TORONTO - The head of a Toronto cardiac centre says the pandemic is compounding pre-existing emotional and mental health pressures on doctors, nurses and other health-care staff, describing their risk of burnout as "a public health crisis."

Dr. Barry Rubin, chair and medical director of the Peter Munk Cardiac Centre at the University Health Network, warned of both immediate and long-term consequences for a health-care system pushed to its limits in COVID-19 hotspots.

"I've been at this for 35 years, I've worked in the ICU for over 20. I think clinician burnout is the most serious issue facing the health-care system," Rubin said Tuesday.

"A critical element is going to be, in my view, do we have enough health-care staff? And do we have enough staff to support the ICU beds that we're going to need?"

Ontario projections released Tuesday suggested there could be about 500 COVID-19 patients in intensive careby mid-January as the number of free beds dwindles, and that deaths could double to 100 a day by the end of February under current restrictions.

Rubin feared what that might mean on the front lines.

"There will be more patients that require ICU beds with COVID than we have ICU beds in Ontario. That means we're going to start having to make choices about who receives care, who is likely to be saved," he said.

Rubin's warning came as he released a UHN study that found 78 per cent of nurses, 65 per cent of physicians and 73 per cent of other health staff described feelings of burnout before the pandemic.

The surveys were conducted between Nov. 27, 2018 and Jan. 31, 2019 among cardiac staff and do not take into account the impact COVID-19 might have had since then.

But UHN's psychiatrist-in-chief said there's no doubt the pandemic has compounded feelings of fatigue, stress and depression for many health-care workers consumed by concern for their patients as well as the safety of their own families and loved ones.

"COVID has really exacerbated a problem that was already there," Dr. Susan Abbey said of findings published Tuesday in the Canadian Medical Association Journal Open.

"Almost everybody's struggling on the front line."

The UHN study surveyed 414 doctors, nurses and allied staff including physical, respiratory and occupational therapists, social workers, and speech-language pathologists.

Burnout can involve professional dissatisfaction, job turnover, decreased quality of life, and thoughts of suicide.

And it's not unique to Ontario, said Dr. Dominique Désy of the association of general practitioners of the Yamaska ​​region in Quebec.

She said health-care workers are trained to cope with intense demands, but said the pandemic has imposed extraordinary pressures throughout the health system.

"As a physician, our job is to receive the physical pain and the emotional pain from our patient and you're doing that morning to night, and overnight, with your own personal issues, if there is any. So it's very difficult as a physician to feel your own pain," she explains.

"Fatigue by compassion is a very well-known issue, and to be able to listen to those inner red flags is a capacity sometimes that's buried."

She stressed the importance of everyone following strict new public health rules meant to contain infections, acknowledging many people are emotionally drained by ongoing calls for vigilance.

"They're fed up. And it's been too long, and they want to live the life they want ... I get that, we get that," said Désy.

"But the narrow angle of this pandemic is going to be at the end (when hospitals may have) to pick and choose who's going to stay on the breathing machine or not. And nobody wants to get there."

Even beyond the pandemic, the impact of COVID-19 will long be felt, Rubin added.

"Because people will have mental health consequences. I'm talking about doctors, nurses, allied health (staff), in addition to the patients that we're dealing with because of delays in treatment, because of the overwhelming nature of the work that we're being asked to do," said Rubin.

"And then when COVID goes away ... we're still going to have that huge number of cancer and cardiac and neuro and rheumatologic patients that need care.

"It's going to take a long time to sort those out. This is really a long-term problem."

This report by The Canadian Press was first published Jan. 12, 2021.

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