How close to the breaking point are our hospitals?

Jordan Sometime over the next couple of weeks I’m sure that you will hear my daughter in the background of this podcast.

Jordan’s Daughter Clip Daddy, Daddy, come quick!

Jordan If you have kids and I’m talking to you on Zoom or whatever, I’m sure I’ll hear yours. Yes, in most of Canada, schools are closed again, and we can debate whether or not they should be until they reopen. But of course, the reason they are closed is not because kids are at serious risk of illness and death due to COVID. No, the schools are closed again because our health care system is on the brink.

Christine Elliott Clip …these additional time limited measures are needed to preserve our hospital capacity…

News Clip …hospital beds aren’t the only issue here in this sector. Absenteeism is becoming a major concern. Impacting between 20 and 30% of staff members…

Nurse Testimonial Clip …we’re seeing six nurses short, seven nurses short. I don’t understand how we can be working in a system where there’s that many nurses that aren’t there to help provide that care…

Jordan If this sounds like a story I could have told you a year ago, it is. Vaccines have helped us so much in our fight against COVID, yet still, here we are again. So the question today is why, why are our hospitals so close to failure right now? Why are our health care workers at or past the breaking point? Why didn’t we prepare for this and listen to the dozens, hundreds of medical professionals who told us what we needed to do to stop this from happening? Why does it feel like 2020 again? And how close to the edge are we this time?

I’m Jordan Heath-Rawlings, this is The Big Story. Dr. Katherine Smart is the President of the Canadian Medical Association. Hello, Dr. Smart.

Dr. Smart Hello.

Jordan It’s a pleasure to have you here. And I’m sorry, I have to start with this question, and I know my producer is going to bleep it, but how ****** are we right now?

Dr. Smart Well, I think that’s what’s on the minds of everybody right now, especially people in healthcare. I think the reality is Omicron has been fast and furious, and it’s hitting the healthcare system when it’s down. And I think one of the biggest challenges we have right now is so many healthcare workers themselves have been exposed or infected, and that’s leading to staffing shortages. And this is on the background of existing backlogs in hospitals that were already full. So it’s I think, really concerning. And I think the next few weeks are going to be very tough for Canadians, for patients and for healthcare workers who are already exhausted and now facing yet another uphill battle.

Jordan From a logistics perspective, how do you manage something like this, which, to your point, is so infectious and can force healthcare workers out of hospitals really quickly? How do you sort of piece it together to keep things going?

Dr. Smart Well, I think we’re definitely learning as we go, as the situation has evolved so rapidly, and it’s different than what we’ve seen in the past, and I think that’s why we’re seeing some of the advice and the approaches pivoting. I think we have to pivot given what we’re facing with Omicron, and I think that’s difficult. It’s difficult for people to accept sometimes change in guidance. It’s difficult sometimes for people to accept the fact that we can’t maybe be as perfect or as precise as we’ve been previously with Covid. We have to sort of accept that in this situation, perfection might be the enemy of good, and we have to really do the best we can to make sure we can service people the best we can with the resources we have.

So what are we seeing? We’re seeing shifts to using rapid testing both to keep people at work and to help people get diagnosed knowing that our PCR capacity has been overwhelmed. We’re shifting to using better masks. I think we’ve seen a lot of dialogue about the fact COVID is airborne, and we’re finally seeing hospitals shift their PPE guidance to continuous N95 mask use, to really try to reduce the risk of contracting COVID in the workplace as low as possible. And I think that makes sense. We’re seeing again having to move to some lockdown or circuit breaker type maneuvers in the community to really try to blunt the wave. I think we all recognize Omicrons here. It’s out of the gate for sure, but anything we can do to blunt and limit people coming to the hospital is going to be really critical.

And then the other big shift I think we’re seeing that’s an ongoing debate is do we need to adapt how long we’re asking people to self isolate when they test positive, particularly healthcare workers who may be triple vaccinated and asymptomatic or mildly symptomatic with COVID. When is it safe for them to come back to work? And given what we’re seeing across healthcare systems, where there’s a huge amount of healthcare workers off work because of COVID or exposures, the answers to those questions are going to have huge impacts in terms of the system’s ability to keep moving forward.

