In mid-March 2020, when the Quebec government announced confinement measures as the COVID infection and death rate tolls soared worldwide, the Montreal Chest Institute (MCI or “the Chest”) of the McGill University Health Centre (MUHC) rushed to launch the MUHC’s first COVID wards. This was a natural fit as COVID-19 is primarily a respiratory disease and the MCI represents the Division of Respiratory Medicine at the MUHC. Dr. Kevin Schwartzman, Director of the Respiratory Division at the MUHC and head of the Chest, was tasked to oversee the launch of the COVID wards at both the Glen and the Montreal General Hospital (MGH). The practice of medicine as we know it would drastically change over the following weeks, as healthcare providers would have to constantly adapt their approach in order to save lives.  

At the Glen, Dr. Schwartzman and the MCI’s Dr. Nicole Ezer, a Respirologist with Acute Medical Care and ICU experience, led the launch of the first COVID ward. Dr. Thomas Maniatis and Dr. Amal Bessissow, both Internal Medicine specialists, alongside Vincent Piché-Roy, Interim Nurse Manager, launched the MGH ward. Their first task: identify separate spaces within the hospitals for the care of COVID patients.

The wards were set up within a two-week period. The first week, staff located the spaces to be converted into COVID units which could accommodate twelve beds each. They developed training materials and forms for the new COVID unit staff, a diverse group of doctors, nurses and residents, some of which hadn’t worked in a ward setting in years and needed to relearn some of their practices through peer-training.  “Primary attending physicians from respirology, general internal medicine, cardiology, infectious diseases, and geriatrics provided back-up and support to the other attending staff and residents,” explained Dr. Schwartzman. “Many of the doctors started with orientation shifts during the day, followed by more independent work in the evenings or overnight.”

The second week, the teams ran simulations to identify necessary changes before accepting their first patients:  transfers from other hospitals or old age residences.  During that time, the teams were met with a new set of challenges. Each environment had to be adapted to ensure that the unit had hand sanitizer dispensers and telephones. “Processes that we normally do, we had to change,” explained Dr. Ezer. “We went from seeing patients every morning and examining them, to speaking to them by phone through a glass window and only examining them when necessary.” Despite physically distancing from them, teams tried as much as possible to maintain personal and meaningful relationships, through frequent interactions over the phone with patients and their families.

While teams at the Glen were able to set up in an area containing single rooms under negative pressure with large windows along the corridor and an antechamber, the team at the MGH was faced with infrastructure challenges. The single-patient rooms had no windows on the doors, making their installation a top priority.

“We have had to adapt our practice and environment daily, because of the increase of patients and the changing unit population,” said Dr. Bessissow. “Each patient that comes in is affected differently by the virus, and so their medical needs change.” The MGH has since added a second ward and continues to improve the environment, adding mirrors in some rooms to better see patients through windows and redoing the plumbing in a room to accommodate a patient needing dialysis.

The practice of medicine has changed significantly during COVID. Healthcare professionals have had to constantly adapt their approach to reduce exposure to the virus for patients and medical staff. Guidelines for ordering tests have changed too: doctors must ensure that any test they order will lead to a change in the treatment of a patient, as they now have to consider the health risks to the technicians or the nurses performing them. Personal protective equipment needs to be inventoried to guarantee each unit has an adequate supply, and nurses are paired to ensure donning and doffing is done appropriately.

The Montreal Chest Institute’s expertise in the management and organization of respiratory care has been instrumental to the success of the COVID wards. Despite changes to medical practice and routines, the healthcare professionals of the COVID units, comprised of experts in their field, have pulled together in a time of pandemic to ensure excellent patient care remains the number one priority at the MUHC.