Voices from the trenches. They are fearful, concerned, admonishing at times, but also full of pride for the job they are doing as workers on the front line of Canada’s health-care response to the pandemic.

They are from written answers to a recent survey conducted by research firm Potloc and the non-profit advocate Canadian Public Health Association, which found that almost half of the 578 respondents felt they need mental health support as a result of this crisis.

These are the words of our health-care providers.

Nurse (Ontario)

Be more empathetic toward one another. Recognize that this is a community effort to protect each other and those who are vulnerable — NOT the apocalypse. It is not every man for himself — it is quite the opposite.

Nurse (Alberta)

The population in their 20s and 30s present a challenge. When I get a case in that group I am far more likely to have multiple contacts for them during their period of communicability. Any epidemiological link to a sick contact becomes a probable case and will launch an entire investigation, and it’s common we have to do that.

The seniors who have been infected, largely by travel, are excellent at abiding by the conditions. They even go over their feared missteps. (One pressed the elevator button after washing his hands and he was terrified he put his neighbours at risk, but I think I assured him well enough that his freshly washed hands made a difference.) We need to get the younger population on board somehow.

Paramedic (Nova Scotia)

Stay at home. Actually practise social distancing. Stop wearing gloves for countless hours doing activity after activity with the same pair. Only use the emergency department for emergencies. Only use ambulance services in emergencies.

Follow the provincial mandate of 811 and waiting for a reply if you think you have symptoms instead of becoming concerned that you haven’t heard back and then calling 911 to have an ambulance take you to the emergency department because you “want a swab now to find out.” Stop putting us health-care providers at increased risk because you think you deserve something a different way than it’s supposed to happen.

Nurse (Quebec)

I’m an assistant nurse manager on an oncology, hematology and palliative care unit. The stress level is very high, but the staff has been incredible.

Staffing is a constant issue because anyone who has symptoms must immediately go off work and get tested and await test results, causing enormous strain on our ability to staff the unit appropriately and provide safe care to our severely immuno-compromised patients.

Also, there is the constant stress of worrying whether yourself or your colleagues are working while being COVID-19-positive but asymptomatic, putting everyone’s life in jeopardy unintentionally. Also the stress of working with potentially positive patients, unprotected, when they are asymptomatic or presymptomatic.

One of the worst things of all for myself has been controlling visitation. Telling our patients, all of which are very sick and/or dying, and their families that they will have to be alone and not see their loved ones has been heart-wrenching. Many have been understanding, but in some cases we are being treated like the worst human beings on Earth, when we are just trying our very best to uphold government and institutional directives and keep our patients and staff safe.

At the same time, many staff members have really stepped up to the plate. Voluntarily cancelling their pre-planned vacations to help out. Increasing their availabilities. Working overtime; 16-hour shifts to make sure their co-workers don’t have to work short-staffed. Team spirit is stronger than ever and I have the utmost respect for every one of them.

Paramedic (Alberta)

Follow the quarantine and social distancing advice. Went to a 74-year-old this morning having a stroke — the entire family from around the area shows up to help dad. We get to scene, ask screening questions of husband and wife, treat and transport the husband and bring his wife. Find out en route to hospital that one of the sons present was in Day 8 of their 14-day QUARANTINE from return of international travel.

I get it, they are concerned, but they have just exposed everyone in that situation to possible COVID, should they have the disease. This happens on 70 per cent of calls.

Did one the day before, a snowmobile accident. One member of the group was also meant to be in quarantine, she was not and decided that going out with a group of friends was the smarter idea. People are being selfish, hoarding supplies, and not being considerate of their neighbours. That needs to stop immediately, but sadly it won’t until those people have a loved one infected and seriously ill from COVID-19.

Nurse (Ontario)

My workday starts after a 40-minute walk to avoid public transit. I change into my scrubs and put on my PPE (personal protective equipment), which includes a mask at minimum depending on my role that day. I will wear this mask until noon when I take it off to eat my lunch. I get two masks per day as we need to ration them.

I work as a registered nurse at a large inner-city family practice clinic. My role changes day to day. Yesterday I was screening patients at the front door for COVID-19 symptoms. If they screen positive (say yes to any of our screening questions) then I escort them into an exam room. They will then be seen by a nurse or a doctor dressed in full PPE (gown, gloves mask, face shield) as needed.

We have been told to limit the number of providers seeing the patient face to face. Not to provide the best care but to limit the amount of PPE we utilize. Currently we only see patients in clinic who have urgent concerns and have gone through many levels of phone and front-door screening first. Most appointments have been converted to phone or virtual. All routine check-ups and non urgent issues have been cancelled until July.

Forty per cent of our patients have incomes below the poverty line. Most are on (Ontario Disability Support Program or Ontario Works). Many have severe mental health issues or are marginally housed.

The changes and the closures of facilities and resources have only just started to have an impact on people. I saw two patients one day who had not eaten that day because the restaurant they go to for all their meals is closed. They have probably eaten at that one restaurant every day for 10 years and now that it’s closed they just didn’t know where to eat. For some people the routine they have created is all they have and when that is thrown off they are lost.