Jordan In terms of that ability, not just in terms of capacity and beds and people to staff them, but as you mentioned, the mental energy and the burnout. I know last time we talked, I think you mentioned how many healthcare workers have left the profession, how close to the breaking point are the ones who are sticking around and showing up to work every day?

Dr. Smart I think many of them are at or beyond the breaking point. To be honest, we’re really seeing that across the system, and I think we’re seeing it in a really dramatic way in nursing because they have carried so much of the brunt of the bedside care of patients, and they’ve been working in under staffed environments for so long, and now they’re being asked to work extensive over time to stay on shifts long past they’re done and to carry numbers of patients that are unsafe from their perspective. And that’s very overwhelming.

And what we’re really hearing now is huge issues with staffing. Emergency departments, ICUs, many nurses not on shift. And then, of course, the knockdown effect of that is it has a huge impact on the healthcare workers that are actually there and able to be working, because now their work is just that much more overwhelming. So I think we are in a really concerning situation when it comes to the mental health of health care workers, nurses, respiratory therapists, personal support workers, physicians, really, everybody in the system. I think people have worked beyond their breaking point in many ways, and they’ll continue to do so because they have a passion for what they do and they want to be there for Canadians.

But I think what’s really concerning is, you know, what are we hearing from our leaders about their plan to help healthcare workers? We’ve been talking about this for months now. We held a summit in the fall where this issue was front and centre, yet we haven’t actually seen any action from any level of government to address it. And I think that’s very, very concerning.

Jordan We’ll talk in a minute about the big picture problem and what governments can do going forward. But first, just because things are dire right now, is there anything that government or even just Canadians can do right now to take some of the burden off of the hospitals and to find the easy wins, I guess not easy wins, but find the immediate wins wherever they are?

Dr. Smart I think there’s a few things. The vast majority of Canadians have stepped up and been vaccinated. And it’s very clear even in this Omicron wave, that that is preventing people from being hospitalized and having severe illness. When you look at the dashboards coming out of Ontario and BC, it’s very clear the people in the hospitals and in our ICU’s are people who are not vaccinated. This vaccine is holding up very well in terms of preventing that outcome. And that is the issue that is overwhelming the system.

So I think we need our politicians to really acknowledge that fact and start talking about it. I don’t think we’re hearing enough about that. As a society. We have made a decision to allocate resources disproportionately to this group of Canadians at the expense of other Canadians, including children who are now not able to attend school. And I think we’re sort of acting like it’s not a choice, but it is a choice. And I think this is a conversation that’s going to need to actually happen overtly so that we, as a society, can decide what we want to do about it. So I think that’s one issue.

I think governments also, they need to recognize what’s going on and call it what it is. And I think they need to commit to healthcare workers that they’re coming to the table with a plan for the future. As I said, we’ve been talking about this issue for months, yet we haven’t actually heard any level of government put anything on the table in terms of dollars or an actual plan to get more health care workers and to retain and better remunerate and support the ones that are in place. So I think acknowledging that is really important.

I think the language that governments are using right now when they’re describing what’s going on is key, right? We’re hearing words like absenteeism. Well, that is language that makes it sound like people are choosing not to be at work. And I think when you have a group of people that are burnt out and morally injured and distressed, using that kind of language actually has a huge impact. So I think being very careful in how we describe what’s going on and the language we use really can make the difference between people feeling like you’re in the fight with them and you’re supporting them versus they’re being judged or minimized. So I think that’s a small thing, but I think it actually has a big bearing psychologically on how people are feeling.

Your average Canadian, I think they can really do what most of them have been doing, but continue to stay committed. I want to be clear. We know the vast majority of Canadians are doing the right thing and have done the right thing, have followed public health advice, have stepped forward and been vaccinated and have listened to health care professionals. So those are not the Canadians I’m concerned with, but we have this small minority, about five to 10% of the population that are leading us to where we are right now. And I think we need to get serious about what we’re going to do about that.

