Surgeries cut beyond Hamilton hospitals’ comfort level
A record number of 17 active COVID outbreaks has resulted in Hamilton's hospitals making deeper cuts to surgery, including cancer care and organ transplants.
We have ramped down our surgery probably beyond where we would like to comfortably do that," said Dr. Greg Rutledge, chief of emergency medicine at St. Joseph's Healthcare. Mostly predicated on our outbreaks that have limited what we can do."
At the same time, staff shortages have reached the point that even McMaster Children's Hospital has had to ramp down care to protect the most urgent services.
There is no doubt the biggest pressure right now is that staffing shortage," said Bruce Squires, president of the children's hospital.
Hamilton has 709 hospital staff self-solating - 135 from McMaster.
Ramping down surgery, diagnostics and ambulatory care is expected to free up about 1,200 to 1,500 beds provincewide and allow staff to be redeployed.
Some hospitals have resorted to bringing back staff with COVID, which is allowed as long as certain protocols are followed. No Hamilton hospital has done that yet, but plans are in place just in case.
Absenteeism is really the acute challenge that we're facing right now," said Matthew Anderson, CEO of Ontario Health.
The province announced Tuesday it will get at least 1,200 internationally educated nurses into hospitals and other health-care facilities with staffing shortages. The first 300 are expected to be matched with about 50 hospitals as early as this week. They will work as part of a team under the supervision of a regulated health-care provider.
In addition, independent health facilities are being asked to ramp down so their staff can be redeployed to vaccination clinics and assessment centres so hospital workers can return to their jobs.
Right now the pressure point is actually our health-care workers who are contracting COVID basically at the same rate as our community," said Cheryl Williams, executive vice-president of clinical operations and chief nursing executive at St. Joseph's.
Omicron is spreading so fast that it far outweighs any decrease in severity. Hamilton has a daily average increase of 578 cases despite the majority of infections no longer being diagnosed. The highest this metric reached before Omicron was 180 on April 20.
When you're talking about such large scale infection rates as we're seeing, even a proportion of those that end up critically ill puts an enormous stress on the system," said Dr. Bram Rochwerg, intensivist and site lead at the Juravinski Hospital intensive care unit (ICU).
The number of hospitalized patients is expected to rise until the third or fourth week of January, Ontario's Health Minister Christine Elliott said Tuesday. The peak for ICUs is expected at the beginning of February.
Hamilton might be slightly ahead as the city had Ontario's highest COVID case rate last week. It now sits at third, shows analysis done by epidemiologist Ahmed Al-Jaishi.
From what we can measure, the numbers have been higher in Hamilton relative to other health regions," said Dr. Zain Chagla, co-medical director of infection control at St. Joseph's. It's likely Omicron took off here a bit faster, a few days even faster, than other regions. With exponential growth means that we're that much further ahead in terms of that exponential spread."
Hamilton hospitals were caring for 258 COVID patients Tuesday. Elliott provided some new context on hospitalizations provincewide.
Across Ontario, 54 per cent of COVID patients were admitted because of the virus with the rest being hospitalized primarily for other reasons. The number admitted for COVID is much higher at 83 per cent for ICUs. However, Hamilton hospital leaders caution the situation is much more complex.
At a hospital level, all of them count in terms of the pressures that we face," said Chagla.
No matter the reason a COVID patient came to the hospital they still require infection prevention and control protocols, higher levels of personal protective equipment for staff, and potential treatment for the virus. In addition, it's far more difficult to discharge them to home care or other settings.
Chagla also pointed out that it's getting hard to tease out" whether a patient came to hospital because of COVID or another illness. A small - and shrinking - group are obvious, such as pregnant people giving birth or mental-health patients.
Really a lot of what is coming in is people with certain issues that relate to their COVID-19," said Chagla. People who are frail, vulnerable, have end organ diseases like emphysema or heart disease where it has been exacerbated by the COVID-19. Much of the management is to deal with that underlying disease but it really is because of COVID-19 that they are with us."
Rutledge also talked about this large group who don't have the classic respiratory failure seen earlier in the pandemic.
It's a little bit different than previous waves in that they tend to present more with general weakness, cognitive decline, fatigue and inability to manage at home," he said.
Joanna Frketich is a health reporter at The Spectator. jfrketich@thespec.com