For the past two years, authorities have claimed that various restrictions needed to be put in place to limit COVID-19 illness in order to reduce the strain on the health care system, particularly the hospitals. Should society have been placed under limitations to prevent a surge of ill patients? Were there other ways to generate surge capacity?
The hospital system became the main focus for protection through the messaging from politicians and public health representatives. In March, 2020, a media blitz showed ICU’s being overrun and ventilators being in short supply. This was used to justify lockdowns resulting in business interruptions, health care delays, and school closures with numerous secondary harms.
Should the burden of protecting hospital capacity been placed upon the general public? Retired Lt Col David Redman explores this issue in his publication Canada’s Deadly Response to COVID-19.
There were other considerations to decrease the burden on the hospital system. Allowing the use of early outpatient treatment would have decreased the burden of severe illness requiring hospitalization. Terminating thousands of hospital staff has decreased hospital capacity and worsened the work and stress loads on remaining employees. Accommodation should have been made to allow access to outpatient care and management of chronic illnesses, as to prevent worsening medical issues.
With respect to hospital’s risk of coping with demand, here are some references to shed light on the situation.
From March 20, 2020 to October 31, 2021, 9,096 Ontarians have been admitted to intensive care units (ICUs) with COVID-19 related critical illness. The COVID-19 pandemic has strained Ontario’s critical care system. At the peak of wave 3, the number of patients on ventilators was over 180% of pre-pandemic historical averages.
The critical care system was able to accommodate this influx of patients by deferring surgeries and procedures, funding new ICU beds, identifying temporary surge space, team-based care models utilizing redeployed staff, and transferring patients between hospitals. This required effective collaboration and coordination across critical care system.
The critical care system does not currently have capacity to accommodate a surge as it did during waves 2 and 3 due to worsening staffing shortages, healthcare worker burnout, and health system recovery efforts. Public health measures to mitigate influxes of critically ill patients are needed.
This report references loss of staff which creates less supply.
The greatest part of the firings was in BC with 3325 workers terminated. Ontario lost 1665 positions.
It does not take a lot of math to understand that the Ontario Science Tables summary of ‘worsening staffing shortages’ may be due in part to hospitals self-inflicted reduction in staff through termination while trying to enforce a vaccine mandate. There appears to be no data to justify this decision either before or after the vaccine deadline. If any segment of our society was likely to develop early natural immunity, it was our health care workers on the front-lines of the COVID-19 pandemic. One must also wonder how many remaining staff were coerced into getting vaccinated only to keep their job. There is no way to measure morale amongst hospital workers, but it certainly must be a factor in ‘health care worker burnout.’
- This reference admits the misrepresentation of the data.
Dr Kieran Moore, Ontario’s Chief Medical Officer of Health has stated that 50% of the people testing positive in hospital with COVID-19, are really there for other reasons. This supports the argument that COVID-19 is not the reason for increased strain on the hospital system while making accurate interpretations of COVID statistics challenging for policy makers and scientists. This news does not enhance trust in the hospital or public health reporting systems.
- This reference sites the long-term lack of supply in Canadian hospital capacity.
In short, Public Health policies created much of the stress faced by hospitals. Note that this National Post article focused on Ontario, which has fewer hospital beds than all other provinces in Canada
A more extensive analysis of Canadian hospitals’ capacities across the provinces is available in a 2015 report by Fowler et al.
While efforts were stepped up to create more hospital beds to accommodate increased anticipated demands for treatment of COVID-19 patients, this remains limited by the availability of health care workers to service these beds.
There are challenges ahead as well. This recent survey by Angus Reid illustrates the bleak outlook of Canadians, especially regarding mental health issues.
In summary, the health care system often faces capacity challenges during respiratory illness seasons. This is not new. As in other years, the burden of lessening this hospital demand should not have been placed on the general public. It could have been reduced through strategic management of the health care system itself. Was there a risk? Yes. Could it have been handled differently? Yes. What will we do next time? Hopefully better.