracted COVID, who recognize that we were a COVID positive unit and decided not to come to work. Some had symptoms; some stated that their symptoms were present. Others stated that they were just not able to work. They were feeling too anxious.
And so we continued to have issues and so the army came in and provided some services to help shore up some of our resources. They're continuing to be present today. We hope they'll continue to be present. We are working on our staffing, and I know that our administration is working very closely with our human resources, and there's a lot of different struggles that are present with regards to that. And I think anyone who goes through COVID within long term care, and they will recognize that because staffing ratios, as we hear about in the news, now certain ratios of long term care has been a problem for a long time.
literally just the ambulance ride and the leg to become ischemic (loss of blood supply resulting in injury to the tissues).
Lalit:
In Ontario, you know where we are, but where you and I both are, there is a wide variety of emotions and experiences. Some communities haven't been hit, and some places have been hit. And then so it varies. And as we're slowly trying to open up, there is a sense of laxity; some people, if they haven't been affected, they feel, "let's open up, let's go" (and others say no).
Because there's real issues about staying closed and then we, and you've experienced the other end where you were telling me about some experiences…. even the one patient whose leg became ischemic. How do you reconcile that?
Dr. Jobin Varughese:
Well, I think it's hard, right? Because I think this is honestly going to be the one disease which is going to hit every single person in the world. Every single person will say I know of somebody, or I know a family who either lost a loved one or been severely ill. As you were mentioning, I have a patient that in the transfer from our home to the hospital, their leg became ischemic, (loss of blood supply resulting in injury to the tissues) and they ended up having significant issues to a point where they were unable to we were unable to do anything because of it. And it was perfectly fine within the home and literally the ambulance ride and the leg to become ischemic. I think that people aren't recognizing that just because you don't have symptoms doesn't necessarily mean you don't have the virus.
We still have, we know of this, I think it's been well-publicized now - that there is an asymptomatic period that can be anywhere from three days, five days to even as much as 14 days. A good example would be that after mother's day in the last two weeks, the new global number of cases increased by a million( that is global). Clearly, this virus has not gone.
I've had nurses tell me who have had it; they said that they wish for death.
But I think that the fact is that people have talked about the virus as if it's just the flu still. My landscaper had told me the other day that that was exactly it. He said, no, "it's just a flu."
I've had nurses tell me who have had it; they said that they wish for death. So there is actually some significant morbidity with it.
It is good that 80 to 90% of people do get better. But the fact is is that this is a virus that will continue to affect us, and it's so new that we're still learning so much about it. You know, people are still unsure about this idea of - are there fomites or not? CDC just put out information that you can't contract it easily that doesn't necessarily mean you can't. So I think that we need to continue to stay vigilant. I think that social distancing does work. And I think it is something we need to continue to push for.
Lalit:
Many people, though, are suffering from other consequences- social isolation, mental health, domestic abuse has gone up, unfortunately, so has child abuse. People are not coming to hospitals or seeing their family doctor because they're afraid of COVID. Are we just not trading one death for another? I mean, that's one argument.
Dr. Jobin Varughese:
It's an interesting conversation. I think interestingly if you talk to people who have been in disaster zones of any kind, and that's really what this pandemic is; it is a disaster. But if you talk to anyone within post effects of a hurricane or an earthquake or tsunami or anything, you'll actually hear that same information. During the initial effects, there's a sharp increase in the amount of need for emergency care and frontline care that way. And then as time goes on, it becomes more and more clear that primary care steps up as the main need. And so speaking to the point of domestic violence is, it's a very fair point, and it comes up all the time with disasters with regards to earthquakes, for example, because of the fact that people's adrenaline is high within initial shocks.
And then the after-effects, your adrenaline never gets a chance to come down. That's similar to the effects we're feeling now, which is a constant barrage of social media or media—always hearing the bad side of things. The fact that people aren't able to get out of it. There's a lot of great stories about how people are socially distancing and able to see their families. This is a sort of thing that will continue to be present. And I think it becomes very clear that we need to have all of our family doctors be very understanding that they need to really work on increasing access for their patients, whether that's virtually or in-person understanding that mental health, domestic violence. A lot of these depressive symptoms are going to be things that we can manage from a distance while doing it quite effectively. Because a lot of people have been able to communicate with their patients by phone, work with people over zoom calls or other media calls.
anytime you do anything, there's a new normal. If somebody dies within your family, there's a new normal. If you have a new baby, you have a new normal. So, I think what it comes down to is that We are adapted for change.
