A Critical Time for Critical Care

Dr. Kendiss Olafson offers an inside view into our ICUs as admissions surge.

By Brad Hartle

“I’m sitting here, bracing,” said Dr. Kendiss Olafson, an Intensive Care Physician in Winnipeg. It was Friday, October 16th, the day Manitoba announced the largest COVID-19 restrictions since the spring lockdown. Firmly in the second wave, Manitoba had registered more cases in the previous two days than in the entire first wave. The test-positivity rate hit a record-breaking 5.2%, hospitalizations were rising, and more patients needed intensive care.

“As a program, we’re very worried about our capacity.”

After her week off, spending precious time with her husband, also a physician, and her three daughters, Dr. Olafson would be back in the ICU on Monday. “It will be ten to fourteen days until the numbers started going up,” she said, referring to the typical time an infection takes to turn critical. “In our first wave, our numbers were pretty manageable. Sometimes we wondered if we were too over-prepared, expecting this onslaught of patients that never really came. Now, they’re going to come.” 

As is the case in other parts of the world, the prospect of Manitoba’s hospitals being overrun by COVID-19 is very real. While that growing threat is out of her hands, Dr. Olafson is focused on using her expertise in critical care, along with her Master’s in Public Health from Johns Hopkins University, and doing the best she can for patients and families.

Since the pandemic began, she has used her background in both critical care and public health to better understand the virus and its treatment.

“Early on we were hearing COVID was so different,” she said, recalling the apprehension and nervousness felt when the first patients presented. “Not just the question of how do we manage these patients, but also where could a wave take us? As ICU physicians, we are the leaders of a large team of nurses, respiratory therapists, pharmacists and others caring for critically ill patients. How do we make sure that we as a team care for our patients and make sure everyone on the team gets home to their families safely?”

“We’ve learned over the last few months that the treatment of COVID-19 is not significantly different from other critical illnesses. We have the toolbox to be able to approach patients with regard to when to intubate and how to ventilate.”

The Winnipeg Critical Care Program has spent months fine-tuning that toolbox, perfecting what is in their power to perfect. “We developed procedures for the minimum amount of people required for a patient, assigned specific tasks, then practice to make sure we’re ready.” Be it preparing for intubations with limited staff, practicing entering and exiting the room, running through role-specific tasks, or donning and doffing their PPE over and over, the focus is on safety and quality improvement.

The need for safety also brings the need for patient isolation, which for Dr. Olafson has been the toughest part. To help overcome patient isolation, Dr. Olafson helped establish the Family Liaison Program, which brought a team of volunteer medical students together and used iPads donated to the hospitals to virtually unite patients and families.

“It has highlighted the importance of families in the ICU,” she said. “They are important for safe patient care, for a patients’ emotional and physical recovery, and as patient advocates, speaking for patients who often can’t, helping us make better decisions.”

“Also,” she added, “one of the most exciting things is to see a patient wake up and look over at their loved one beside them on the screen.”

In many ways, this is what Dr. Olafson got into critical care to do. “I’m not an adrenaline junky. I got into this line of work because I enjoy the intellectual challenge of thinking through the complexities associated with critical care.”

Important to her, too, is the way the pandemic has brought intensive care work to the forefront of the public discussion, bringing with it an opportunity to mobilize research resources within the ICU program. “We have wonderful researchers embarking on COVID- specific research,” she said, adding that the pandemic has enabled the collaboration of specialties that don’t often work together, such as intensive care and public health, furthering new research opportunities.

And yet, those reasons for optimism – research prospects, innovative ways to overcome isolation, an improved understanding of the virus and how to treat it – they fall away when Dr. Olafson looks ahead to next week. “Our intensive care units are frequently full, and we experience anxiety over not knowing where we will put the next patient. Even if the issue of capacity was suddenly, magically solved, the ICU team is a limited, specialized service. If Manitoba is not successful in our public health efforts, we will be quickly overwhelmed.”