Ontario will need to turn to public health measures to protect its hospitals from patient surges amid staffing shortages: science table
Published Tuesday, November 30, 2021 1:29PM EST
Last Updated Tuesday, November 30, 2021 11:11PM EST
Ontario will need to use public health measures to “mitigate influxes” of critically ill patients over the coming months and protect a health-care system that is now struggling with “worsening staffing shortages” and “worker burnout,” a new report prepared by the group of scientists advising the Ford government argues.
The report from Ontario’s Science Table says that while the province has been able to accommodate past patient surges without having to turn to a triage system to ration critical care resources, it likely now “lacks the capacity” to accommodate the sort of uptick in hospitalizations it saw during the third wave of the pandemic this past spring when as many as 940 COVID-19 patients were in intensive care units simultaneously.
The scientists say that in addition to a “shortage of critical care nurses and staff” that has worsened through successive waves of the pandemic, hospitals may be less able to achieve “significant reductions in surgical and procedural activity” amid a “growing care-deficit.”
Dr. Kali Barrett, who sits on the science table and co-authored the study, told CP24 Tuesday night that nurses have been “disproportionately” affected by the strain of the pandemic and many of them have left in order to protect their own mental and physical health.
“So we're having difficulty staffing the existing beds and the patients who are in ICUs at present,” Barrett said. “And so the concern is that if we were to see another huge surge like we saw during the third wave, it would be a lot more difficult. We wouldn't have the same resources in terms of healthcare workers who would be available to look after those patients.”
The scientists also say that the “complete absence of influenza transmission” during the 2020-2021 flu season is unlikely to repeat itself this year, lending additional “uncertainty” to the health-care system’s ability to withstand future waves of the pandemic.
“Going forward, it may be more challenging for the critical care system to rapidly increase capacity as it did during the height of Wave 3 due to staffing shortages, healthcare worker burnout, and a desire to preserve non-COVID clinical activity,” the report states. “It is imperative that public health measures that help to reduce transmission of SARS-CoV-2 as well as other infectious diseases with the potential to burden the healthcare system, including influenza, are in place over the coming months.”
Barrett added that the possible effects of the Omicron variant could also compact existing problems.
“We really don't know yet enough about the Omicron variant so I think it's too soon to say but if that turns out to be a variant that has a really impactful effect on hospital and ICU numbers, of patients in hospital and ICU then yeah, that could be very concerning for us,” she said.
ICU admissions have been slowly rising
The number of people in intensive care with COVID-19 has held relatively steady throughout the fall but could be slowly beginning to rise now.
As of Tuesday there were 153 COVID-19 patients in the ICU, up from 134 one week prior.
In their report, the scientists say that “ICU resources and staffing were not sufficient during COVID-19 surges” in the past but they say that the “worst case scenario” was avoided through a number of strategies, including using ward beds to care for non-ventilated patients and identifying non-traditional spaces for ICU surge capacity.”
They say that this time around health system recovery has been deemed a “key priority” with Ontario Health recommending that hospital operations over the coming months preserve access to non-COVID-19 scheduled surgeries, procedures, and diagnostic imaging, all things that could threaten the ability of hospitals to accommodate patient surges.
The scientists also argue that the ability of hospitals to withstand future waves will be limited by the “growing staffing shortages in critical care units” where nurse vacancy rates exceed nine percent, up from 5.8 per cent prior to the pandemic.
“Burnout has likely contributed to this staffing shortage,” the report notes. “Nurses in particular have been at increased risk for burnout during the pandemic for a variety of reasons, including heighted anxiety about risk of exposure to SARS-CoV-2 at work, an increase in patient acuity, increasing demands for overtime, reassignment to unfamiliar roles, and sustained exposure to the moral distress associated with caring for patients with COVID-19.”
While the report did not call for any immediate new measures, Barrett said it is critical that the province continue to implement current infection-prevention measures that have worked well.
“We're actually doing really well in Ontario when you compare us to our peer jurisdictions, and that's due to our high coverage of vaccines, our adherence and our continued use of masking in indoor spaces, focusing on ventilation and making sure that air quality and ventilation and filtration is optimized as much as possible. And so this is not the time to be relaxing those measures,” Barrett said.
The 15-page report released by the Science Table on Tuesday comes less than a week after Dr. Chris Simpson, who is the medical vice-president of Ontario Health, expressed confidence about the healthcare system’s ability to withstand future patient surges in an interview with The Canadian Press.
At the time he said that investments in boosting capacity as well as lessons learned about managing surges through patient transfers would allow Ontario hospitals to accommodate 250 or 300 COVID-19 patients in intensive care at one time without having to ramp down elective procedures, up from 150 during previous waves.
However, in its report the science table expressed concern about accommodating patient volumes that could easily surpass those sort of numbers, as was the case during the second and third waves.
The science table did not specify what sort of public health measures would be necessary to limit the spread of COVID-19 over the winter months in the report.
“Public health measures are needed in the short term to reduce transmission of SARS-CoV-2 as well as other infectious diseases, including influenza,” their report notes. “Longer-term policies need to be simultaneously implemented to address the existing critical care staffing crisis. These combined efforts will help ensure that there is critical care capacity for all patients who require it, and reduce the burden on an already strained workforce.”
With files from The Canadian Press.