Lalit:
I think people are getting kind of tired of the word a 'new normal' or we don't know what normal is any more. Now we're looking at the discussions about the second wave. We have so many varied opinions about it. How do we come up with solutions to these problems any suggestions?
Dr. Jobin Varughese:
Yeah. I think this fatigue of new normal is going to be something that I think we need to be a marathon runner on; because that's going to be a conversation we're going to hear often. There will be a time that we're going to be talking about the before COVID times, the after COVID times. This is a game-changer. It will change a lot of the ways that we do things. And that will be the case for quite some time. And so I think the idea of what normal is, is an interesting concept in itself; because no matter what, anytime you do anything, there's a new normal. If somebody dies within your family, there's a new normal. If you have a new baby, you have a new normal. So, I think what it comes down to is, is that everyone is …
We are adapted for change. That's how we've lived our lives. That's how we've grown as a civilization. We'll continue to adapt to what's new and what needs to be done. I think capitalism will continue to do what it needs to do. And I think people will be innovative and it'll breed some extra information for all of us. I think we actually have already seen people who have been saying for years that I could totally work from home. There's no reason for me to go to work, I have actually found out I can actually do this within a very short timeline. And that becomes the new normal. Now the question is going to be: Is there a need to travel that distance for people who are travelling an hour both ways and losing two hours in their day just to commuting? Do they have to do that? Or if they can, then they'd be more productive for two more hours.
Lalit:
But there are many people being laid off because of virtual work and the way companies are working. So that is one of the biggest things. How do you replace those jobs, and the economy is so affected. I think that's a problem and I don't have any solution or comment about that.
If it's outside of your actions and your words, you don't control it, you don't have actions on it- you can't do anything about it.
Dr. Jobin Varughese:
I'd vote for you if you did. Yeah, I think honestly, it's one of the biggest things we're going to have to look at because we've known for quite some time that there's some jobs that are starting to phase out because of AI (Artificial Intelligence) because of robotics, because of computers. I think those jobs are the ones that are still at risk. And I would highly encourage all your listeners to shore up your skills. There's a lot of different universities offering free courses that can be done during the time people are kind of at home, whether they're trying to figure out what they can do with their time. You know there's a lot of people work on their sourdough bread, but maybe there's other tasks that can be done to try and help shore up those life skills to help with that. I think the bigger point is that there is going to be a big conversation of how those layoffs look and what the government's going to do to help build skills for people in a new world. Again the shift in what's going to happen virtually or what's going to happen in person. We've already seen it with different sectors.
Lalit:
Yeah. Well, last night I was talking to another friend of mine, and you know, he said it clearly, "you can live better if you choose better" There's so much to think about. There's so much information, and I know what keeps me sane is just focusing on the little itty bitty things that I can do. And I do think that people need to, instead of watching Netflix, going on their phone is, is think about skills that can elevate them, their ability to earn and, and be more productive so that they are better. I think it's about that.
Dr. Jobin Varughese:
I always tell my patients that there's a little bit of a triangle you always have to think about, right? Cause when you want to find the motivation to do something, which will show you results, which will give you more motivation. What ends up happening is that motivation doesn't come. So sometimes you just have to do something which will give you results, which will then give you the motivation to do more. And, and I agree with you, wholeheartedly. I think that's a huge point that when you see, you know, "Oh gosh, I have to do all these different things"- sometimes it's just a matter of doing that first step. And then what you'll do what everybody does after you take the first step, you'll take the next step, and maybe it's a misstep, maybe not, but you'll at least you'll be able to move forward.
Lalit:
And so much of it is exactly that. The energy that it takes to say turn on and watch a Netflix episode, versus the next step to do something more productive, is really not that much more. It's that initial inertia. And that's why I always say it's very important to have people that will help you move forward -setting up a buddy system, working on things, listening to podcasts. What are those little things in our routine that make life successful? I mean, one of the best quotes I heard recently, "inch by inch life is a cinch, yard by yard life becomes hard." Thank you, Dr. Varughese; I want to thank you for taking the time to share this with me. Is there anything we should talk about more that we didn't cover?
