These health-care workers have informed thousands of patients they have COVID-19. Why breaking the news is different in the fourth wave

An emergency physician who now sees both fear and remorse on the faces of her unvaccinated patients admitted to hospital.

A pediatrician who has told hundreds of people they’ve tested positive and still hears patients say they didn’t know could make them feel so sick.

An infectious diseases doctor who watches patients struggle to breathe in the ICU, wishing they could turn back time and get vaccinated so they could see their kids just one more time.

For doctors and nurses who work on the COVID front lines, learning a patient is unvaccinated has become a new source of distress in a pandemic already filled with trauma and tragedy.

Months after vaccines have been widely available, offered in mass clinics at malls, workplaces and transit stops, health workers who speak with COVID patients are now hearing words of regret mixed in with the shock and worry that comes with a positive test.

In Ontario, 78 per cent of people over the age of 12 are fully vaccinated, leaving more than a million still vulnerable to the more virulent Delta variant. Last week, show unvaccinated adults are 36 times more likely to be hospitalized for COVID.

Though , doctors and nurses worry about those who’ve yet to get a jab, knowing it is only a matter of time before they become ill with the virus. And while their compassion has yet to wane, even as small numbers of anti-vax protesters yell insults and mistruths outside hospitals, they hope their message will — this time — get through.

As the fourth wave threatens to get worse, the Star spoke with four health workers to find out what it’s like to speak with COVID patients during this stretch of the pandemic.

Dr. Tasleem Nimjee is an emergency physician at Humber River Hospital and physician lead for its COVID response. Through much of the summer, as cases declined on the downward slope of the third wave, there was a welcome break in the number of COVID patients coming for emergency care. That lull is now over. Nimjee says the hospital is again seeing patients with the virus, many of them unvaccinated.

Every patient I speak to — whether they are in the emergency department for a COVID-related reason or something else — I try to raise the topic of vaccines to find out if someone is immunized. Sometimes it’s relevant to the clinical case, and sometimes it’s not. But it’s still an opportunity to talk to patients about vaccination.

For those who are not immunized, the main themes I hear are: ‘I don’t trust the vaccine’; ‘I wanted to wait until a lot of people have the vaccine to help me feel safer’; ‘I haven’t gotten COVID so far, so I don’t think I’m going to get it.’

Recently, a middle-aged woman with no medical history, who was otherwise healthy, came in with COVID. Her partner also has COVID. They did not get the vaccine — they just thought they wouldn’t get it — and had travelled overseas for a family celebration.

She came in (to the ER) because she was getting increasingly short of breath at home. Just to get up from the bed to go to the washroom made her feel like she might pass out. She was also vomiting and quite dehydrated. She needed to be admitted and there was COVID pneumonia in both of her lungs.

This is an otherwise completely healthy middle-aged woman, and this was a completely preventable illness and hospital admission for this patient. Her response (about not getting the vaccine) was: ‘I didn’t think I was going to get COVID, and I figured if everybody else got the vaccine, I would be safe, and now I have a lot of regrets.’ She said: ‘If the vaccine could have kept me out of the hospital, I wish I had gotten it.’

Some people won’t make that last statement, especially people who don’t, for a variety of reasons, trust the health system. And if somebody is sick enough to need admission to the hospital, I also don’t think that’s the right time for me to say, ‘you should have gotten the vaccine, that this was preventable.’ I just wouldn’t do that.

We do see COVID patients who come back to the emergency department after their period of isolation (is complete) because they’re still symptomatic. And they don’t know if that’s normal. This might be somebody who has a residual cough, or they’re still fatigued, or their exercise tolerance is not what it used to be and they’re still short of breath.

Sometimes it’s this second time when patients come back, when they realize it may take them longer to recover than they had expected, where you see some vaccine regret.

Dr. Jane Healey is a pediatrician and physician lead for COVID-19 test results notification at Trillium Health Partners, which includes Mississauga Hospital and Credit Valley Hospital. Team members call people who test positive to check their health, answer questions and offer advice on when to seek further help. Healey says she has told hundreds of people they have COVID during the pandemic.

The conversations I have now with people when I call to disclose a positive result are different than before. Most of the time, the individual hasn’t been vaccinated and they will often express regret once they know they have COVID and are feeling unwell.

When I counsel them about when to go to the ER, what symptoms to watch out for — shortness of breath, difficulty finishing a sentence — that’s when I think it sinks in. Sometimes, they ask if they can have the vaccine now. Then I talk to them about why they can’t get it now that they are ill, but I do encourage them to get vaccinated when they are out of isolation.

Just the other day, I was talking to a family who had COVID, and they told me: ‘I never imagined it could be this bad.’ This whole family is affected, with a family member in the intensive care unit. And I thought that was really striking, that they could say ‘I never imagined it could be this bad.’ Because this is what we’ve been talking about through the whole pandemic, that while many people will have a mild course, there are people who will get severely ill and need to be in the ICU and some will, unfortunately, not survive their COVID-19 infection.

