COVID-19 infections of health-care workers — among the highest levels since the start of the pandemic — are resulting in surgery cancellations or delays and reduced emergency department hours and capacity in several hospitals across the province.
Staff absences are also forcing hospitals to redeploy nurses to cover for sick colleagues and to ask some to work overtime shifts to lessen the impact on patient care — a situation that is contributing to burnout, according to front-line workers.
New data from Ontario’s COVID-19 Science Advisory Table shows the number of acute-care health-care workers infected with the virus every day is at the same level as at the peak of the last Omicron wave, and is likely even higher because official numbers are derived solely from polymerase chain reaction (PCR) testing, which is not required by all Ontario hospitals for ill staff.
“Taking large numbers of workers out because of exposure or illness means that we have to reduce the number of patients we care for. This is not always possible,” said Dr. Wael Haddara, chief of critical care at London Health Sciences Centre (LHSC), which last week had to close part of its emergency department due to the number of nurses off sick.
“Hospitals can reduce ‘elective’ patients, but not emergency patients. And so surgeries, procedures and appointments get cancelled while hospitals move nursing staff around to cover shortages in critical areas … This could be doable in the short term, but after two long years, health-care workers are on the verge of breaking.”
The situation is similar to that faced by other Ontario hospitals in recent days and weeks.
A Star survey of the province’s 14 largest hospital systems reveals that more than 2,900 health-care workers are currently off sick due to contracting or being exposed to COVID. That includes 400 at Sunnybrook Health Sciences Centre, 317 at University Health Network, 325 at Hamilton Health Sciences, 260 at Sinai Health, 230 at Trillium Health Partners, 227 at William Osler Health System and 210 at Unity Health.
While these numbers are small compared to the overall number of health-care workers in the province, it still means patients feel the impact of an overburdened system.
In addition to being forced to reduce capacity at its emergency department, LHSC also had to cancel a cardiac surgery due to a lack of ICU staff and had to ask other hospitals in the region to accept patient transfers in the last three weeks, Haddara said. There are currently 283 LHSC staff off work due to COVID, comparable to what the hospital saw in the January Omicron wave.
St. Marys Memorial Hospital in the town of St. Marys, about 40 minutes north of London, closed its overnight emergency department this week due to COVID-related staffing shortages.
“We regret being in this situation again, however the immediate staffing pressures resulting from our current COVID-19 outbreak make temporarily reducing hours the most responsible and safe decision available to us,” said president and CEO Andrew Williams in a statement.
On Monday, Cambridge Memorial Hospital was forced to close its COVID assessment centre early due to staffing shortages caused by the virus. It is also warning that high patient volumes combined with ongoing staff shortages mean longer wait times in its emergency department.
At Kingston Health Sciences Centre, more staff have called in sick due to a COVID infection over the past several weeks than at any prior time in the pandemic, the hospital told the Star in a statement, which noted that at the peak last week, the hospital was averaging about 170 individuals out sick at any one time.
On Wednesday, the hospital was sitting at about 120 individuals off sick. That number does not account for individuals who are unable to work as they isolate due to a close contact with an infection in their household — a number the hospital says could be an additional 40 to 100 people off per day.
The hospital has yet to return to 100 per cent surgical capacity as a result of staffers testing positive for COVID during the sixth wave, and in the past few weeks, it has experienced some ad-hoc operating room cancellations for non-emergency procedures when it wasn’t able to redeploy staff and physicians to cover gaps in schedules.
Burnout and stress levels are at an “all-time high” at the Ottawa Hospital, said registered nurse Rachel Muir, who has spent 27 of her 34 years at the hospital in its birthing unit.
Muir said that as of last week 450 staff were off sick at the Ottawa Hospital. A spokesperson for the hospital did not provide updated figures when asked by the Star.
“Our staffing levels have been in crisis for so long now,” said Muir, also the Ontario Nurses’ Association bargaining unit president for the hospital. “It’s a rare shift where you come in to full staff, and if you do, you rarely keep your full staff because there’s another unit which has had three or four sick calls.”
She said it’s not just nurses who are affected, but also professions such as technologists, respiratory therapists, occupational therapists and social workers.
“Basically, all the front-line workers you would encounter in a health-care setting.”
Toronto-area hospitals, while still experiencing staff absences due to COVID, say they have been able to avoid significant service disruptions or surgery cancellations as of late.
“If you’re really sick and you need the procedure, it gets done,” said Dr. John Granton, an ICU physician at University Health Network, who added that some procedures could be delayed depending on the severity of the patient’s condition.
He said if staff members who fulfil specific roles such as ICU nurses, respiratory therapists or perfusionists, who run pumps for bypass cases, are off sick in large enough numbers, it can have a “huge impact on the ability to do care in specific niche programs.”
While UHN is not seeing staff absences at the same level as the last wave, Granton said when there are a bunch of people off sick, nurses might need to take on extra patients — contributing to burnout — or move patients to other units to be cared for, which may impact the ability of those units to conduct surgeries.
“It has a ripple effect to other areas that have to backfill to make sure we can care for those emergent cases,” he said. “It puts pressure when you’re trying to increase your operations and get people in for their cardiac surgery and their cancer surgery and now the ICU is kind of full because we don’t have the effective number of beds because there are nurses off sick.”