‘Significantly over capacity’: Island hospitals overwhelmed amid silence and data gaps

Nearly 200 scheduled surgeries were postponed in the first week of the year to make room for a surge in hospitalized patients across BC. Twenty-three of the patients were in the Island Health region.

Health Minister Adrian Dix announced the numbers on Friday at a press conference where he and Provincial Health Officer Dr. Bonnie Henry announced that influenza cases are trending down, RSV is still high, and COVID-19 cases are steady at hospitals across BC.

The respiratory illnesses and pandemic virus have been the main cause of overflowing hospitals in recent weeks, prompting the province to reconvene emergency meetings at 20 hospitals—including Victoria General, Royal Jubilee, and Nanaimo Regional General hospitals—to discuss how to make space for more patients.

One week since the meetings, called Emergency Operation Centres or EOCs, were reinstated, Island Health has yet to answer questions about what actions they have undertaken.

Dr. Henry said hospitals are also seeing a spike in gastrointestinal illnesses and norovirus cases—symptoms of which are prevalent from schools to clinics on Vancouver Island, according to frontline workers who talked to Capital Daily.

These symptoms—vomiting, diarrhea, fever—can also be signs of COVID-19, especially in children and older adults, but patients are not tested for the virus at hospitals. That testing is something experts recommend.

“For some individuals, [COVID] may be mainly manifested in the GI tract,” said Dr. Sarah Otto, UBC professor, infectious disease modelling expert, and COVID-19 modelling group member.

She advised that people treat gastrointestinal symptoms as a potential sign of COVID infection.

“Test [yourself], just to ensure that you're not infecting others, or just stay home if you can.”

Avery, a Vancouver Island elementary school principal who asked that we change her name because she is not authorized to speak to the media, said the school has been sending unusual numbers of children home with fever and nausea, amounting to several times a day over the past week.

Dr. Sienna Bourdon, medical director of Shoreline Medical’s Brentwood Bay clinic, said she recommends her patients test themselves for COVID-19 if they present with gastrointestinal problems, but there is no standard for doing so.

It’s the absence of regular, complete data—about hospitalizations, surgery postponements, wastewater (which the province has been promising since September), COVID-19 reinfections, and more—that makes it difficult to pinpoint the cause of the recent surge in patients.

From the frontlines

Saanich Peninsula Hospital was at 158% patient capacity last week due to a range of issues, not mainly due to respiratory illnesses or COVID-19, according to Dr. Bourdon, who also works at that hospital as the medical staff president.

A variety of healthcare needs like diabetes, hypertension, congestive heart failure, COPD and mental health issues are the main problems at the moment, according to Dr. Bourdon.

“We're definitely seeing way, way more volumes through our emergency department and our hospital,” she said. “I worked there for eight years and there's people who've worked there for 30 years; we've never seen volumes like we're seeing right now.”

Over in Saanich, family doctor Jennifer Lush has a different caseload. Despite what the province said in the press conference, respiratory illnesses are still prevalent among her patients.

“I have not yet seen any drop off in numbers of cases in our clinic,” Dr. Lush wrote in a message in response to Capital Daily.

Island Health has not answered questions about hospital occupancy rates and surgery postponements at Royal Jubilee, Victoria General, and Nanaimo Regional General hospitals. According to Dr. Bourdon’s anecdotal knowledge, all three are “significantly over capacity.”

At Saanich Peninsula Hospital, Dr. Bourdon said all respiratory illness patients are tested for COVID-19, but not every hospital tests all patients.

As of Jan. 7, BC has reported 24 known cases of XBB.1.5, the more contagious and more immune-evasive COVID-19 variant that is rapidly spreading in the US. The pandemic virus is not a top priority for BC public health leaders, who say cases in the province have been steady. Experts argue that this is exactly the time to take action.

“The best time to keep a variant out is when it's small in numbers so we should be very hesitant [saying] ‘We haven't seen it here so we don't need to act,’” Dr. Otto said.

“We really have no idea how much COVID there is in this province, especially because the official numbers don't include reinfection,” they added, referring to BC’s practice of not counting people who were hospitalized or died after catching COVID-19 a second or third time in their official numbers.

‘It’s not black and white’

The data gap is even bigger when it comes to long COVID—a topic that was not brought up by Dix or Dr. Henry at their announcement on Friday.

“We know that having COVID-19 increases risks of a whole bunch of vascular diseases over the year to come and that comes from a very large study of veterans in the United States,” Dr. Otto said. “But does it also make the next flu worse and the next RSV case worse? We don’t know at this point.”

The study Otto referred to was published in Nature on Friday, and is based on an analysis of the US Veterans Affairs database of 150,000 people. It synthesized long COVID research findings over the past two years and found that risk of cardiac arrest, death, diabetes, heart failure, pulmonary embolism, and stroke is heightened one year after a COVID-19 infection.

Another study of about 300,000 people in Israel published two days earlier suggests most of those who develop a health complication after catching a milder case of COVID-19 have their issue resolved within a year. Both studies emphasized the need for more research.

For Dr. Otto, COVID-19 cases will rise mainly as a result of waning immunity. People are becoming more susceptible to the now-more-contagious virus because it has been a long enough time since they were infected or had a booster shot, she said.

In the absence of data and amid the current hospital crisis, Dr. Otto and Dr. Lush are calling for public health leaders to take a stronger stance on mask use.

“Masks do make a difference and should have been continued for public settings to mitigate the overwhelming surge of respiratory viruses our hospitals have been dealing with,” Dr. Lush wrote.

Mandating mask use can help increase the number of people who put one on. A survey-based study of 44,301 British Columbians over two years found that the odds of people wearing masks in public indoor spaces is 3.68 times higher when there is a mask mandate than when there isn’t one.

But mandates could also have the opposite effect, according to Dr. Otto, who cited a behavioural psychology study that found some people are more likely to adopt an anti-mask stance when faced with a mandate.

“It’s not black and white; it’s not mandate or nothing,” Dr Otto said. “Here in British Columbia, we've had very mixed messages about the value of masking even without mandates. We have not had a really big community call for protecting others, especially in indoor crowded environments with masking.”

Dix and Dr. Henry have repeatedly dodged questions asking them to clarify their stance on masking, and steadfastly refused to ask—let alone mandate—everyone to wear a mask while inside a public space.