I feel for that family because you know they are experiencing a huge amount of stress worrying about a loved one who is so sick. Talking to them, you can hear that regret: ‘I should have listened, I should have taken it more seriously, because maybe if I had, we wouldn’t be in this situation.’

It is very disheartening to see the protests happening, especially around hospital properties and health-care workers being targeted by protesters. But ultimately, when patients come into hospital, we still care for them with dignity and professionalism. We want them to get better.

There are feelings of frustration and compassion fatigue in the medical profession. But when you have a family in front of you, we still do what we always do, which is be professional and provide the care that individual needs and deserves, regardless of choices they’ve made around the vaccine.

Nancy Vandenbergh is a nurse practitioner who leads the . Launched in March 2020, the virtual care program supports patients who test positive at the hospital’s assessment centre while they isolate at home. Since then, COVIDEO has cared for more than 9,000 COVID outpatients and in July transitioned to being fully run by nurse practitioners. Vandenbergh describes COVIDEO as a “medical safety net” for patients while they recover from mild to moderate illness.

One of the things we do is gather information that helps us to assess a patient’s risk. Things like age, if they have any other illnesses, and now a key question is are they vaccinated or not. Right now, the greatest risk to most patients is not being vaccinated.

It used to be before Delta that we’d not worry too much about a patient who is, say, 26. But now, if they’re not vaccinated, I can’t honestly tell them they will have a smooth ride for the next 10 days. Before, I could easily have said that.

Vaccination does change the risk profile of our patients. But we never say: ‘Oh, you should have been vaccinated.’ Instead, we use the opportunity to educate, to say that their greatest risk is not being vaccinated, and to ask if they’ve looked into getting the vaccine.

Usually, we find it’s misinformation which has halted them from getting vaccinated. Any opportunity we have, we try to clarify the facts. But sometimes it’s not the right time to talk about vaccines, especially if they’re feeling really unwell or after we shock them with the information they have it (COVID). But we do try.

This September is very different than last September because of Delta. We follow up with some of our higher-risk patients and today on my followup list are 20 year olds, 30 year olds, 40 year olds, 50 year olds, 60 year olds, 70 year olds and 80 year olds. Last year, there wouldn’t have been any 20 or 30 year olds on this list.

I want people to know that COVID is an illness, and it is unpleasant. And it is largely preventable. And if you are unvaccinated, I’m worried about you.

Dr. Jeff Powis is the medical director of infection prevention and control at Michael Garron Hospital. Since the start of the pandemic, some 20,000 people have tested positive for the virus at the hospital’s assessment centres. Powis, who also cares for severely ill COVID patients in the hospital, says he has called more than 5,000 people at home to let them know their positive result. Those calls have not gotten any easier in the fourth wave.

When I call individuals who are vaccinated and tell them they have COVID, the first thing I hear from them is they feel ripped off. They say: ‘I got the vaccine and I got COVID? Come on.’ I remind them that this is now a cold and that the vaccine is incredibly effective. That it’s amazing you’re in a position where this (positive result) is not something I’m worried about.

I tell them there are people I’ve called — older people with lots of medical problems — who would not be with us anymore if they had not been vaccinated. I remind them that while the vaccine is helpful to prevent infection, it’s also helpful to save your life, as it has saved those individuals’ lives.

For the (COVID) outpatients I call who aren’t vaccinated, I ask: ‘Would you like us to book a vaccine appointment for you?’ Just because I want to make sure I give them that opportunity, to make darn sure I do what I can to answer their questions about the vaccine.

I tell them why I still want them to be vaccinated after their COVID infection. That immunity from infection only lasts a certain period of time. That a vaccine will help protect you from any future variants. That we need to get as many people in society vaccinated because that’s how we will get past this (pandemic), and move on to doing the things we love to do.

I’m not sure if it’s the infection that makes them rethink their decisions, or the fact they had a one-on-one conversation with somebody who could answer their questions. But the vast majority — I’d say about 80 per cent — allow us to book an appointment.

In the hospital, the vast majority of COVID patients are unvaccinated. And the vast majority of those patients — I’d say about 90 per cent — say they wish they would have been vaccinated. They say they didn’t think they would be one of the few people who got sick, that they want to go back in time to get vaccinated.

For many of them, there aren’t distinct reasons why they didn’t get the vaccine. They are not anti-vaxxers. There might have been some question about the vaccine they didn’t get answered, or they didn’t prioritize it because they were busy, thinking COVID wouldn’t happen to them.

To everyone who is unvaccinated, I want them to ask themselves: If there is something they could do to see their kids again, to spend more time with their loved ones, would you not try to do it?

There’s one recent case in our intensive care unit who said to me they would have done anything — would do anything — to see their kids again. But they did have that opportunity. They would not have been in the ICU if they were vaccinated.

I’m worried about them (the unvaccinated) right now. I’m worried about their health. And I really feel as though they’re putting their health at risk by not being vaccinated. I’m not judging them in any way. I want them to not have to wish they could have done something that would mean more time with their loved ones.

These interviews have been edited for length and clarity.

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: