Victoria healthcare workers brace for Omicron’s impact on nearly full hospitals

Frontline emergency physicians in Victoria are sounding the alarm about a lack of preparedness for the onslaught of COVID-19 patients expected to overwhelm hospitals that are at nearly 92% of their capacity.

“There’s no sense of urgency,” said Dr. Amy Tan, a physician who works at a hospital in the Island Health region. “There’s no contingency planning at the system level in terms of what’s going to happen come January when healthcare systems are going to be overrun, probably because of the holidays, but also because of how transmissible omicron is.”

Both Dr. Tan and James, an emergency physician who works at Royal Jubilee and Victoria General hospitals and who requested to remain anonymous, say some hospitals in the region are already full, with beds being put in hallways and public lounge areas to keep up with demand.

No plan has been communicated to them by Island Health or the provincial health officer regarding upgrading safety measures at hospitals, or adding resources to support already burnt out and diminishing frontline staff.

A yet-to-be-peer reviewed study from South Africa published this week suggests Omicron causes less severe illness than the Delta variant, finding that between Oct. 1 and Nov. 30, people diagnosed with Omicron were 80% less likely to be hospitalized than those who had Delta between April and November 2021. Another pre-peer reviewed study from the UK came out the next day, suggesting that hospitalization risk is 40 to 45% lower for double vaccinated people who were infected with Delta than with Omicron. The understanding of the variant’s severity is changing day by day: Reuters has reported conflicting studies this week, suggesting Omicron is no less severe than Delta, and saying the variant causes far less severe illness.

Even with the assumption that the risk of severe illness from Omicron is much lower than it was for Delta in BC, experts say the high transmissibility of Omicron means far more cases than BC has ever seen before, and that will correspond to hospital numbers that far exceed anything we’ve seen before.

“I do think it will rip through the population, and it will end faster than the previous waves,” said Dr. Sarah Otto, citing a downturn in cases in South Africa where the variant was first identified. “To some extent, that's going to be good news; it'd be nice to be past this wave. The thing that really worries me is that because it's so sharp and so short, that everybody's getting sick at the same time [and] needing to go to the hospital at the same time.”

The latest data from the BC COVID-19 Modelling Group shows that overall, cases in BC are rising at a rate of at least 13 to 29% per day, and by the end of December, BC will exceed 2,500 cases per day.

For the past three days, case counts in BC have surpassed all previous records for daily cases, reaching a new high of 2,046 on Thursday.

In the best case scenario, modelling shows the province can expect upwards of 700 hospitalizations and 400 people in ICU by Jan. 8. As of Dec. 23, there are 195 people hospitalized with COVID-19 out of which 75 are in ICU.

Health minister Adrian Dix has said the province has 9,218 base hospital beds and 2,535 surge beds, but surge beds require extra human resources—something BC has far less of now than in 2020.

Across Island Health, the authority says hospital base bed occupancy rate is 91.9%, and total occupancy rate including surge beds is at 84.5%.

“It looks like [hospitals] could be overwhelmed even before the end of this year, but if not, then in the first weeks of January,” said Dr. Dean Karlen of the BC COVID-19 Modelling Group.

Image: BC COVID-19 Modelling Group

Double whammy

Already, Dr. Tan says healthcare is being compromised for patients seeking care at hospitals in Island Health because of limits in bed capacity, human resources, and testing limits.

“It’s a double whammy because not only are we over-capacity for patients, we’re short-staffed on nurses,” she said. “People are burnt out, people have retired, people have quit. It's actually worse than March 2020 because the system is so burnt out from two years of this, and people aren’t coming out of retirement to help out anymore, because they're done.”

Dr. Tan and her colleagues are worried about what will happen when healthcare workers themselves, exposed to large numbers of COVID-19 patients, become ill and need to self isolate. Until recently, Island Health was assisting other jurisdictions by accepting patients from Northern and Interior Health regions, but that is no longer an option.

The questions she’s hearing from colleagues on her unit—physicians, nurses, and social workers—are all expressing uncertainty: “What happens in two weeks if we’re isolating? What’s going to happen to the unit? What is the contingency plan?”

The possibility of more and more healthcare workers becoming exposed and, consequently, infected is already higher now—at least anecdotally—than ever before.

“In the last two weeks there's many more physician friends in BC and Alberta—because I used to work in Alberta—that have COVID that never had COVID before,” Tan said.

The consequences of more and more healthcare workers needing care are twofold and dire, according to James: the shortage of staff will cripple an already overwhelmed hospital system, and staff can spread the virus easily to more patients before they even know they’re infected.

“We've had a huge turnover in nursing staff—I think it's 35% so far this year,” James said. “If you have a whole bunch of nurses that go down [and] a bunch of physicians that go down, it would be very difficult to keep the departments running.”

One step the province is taking to alleviate the pressure on hospitals is pausing elective surgeries starting Jan. 4. It’s a measure that worked in March 2020 to get hospitals ready for COVID-19 patients, and is expected to help improve bed capacities.

But there is one simple measure that both Dr. Tan and James, as well as other healthcare workers, have been calling on public health officials to take to lessen the risk of staff becoming infected: the provision of N95 masks when dealing with COVID-positive or suspected COVID-positive patients.

It’s also a step that Island Health and provincial health officials in BC have refused to take, despite changes in other provinces and jurisdictions.

BC not following the science

Island Health, along with the rest of BC, still bases their PPE guidelines on the outdated theory that COVID-19 is spread through droplets, despite studies as far back as summer 2020 providing evidence that the virus is airborne. This means tiny particles of the virus hang in the air when an infected person breathes, and another person who enters the room can contract the virus just by breathing.