But for everyone else who’s kind of with us and supporting us through this, I think that continuing to do the things that public health is asking you to do that will make a difference. And we appreciate that. And I think kindness, recognizing the healthcare professionals in your life, thanking them, thanking them publicly. And we are seeing that. We’re seeing people step up in public spaces defending healthcare workers. We’re seeing people on online spaces defending healthcare workers who are being attacked by trolls, all that sense of camaraderie of appreciation, again, that really goes a long way. And I think that’s something that everybody can do.

Jordan In terms of morale and frustration, from yourself to the doctors who are leading at the hospitals to the everyday nurses. What’s it like to see so many of your precious resources going to the people who have refused to be vaccinated, who in some cases were may be protesting outside those hospitals a few weeks ago? I can’t imagine what that feels like.

Dr. Smart Well, it’s just beyond frustrating. And the reason I say that is because of how it’s impacting other people. If you make a personal decision, that’s a bad decision, and it only impacts you, then that’s your call. And we live in a world where you can do that. And that’s fine. I may feel badly for you and have hoped for a different outcome, but I accept that that’s your choice. I think throughout this pandemic, we’ve really seen a segment of our society have a challenge to really understand the limits of personal freedoms when it comes to impacting other people. And right now, we are broadly impacting every Canadian through this small group of people who are unvaccinated.

Why are schools closed? Because our hospitals are being overwhelmed again, why are they overwhelmed? They’re overwhelmed with people who aren’t vaccinated. So the frustration of that is huge. So many Canadians have not been able to access health care they need. Again, we’re seeing elective surgeries canceled. And again, when we say elective, we don’t mean like, oh, it’s a nice to have surgery. These are cancer surgeries, hip replacements like serious things. So again, language is important, right? These are non life threatening surgeries. That would be a better term. So we are seeing hundreds of thousands of Canadians not get that care. And we’ve also seen Canadians lose their lives because they’re not able to access the health care they need because of the system overwhelmed with COVID. And that’s to me, what is so frustrating about this.

I appreciate it’s not an easy or a pleasant conversation to have, and no one really wants to perhaps talk about it, but it is what’s happening. And I think we need to call it for what it is and actually have a conversation about what we’re going to do about it, because if Omicron signals the end of the pandemic, great, and we come out the other end of this and things are different, great. But we have no guarantees that’s what’s happening. And we’re into the third calendar year of this. At some point, we’ve got to address these ethical situations that are actually impacting Canadians and really make sure that the way we’re dealing with them is on purpose and not just by accident.

Jordan In terms of that, then, I’m glad you mentioned an important ethical question. What about when it comes time to and hopefully it never comes. But what about if it comes time to triage care? Should the unvaccinated people go to the back of the line? Is that a call we might have to make at some point?

Dr. Smart Well, I think arguably we already are triaging care. And again, this is part of what’s I think frustrating in the communication is that when people are using that, what they’re meaning is where you come to the door of the ICU, and we say yes or no that you’re the one coming in. You get the ventilator, this person gets the ventilator. But that is actually already happening for many Canadians who have been triaged away from care because the bed they needed was full with someone who had COVID. So I think we should be honest with the fact that people have been triaged based on hospital overcapacity due to overwhelming from COVID, and that is happening. It’s not maybe happened yet in terms of someone being denied a ventilator because of COVID, and that’s often what people are referring to. But levels of triage have occurred. And we know just from the study that the CMA commissioned that several thousand Canadians have died from not accessing health care. So in my view, that means they were triaged away from care that they needed, and it resulted in an untimely or early death.

In terms of where do we go? I think these are things that we need to think about and answer. I mean, of course, we never want to not be able to care for people, and I would never want to have to make that decision. And I would never wish that on somebody. And I feel for a lot of people who have chosen not to be vaccinated because I think a lot of them have been misled by very purposeful spreading of misinformation. So it’s certainly not that I have any wish for this group of people to suffer, not get the care they need. I just think we need to acknowledge the impact it’s having and make sure that the ethical decisions we’re making around it are intentional. And right now, I think we’re sort of passively deciding these things, and we’re not really hearing people say what’s actually happening, which is hundreds of thousands of Canadians have been triaged away from care.

