Record pandemic case numbers and hospitalizations are already sending Vancouver hospitals into crisis mode, with staff out sick, too many COVID-positive patients to allow isolation and overcrowded emergency departments.
Contact tracing for cases and exposures between staff and patients within Vancouver General Hospital has stopped, according to a recent email from a senior physician shared with The Tyee.
“Individuals are therefore not being informed that they have had a contact,” wrote the doctor last week, noting a number of new positives among nurses and physicians. “Each of those people might have had dozens of contacts in the prior days. Many of those contacts won’t know they were a contact.”
Doctors and residents have also been told not to encourage the wearing of N95 respirators at the hospital, despite limited isolation and testing measures in place, according to another physician at the hospital.
And at Lions Gate Hospital in North Vancouver, patients who have COVID-19 or later test positive are flooding the emergency room with nowhere to isolate themselves while they wait to be admitted, according to one nurse. Many are elderly.
On Thursday, a record 534 people were in the hospital with COVID-19, surpassing the previous peak of 515 patients in April. Modelling suggests that number could increase to 4,000 in hospital by the end of January.
Two health-care workers told The Tyee that staffing and infection controls are already breaking down due to more patients and isolating employees, as hospitals prepare for a deluge of patients in the coming weeks.
From Jan. 3 to Jan. 9, health-care workers missed 27,937 individual shifts due to all illnesses, including COVID-19, with 5,183 of those in Vancouver Coastal Health, according to Ministry of Health data provided on Tuesday. That’s about 3,800 shifts missed per day among more than 120,000 health-care workers in the province.
Vancouver Coastal Health did not provide numbers of missed shifts at VGH or Lions Gate Hospital when asked by The Tyee.
Health Minister Adrian Dix said this week the province is looking at a field hospital “if necessary” at the Vancouver Convention Centre, but he did not detail how it would be staffed.
Frontline workers are worried about the rapid spread of Omicron and the exhaustion of staff.
“The fact that [Omicron] is milder doesn’t help hospitals when the case rates are so high,” said one physician at Vancouver General Hospital, who was not authorized to speak publicly. “But this isn’t the first wave; we don’t have the energy we did at the beginning.”
On Monday night, 26 of the 46 patients requiring admission to Lions Gate remained in the waiting room or hallway overnight after the hospital’s 20 intensive care beds filled up, according to the nurse and a scheduling email shared and verified by The Tyee.
The overnight emergency room nursing team had 10 nurses that night instead of the usual 16, and beds in other units where patients would have usually been sent were closed because the staff were out sick, said the nurse.
“Spending the night in ER at the best of times is terrible… but to have to spend the night in the waiting room as an elderly person is even more of an issue. It exacerbates their illness,” said the nurse in an interview.
“We’re not able to provide the level of care that we would like to provide. We’re not able to connect with patients or make them feel secure or heard. And having to pull some plastic curtains around someone in the waiting room to toilet them is just degrading.”
The Tyee is not naming the nurse because they were not authorized to speak publicly.
Lions Gate’s four appropriate isolation spaces for airborne protocols, as COVID-19 patients require, are nearly always full, the nurse added. And tests for the virus ordered in hospital often don’t come back until hours later.
“We frequently have patients who are COVID-19 positive spending hours or even a day in the emergency department,” they said. “They are short-staffed upstairs and closing beds, so everyone backs up into emergency.”
“This is the worst it’s ever been,” said the nurse, who estimates as many as 15 colleagues have left the emergency department since July either to change professions or for nursing work elsewhere.
In a statement, a spokesperson for Vancouver Coastal Health said that “hospitals mirror what’s happening in our communities, which means we are still seeing COVID-19 cases.”
The statement did not address a question about protocols being taken to address the reported bed and staffing shortage at Lions Gate or Vancouver General but said that beds are opened and closed daily based on need and staffing levels.
“This process occurs throughout the year and is not specific to COVID-19 related staffing shortages.”
The doctor at Vancouver General described similar staffing challenges. At least two shifts in the last month have been understaffed, and multiple other shifts have required exhausting all back-up options to fill.
People are working longer hours, coming in on days off, and returning to work after only five days of COVID-19 isolation because multiple units are under-staffed.
Staff with children or other household contacts who tested positive are also permitted to work if they don’t have symptoms when previously they would have been directed to isolate.
“It’s just exhausting, and everyone is working at 110, 120 per cent of their capacity, and I think it’s more difficult just knowing that is an unsustainable level of work,” said the doctor. “Maybe something terrible hasn’t gone wrong yet, but it is inevitable that it will.”
“I feel anxious about if cases continue to get worse and with even more patients and staff sickness.… I don’t really know how long this can be sustained.”
The doctor and colleagues have been informally encouraging their teams to wear KN95s or N95 masks when possible.
But management has discounted the need for the masks, adding to anxiety as contact tracing for cases within the hospital has ceased, the doctor said. “I was told over the weekend that the hospital is not doing any contact tracing for positive COVID-19 cases,” they wrote.
Many patients have also tested positive for the virus after being admitted for other issues, exposing multiple staff members who don’t have the resources or space to isolate potentially positive patients while awaiting test results.
The doctor said at least two colleagues who were not wearing N95 masks have been infected by COVID-19 patients in recent weeks.
Contrary to parts of the email shared with The Tyee, Vancouver Coastal Health said in a statement it still provides testing in hospital and case followups but did not specify whether routine testing of all new patients had stopped.
N95 masks are worn in high-risk settings, the statement said, particularly during aerosol-generating procedures with patients who are confirmed or suspected COVID-19 cases.
“VCH has been consistent in its approach to PPE, aligning strongly with the most current provincial guidance,” said the statement.
But the doctor said without routine testing and with a high risk of infection everywhere in the hospital, “it’s been frustrating to feel like we can’t fully take the steps to protect ourselves.”
Provincial health officer Dr. Bonnie Henry has downplayed the importance of wearing an N95 mask or the increasing risk from aerosol transmission.
The BC Centre for Disease Control’s current infection control protocol document on masking also does not mention aerosol transmission and advises use of N95 or similar masks only when the risk of transmission is high.
Dix has said all health authorities have protocols in place to call staff back from vacation and days off and to extend shifts if other staff members are out sick.
Both the nurse and doctor stressed they hadn’t witnessed staffing levels they considered unsafe and said that all their colleagues and supervisors are working hard to keep things going.
But they expressed deep worry about how much longer they and their colleagues could continue working at this pace, and who will leave the health-care sector because of this experience when the pandemic eventually fades.
“It’s just a matter of time until people burn out,” said the nurse.
“The system is mainly being sustained by people stepping up and being willing to take extra shifts for colleagues... that’s what we all feel responsible for doing,” said the doctor. “We’re just doing it because we have to, and we don’t see a lot of alternatives.”