At the moment, BC public health guidelines still require healthcare workers to wear surgical masks—loose fitting and disposable blue masks—when attending to COVID-positive patients rather than N95 masks known for efficient filtration of airborne particles.

An Island Health poster in hospitals showing recommendations based on droplet spread, not aerosol. Photo: Submitted

“Still, to date, if I go and see a patient who is highly suspected of COVID or has got a diagnosis of COVID, there’s a sign outside their cubicle—which has just got curtains around it—which says ‘droplet and contact precautions,’” James said. “It tells you about washing your hands, and using a face shield and a surgical mask.”

The only situations in which physicians and healthcare workers are required to wear an N95 mask in BC are during aerosol-generating medical procedures. But an N95 is not required when talking to a COVID-positive patient in a room where they may cough or sneeze.

Until this fifth wave of the pandemic, Island Health has had relatively few COVID-positive patients in hospital wards. As hospitalizations are projected to rise with higher case counts, James says the risk for healthcare workers in those units also increases.

When doctors and nurses in recent weeks have been infected with the virus, James says public health officials have discounted the idea that transmission could have happened at the hospital level.

“What they turn around and say is, ‘They weren't infected at work, they were infected at home or somewhere else,’” he said. “It's the same as the UVic story where they're saying, ‘Oh, these people didn't get it on campus.’”

James went on to add that while the health ministry denounces anti-vaxxers for spreading misinformation, BC’s public health officials are doing the same thing.

“They are using a sort of propaganda to tell everybody that this is droplet spread, and not airborne spread and that you don't need to take airborne precautions,” he said.

Once again, BC lags behind jurisdictions like Ontario where the public health body updated their guidelines on Dec. 15 in light of the Omicron variant. They now recommend healthcare workers wear a “fit-tested, seal-checked N95 respirator,” or equivalent, in addition to other PPE, while treating a suspected positive or positive COVID-19 case.

Alberta followed suit this week, requiring anyone who enters a room or space, or are within two metres of a suspected COVID-19 patient to wear an N95 mask. The province’s PHO, Dr. Deena Hinshaw, acknowledged airborne transmission on Dec. 21 and tweeted, “This was happening [with] previous variants in crowded, poorly ventilated indoor spaces but is being amplified [with] Omicron.”

At the federal level, the Canadian government also updated their recommendations for everyone in healthcare settings, stating that while not enough information is known about airborne transmission, “it is prudent to continue to use fit-tested N95 respirators.”

“Health care workers can choose to wear a respirator at any time taking into account such factors as the community incidence of SARS-CoV-2, patient’s ability to tolerate a mask, patient behaviours such as shouting or heavy breathing, requirement of extensive or prolonged close proximity, and other factors,” the updated federal guidelines read.

‘We don't feel like they have our backs’

Island Health has not responded to Capital Daily’s request for information in time for publication, other than stating that the guidance around N95 masks is under provincial jurisdiction.

There is evidence that shows the health authority is working on trying to find staff to fill the impending need at hospitals and at COVID-19 testing facilities.

One email, seen by Capital Daily, was sent to “critically trained staff” in Cowichan Valley on Dec. 20 urgently asking for more people to take on shifts at the Cowichan District Hospital, stating the emergency room and ICU is “in need over the next 2 weeks for essential support.”

Another email sent to healthcare workers at COVID-19 testing sites by an Island Health regional manager pleads with employees to extend their shifts or start earlier over the next week.

“We have been working hard to find some help without much success. You are all working so hard and yet I find myself in a position of needing to ask you the following,” the email reads, before going on to ask people to work more.

While multiple sources say wait times for a COVID-19 test in the region this week have ranged from two to five days, these callouts have born some positive news: according to a statement from Island Health on Dec. 23, COVID-19 testing centres in the region will be open on Christmas Day due to increased demand.

“On a typical weekend we would receive approximately 600 calls per day for testing,” reads the statement. “This past weekend (Dec 17-19), our call centre received approximately 2,000 calls per day. This has recently grown to more than 2,500 calls each day.”

But there is no commitment yet to improving workplace safety for hospital staff.

“What I'm hearing directly from my colleagues and from my friends is we need to feel that the government and public health have our backs. We don't feel like they have our backs with regards to not giving us N95s,” Dr. Tan said. “They’re not doing what they can outside of healthcare to keep cases down so that healthcare is protected. They just keep telling us, ‘Yeah we’re burnt out,’ but they actually have the power to do something about it and they’re not.”

N95 masks, she says, are kept under lock and key and not given to healthcare workers unless they need one for one of the specific “aerosol-generating” procedures described above.

On Dec. 21, the provincial health officer and health minister announced a host of new restrictions in light of rapidly rising COVID-19 cases fuelled by Omicron.

Many of those measures seem arbitrary in light of airborne transmission: closing gyms while allowing religious gatherings to continue at up to 100% capacity, and shutting down bars but allowing people to take off their masks to eat at restaurants, for example.

“We know if the virus is transmitted in the air, it doesn't matter where you are,” James said. “The virus doesn't know whether you're in church or whether you're in a gym or whether you're in a shopping mall, or in a restaurant.”

One thing James and the provincial government agree on is the fact that it is now inevitable that everyone will be exposed to COVID-19 at some point in time.

For the upcoming holiday season, James has one more recommendation for safe gatherings, in addition to only inviting vaccinated guests and limiting the number to one household plus 10 people in accordance with provincial orders.

“You can buy yourself one of those [air filtration systems] especially if you’re going to be having a whole bunch of people at your house,” he said, especially when it is too cold to open a window. “If people can't wear masks and they’re gathering together, that's the next best thing.”