Jordan in terms of what hospitals are seeing on the ground, there have been lots of reports, not from Canada, necessarily, but from around the world that with Omicron, hospital stays are shorter and fewer people need ventilators in the ICUs. And I realize, as you mentioned, the sheer numbers that we’re seeing, especially unvaccinated folks, could overwhelm that. But I guess I’m just trying to get a picture of what looks different inside those hospitals and ICUs than it did say two years ago.

Dr. Smart Yeah, I think that’s an important question. And I think, to be honest, we’re still understanding that. I think it is true to say that that rapid onset of people with severe COVID pneumonia doesn’t seem to be quite as dramatic with this wave. But I think it’s important to understand we’re still early in the Omicron wave in Canada, and hospitalizations, especially people that are critically ill, do tend to lag behind the case counts. So as those case counts have gone up exponentially, that may still happen more and more. We’re seeing a definite uptick in people being admitted to hospital. And as you said, it does appear that people are staying slightly shorter and needing less acute care. But the bottom line is our system still does not have the capacity to accommodate that volume of people that we’re seeing, and that impacts the movement of patients in the hospital.

So if the word is completely overwhelmed with patients on oxygen for COVID, there’s nowhere to move patients from ICU to, which means you can’t free up your ICU bed. It also means there’s been nowhere to move your admitted patient to from the emergency Department, which means your emergency Department backs up. Where do all the people go that are awaiting long term care beds when that system’s also overwhelmed? And what you get is this whole backlog bottleneck effect that rolls down to impact every aspect of the hospital. And that’s what we’re already starting to see. And I think that’s what’s really concerning.

And I think again, there’s enough people that have chronic medical conditions that have medical vulnerabilities and that are unvaccinated that we are going to see a lot of those patients tipped over into needing care in ICU. And I think we’re going to see those numbers uptick here over the next few weeks. But again, the biggest issue really is just the contagiousness, the exponential rise in cases and the very rapid uptick in people needing care and a system that’s already overwhelmed and understaffed trying to absorb that surge. That’s going to be the problem.

Jordan I promise I won’t end on this question because I do want to ask you something hopeful at the end. But we’ve talked a lot here about the precariousness of the situation right now, and one thing backs up another and backs up another and causes absences. And I guess what I want to know from you is is there a time when it just falls apart? And how does that happen? And is that keeping you up at night right now?

Dr. Smart Well, it definitely is keeping me up at night. We saw hospital systems in Ontario calling an internal code Orange just yesterday, meaning that they’re in a disaster mode. And I think we’re going to see that more and more across the country as the numbers keep surging. And that does really concern me. What does it look like? It starts to look like people in hallways not getting care, right? Hospitals overflowing with patients, no beds with no staff. And suddenly you’re just going to have incredible wait times, ambulances that aren’t available and people showing up at the hospital and there’s no one to look after them.

I think we’re already starting to see that of a low level in some jurisdictions, and I think it’s not unlikely that that’s going to tick up more here over the next couple of weeks. I hope that that’s not what happens, but I think the modelling and the numbers that we’re seeing make it very concerning that that could be where we’re headed.

Jordan Last question and slightly more hopeful. One of the things that I’ve seen a lot of is explanations of just how close to the brink our healthcare system was operating at normal capacity without COVID without a new wave. If you had a blank check to get busy on fixing this thing, what is the most pressing need? Where does that money go right now?

Dr. Smart I think we have to invest in healthcare workers. It’s so important for people to understand that a bed in a system is meaningless if there’s no skilled staff there to operate it. And the backbone of health care is the healthcare workers who deliver care. So I think we need to seriously invest in plans to retain the people we have and train more nurses, doctors, RTS, other healthcare professionals to make sure that we’re meeting the needs of Canadians. And we need to actually get serious about that. And this is what we’ve not heard so far. So if I had dollars, I would definitely invest it there.

