Dr. Wendy Sligl

on the frontline

This icu/iD doctor is on the cOViD-19 frontline, from the ward to research

Last may, alberta became one of the earliest provinces in canada to open up its economy following a nation-wide shutdown triggered by cOViD-19. in the weeks and months that followed, provincial coronavirus rates began to soar. Soon, alberta had the highest infection rate per capita in canada; with a population of 4.4 million, the province had a higher number of active cases than Ontario, with 14.6 million people. hospitalization rates also rose, with Edmonton seeing the largest number of cases in the province. it’s a time that Dr. Wendy Sligl, a critical care physician and infectious diseases specialist at university of alberta hospital in Edmonton, won’t soon forget. “i can remember one icu call shift that was probably the worst shift i’ve ever worked. it was so busy with admission after admission. after 32 hours of constant work and no sleep, i was completely destroyed,” says Sligl.

For more than a year now, Sligl has toiled, donning heavy and restrictive personal protection Equipment (ppE)— gowns, gloves, eye protection and masks—as her daily armour. certified in both infectious diseases as well as critical care, Sligl is uniquely qualified to treat the disease. She has helped command cOViD-19 defence and attack: implementing strict infection prevention and control protocols to ensure the virus didn’t infect the rest of the hospital. cOViD-19 patients were placed on droplet and contact isolation in single rooms so they could be cared for safely. Where possible, all infected patients were admitted into the same section of the icu to make it easier to look after them, but as case numbers rose, the staff opened a dedicated cOViD-19 icu.

Despite the entire team’s care and vigilance, Sligl watched many patients die. “The mortality rate was very high and emotionally difficult on everyone,” says Sligl. “it’s hard to say what the worst part is—the inability, in some cases, to do anything to help. Watching a patient continue to worsen despite doing all we can do in the icu is hard.”

Yet hundreds more survived with supportive care and experimental treatments, none of them a magic bullet. Sligl looked to research studies from around the world to help inform patient care. although few treatments are available to treat the disease, the uK-based rEcOVErY trial, with nearly 40,000 global participants, demonstrated that patients were less likely to die if they received steroids, specifically dexamethasone, which has since become standard care in cOViD-19 icu patients, says Sligl. Other treatment studies that she has contributed to include “convalescent plasma,” when plasma from the blood of a recovered cOViD-19 patient is harvested. The plasma contains antibodies to cOViD-19 that theoretically fight off the coronavirus. however, convalescent plasma hasn’t been found to be helpful in critically ill patients and may only provide benefit if given early in the mild stage of disease, Sligl says.

Sligl is no stranger to coronaviruses or epidemics. in 2003, she encountered several cases of severe acute respiratory syndrome (SarS) while in training. in 2009, she looked after numerous pandemic h1N1 influenza patients in icu. The deadly h1N1 contagion, however, was “dwarfed in comparison to cOViD-19,” she says. (about 575,000 people worldwide died from h1N1. at deadline, 2.5 million people globally had perished from cOViD-19.) “in each pandemic, the same fears were real—fear for our patients, our families and our ability to cope at a health-systems level,” says Sligl, who has had several colleagues contract cOViD-19 and recover.

The vaccine rollout has slightly assuaged Sligl’s worry, but she’s still very much aware “that this pandemic is far from over.” The second cOViD-19 wave has been especially challenging, and during its peak a new night-time doctor was added to the icu staff roster to help manage increased patient numbers. Sligl herself spends about 80 hours a week treating patients. She also undertakes research and holds numerous administrative responsibilities. as well, she has chaired the royal Society of canada’s Working Group on the Epidemiology of cOViD-19 and serves as a member on its Task Force on cOViD-19.

The grind of the pandemic has led, Sligl admits, to “extreme fatigue, anxiety, and burnout, which i’ve had to learn to manage. i can’t say i’ve really done a great job, and have experienced some pretty dark times myself. i’ve tried my best to cope.” it’s been tough on her family as well. Sligl has two young but resilient kids who were used to mom working long hours pre-pandemic but have endured even more of her absence. “But they know that these additional shifts will end.” looking back, Sligl says she’s proud of how the health care system and icu team has managed. “it wasn’t easy and we had to overcome a lot of challenges but we supported each other, conquered fears and provided excellent care.” There’s one key lesson from cOViD-19 that Sligl hopes the international community takes to heart. “We need to protect each other and care about one another. This pandemic has reminded us that we are a global community of people that is inexorably interconnected.”

Dr. Wendy Sligl after getting the first dose of the COVID-19 vaccine alongside her colleague, Critical Care RN Peter Anderst