Dr. Jobin Varughese:
I just wanted to say I'm a big fan of the podcast. I wore my CONQUER COVID- 19 shirt just in honour of your previous podcast with Haley Wickenheiser. So I think the CONQUER COVID- 19 movement was amazing. I'm glad that it was there and I want to do my little part. I think the other thing, though, I would highly encourage that everybody understands is that another part of the new normal is going to become access. So in Ontario or in Canada alone, our access has always been an area that people struggle with. People talk about all the time how hard it is to get into their, their family doctor and get into seeing doctors in general. This is going to be worse at least within the short term and just understanding that this is going to be stuff that will need to be planned ahead of time.
There are things that can be done early and, and connecting with your family doctor in whatever way that that is- whether it's virtually, whether it's leaving a message with their staff, whatever it is, allowing that sort of forward movement that gets rid of the inertia and makes sure that things are moving forward is going to be things that are useful because there are parts that are out of your control. And I tell people on a daily basis that really and truly you can only control your actions and your words, those two things. That's it. If it's outside of your actions and your words, you don't control it, you don't have actions on it- you can't do If it's outside of your actions and your words, you don't control it, you don't have actions on it- you can't do anything about it.
a lot of family practices have been having challenges because patients are afraid to come in and we're trying to encourage patients to call us and contact us. We do take proper measures to ensure that if it is safe for you to come, we keep a clean environment.
Lalit:
I agree with you. And you know, a lot of family practices have been having challenges because patients are afraid to come in and we're trying to encourage patients to call us and contact us. We do take proper measures to ensure that if it is safe for you to come, we keep a clean environment. We need to remind people we're trying to do that, but people are still afraid of coming in. But we don't you to come in if we can deal with things on the phone. So I think that's another important message. And also to go to the emergency room if you really need it. We don't want people to be dying of heart attacks and strokes at home because they're so afraid of a COVID-19.
Dr. Jobin Varughese:
And I'll send you some resources that I have with regards to the mental health side. There's a lot of different crisis lines. I'm sure your users have had had them in the past, but there's some worldwide ones. There's some global ones, and there's some national ones as well that are useful.
Lalit:
That's good. And I will take a moment to plug that pandemic guidebook, which I wrote a few weeks back. You said you found it quite helpful and a lot of people have been thankful. I wanted to make it easy to read and usable. So that was a big thing for me to write that book because there's so much information that probably needs to be updated as we try to open up and return. But may, you know, so probably should be developed further.
Dr. Jobin Varughese:
Yeah. Well, I totally agree. I think that the idea of having a living document really allows people to have some freedom with it. So I would highly encourage people to review it. I agree it probably can work on some updates, but I think over time it's going to be something that will be almost crowdsourced or, or used by a large group. And I think that will help.
Lalit:
Some people feel that we're just now that we're opened up the first stage, but now we're back to normal.
Dr. Jobin Varughese:
Yeah. There's a big thing where they actually did a survey recently, and they found that most people actually agree with the way that, at least Ontario is doing their opening and their pace and their methodical nature of what they're doing things. Currently, about 30% of people want to do things slower, but only about 14% of people say that they would like to see things quicker. I think the fact is that we know that whatever effect you have now, you won't see it until a week or two weeks from now. So the shop owner who opens their door and says day one was great then, and it really won't know that effect until two weeks from them.
Lalit:
Just is that every region is so different. If you're not having any problem in your region or think you're doing good, then life is great.
Dr. Jobin Varughese:
Right. And it's really interesting because had I not had my experience, I probably would have felt very similar. I know that a lot of my colleagues have said that within the hospital systems, it hadn't been too bad early on. Now it's getting busier. One of the benefits of having a smaller community is that idea we can collaborate. And I was thrilled to be able to work with William Osler in helping our as many patients as possible with some work with some of the COVID patients because our nursing home was overrun, but the hospital was a little bit lighter. We were able to work with that. And so that sort of experience was something I think as we continue to see cases could be something that other areas could consider reaching out to or, or working on. It really helped not only the nursing home, when it was busiest but also the hospital as it got busier, with that idea of bringing back the patients to help improve the hospital's capacity.
Lalit:
Yeah. Thank you so much, and thank you for taking the time out of your schedule and doing this. I really do appreciate this. If you enjoyed this podcast, please share it with your family, friends or colleagues because there's some valuable information from somebody who's really been in the hard part and the thick of things. Dr. Jobin Varughese is exceptionally knowledgeable. He is very fair. And he's not an alarmist, and he knows what's happening. He's a very calm voice in all of this. So I think this is very helpful. Thank you so much for listening, and I will see you again next week. Take care.
I would love to hear any comments about this podcast and what would you like to hear in future episodes?