I think the other piece that we really need to get really serious about is the mental health of our youth. They have been so disproportionately impacted by this pandemic. It’s happening again now with school closures, and this is going to impact our society and our system for years to come. And I think we need to get serious about investing in that space as well. And we’re going to have a whole generation of Canadians that are going to have long term mental health challenges that we’re not able to address. So I think that’s another area that really needs a serious look.

Jordan I want to ask you one more thing really quickly because you just mentioned it and taking aside the burden to the healthcare system that keeping schools open and spreading causes. So I understand that’s why the schools are closed right now. In your view, is the risk just to children and educators from being in school if they’re vaccinated, does it outweigh the safety of keeping them out? Because we’ve talked before you and I about the mental health impact on our children.

Dr. Smart I would argue that I think the impact of closing schools is disproportionate to what you’re actually gaining in terms of impacting what’s happening right now with the pandemic. So if I was making decisions, I would not close schools. I think we should be doing absolutely everything we can to make sure schools are optimally safe. And what’s frustrating is we’ve known what lots of those things are for weeks, and we didn’t really see any change or maneuvering when we heard about Omicron. So now we’re sort of playing catch up, which is really frustrating.

I think what’s been so challenging about COVID in terms of what we’re talking about right now with schools, but throughout the system, is there’s a lot of black and white thinking. All or nothing. People wanting all or nothing type answers and things being black and white, and everything about COVID is very nuanced and nothing is black and white. And again, when we’re talking about children, the risk of COVID to children is very low. It doesn’t mean it’s zero. It doesn’t mean we should minimize it. But there’s other very real risks to children. And I think what we’ve done is we’ve inflated the risk from COVID, and we’ve acted like none of these other risks exist. We’ve talked about children who get fed at school. It might be the only safe place in their life. It might be the only place where there’s adults around them that are safe. We’ve got people that are poor and marginalized that can’t access online schooling. We’ve got parents in precarious employment situations losing their jobs because their kids can’t go to school.

And where are these kids right now? I mean, the reality is they have to be somewhere. And it’s not like there’s spaces for these children that are safe that are free of Omicron. So I worry that we have really in our minds, made school seem a lot scarier than it is. Is it perfect? No. Is no one ever going to get COVID at school? No, of course not. But there’s no evidence that that’s driving infections in children. But what’s very clear is children not being in school has had serious negative effects and disproportionately so on children and families that are already marginalized. And that’s really what concerns me.

So I think we need to not think of COVID as the only risk to our kids. We need to realize there are many other things that are going on that are infecting and impacting children, actually at a much higher rate. So yes, let’s do absolutely everything we can to make schools as safe as possible from COVID. But let’s not forget about all the other things that schools do for children and the very serious health impacts that we’re seeing by not having them open.

Jordan Doctor Smart, thank you so much for this. I’m really glad I asked you that last question. And thanks for all you’re doing, and I’m going to go upstairs and take care of a toddler now.

Dr. Smart Thank you so much and hang in there. We’re going to get through this. I know we are, but it’s going to be a rough few weeks.

Jordan Dr. Katharine Smart, President of the Canadian Medical Association. That was the Big Story, for more from us head to thebigstorypodcast.ca. Find us on Twitter at @TheBigStoryFPN. Write to us anytime, thebigstorypodcast@rci.rogers.com [click here!].

And as I mentioned, please forgive me if you hear a little one in the background over the next few weeks. I’m sure many of you have the same problem. And hey, I wish you all the best. We’re all going to need it. You can find this podcast anywhere you like to listen to podcasts in Apple or Google or Stitcher or Spotify. If you do happen to listen on Spotify, please note they now allow you to rate podcasts, is a hint that your favourite podcast needs a five star click sometime soon.

Thanks for listening, I’m Jordan Heath-Rawlings, and we’ll talk tomorrow.

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