I do a lot of phone calls these days. I am calling patients who have symptoms and wondering if and where they should get tested for COVID. Our answer to them is unacceptable.

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Unless you are either at high risk of transmission (work in health care, work or live in a shelter, long-term-care home, prison, etc) or are sick enough to present at the ER you don’t fit criteria for testing. Our instructions are to self-isolate, manage your symptoms at home unless you can no longer manage at home then go to the ER.

The other half of our phone calls is triaging health concerns. I spoke to a mom whose baby had a high fever for five days and was showing signs of dehydration but she was avoiding bringing him to see a doctor for fear of her baby getting COVID from exposure at a hospital or doctor’s office.

Another new task for us is doing a daily inventory of all our PPE. We now have to keep it all stored in a locked room for fear of it being stolen. The other day a patient, frustrated with our screening questions yelled at us that “this is bulls---.” Part of me agrees. Having to ration protective equipment, not being able to test widely, having to advise patients to monitor their illness at home because we can’t safely assess them in person. This whole situation is bulls---.

Nurse (Alberta)

We are an outpatient dialysis unit. Patients come from community settings often sharing HandiBus rides together when asymptomatic. They are screened prior to entering our unit and isolated if presenting with a cough. We are unable to distance ourselves from our patients as we have to put them on dialysis treatment.

Curtains are the only measures we have to give patients the privacy all are requesting. We have to enter our patients’ environment continuously as there are multiple alarms of our HD machines; patients often crash so immediate attention is necessary. We have no Microsan hand rub.

Our patient population does not change much. In 27 years that I have worked there we have NEVER run out of hand sanitizer. This is our first line of defence. The soap is literally eating away at my skin and I have cracked, bleeding wounds on my palms. Lotions are useless because they are not on my hands for five minutes and I have to wash again.

Other inpatient units in the same hospital have a healthy supply of sanitizer yet we are not allowed to borrow? … I thought we were supposed to be proactive in our practice but we are made to be reactive because no one seems to hear our cries!

Nurse (Ontario)

As the situation evolves there is new information emerging, new policies in place, which makes for increased confusion in my workplace. It is challenging to obtain accurate information from administrators and the information we do receive is different depending on who we talk to — infection control says one thing, managers say another, and staff members all have their own interpretations.

The last few weeks have felt very disorganized and have left me only more worried. Each health-care centre in the region seems to be doing different things. My biggest concern is adequate PPE to allow front-line workers to do their job safely without concerns of contracting the virus and bringing it home to our families.

It feels as though the changes to PPE were made to align with the supply at hand as opposed to scientific evidence as to what is safe, which goes against many of the infection control guidelines we have previously followed.

When care providers overseas are wearing N95 masks, shields, bodysuits, hairnets, shoe covers, nitrile gloves — and we are expected to wear only a gown, surgical mask and gloves … there seems to be a vast disconnect as to what is deemed safe, and it should be standardized to ensure all staff are adequately protected.

Administrative health-care professional (Ontario)

In my city, many people are not physically distancing. Stores are not enforcing it. Police and bylaw officers have not been enforcing it. People were seen in the background on a news broadcast on a closed golf course. Police attended to find 30-40 people had snuck onto the course to play.

A man was seen out after returning from vacation, police issued a warning. The next day, police observed the same man making deliveries. There are pictures of 10 people standing around talking in the local Tim Hortons parking lot. A local gym was found to be open after being mandated closed weeks ago. People not physically distancing in stores when shopping for essentials has to be the absolute worst!

Nurse (Quebec)

Reading, translating, writing, communicating the wave of directives that has been issued from the governing health body. Working remotely from home because of a mandatory 14-day isolation due to a positive contact at work from a health-care worker who returned from travel just before the precautions were initiated.

Getting up at 5 to start reading in my son’s old room, converted to storage space, (which) has a sleeping bag and mattress on the floor to accommodate my isolation. Using a borrowed laptop and iPad and phone to designate and delegate work in my absence.

My role involves hands-on teaching of safety techniques, donning and doffing PPE, educating staff on the rules and new guidelines. Phone calls … Research. Trying to connect with friends, colleagues online. And on and on till my brain is broken. Worrying. Have I prepped enough, did I forget anything. Are we all going to be OK.

Nurse (Ontario)

Within my organization, due to different sources including WHO, CDC and local health authorities having different (infection prevention and control) recommendations, there is a sense of mistrust brewing between front-line care staff and the administrative upper management.

Care workers have been feeling the burden of dangerously worsening patient workloads and resources for years, and feel scared about meeting the needs of their patients and keeping themselves and their families safe. Despite all of this, I still hear laughter and singing in the hallways on the units and staff putting on a brave and reassuring approach with patients and their worried families.

We talk about how we can support each other and how we will make taking on more hours’ work, because we know it is needed.