Fourth wave highlights health system's fragility – The Daily Gleaner Op-EdOctober 21, 2021
New Brunswick hospitals are on "red alert," reducing or suspending services to increase capacity for COVID-19 patients as the fourth wave continues. There are 57 patients hospitalized for COVID-19 and 18 in intensive care, at the time of writing – a number that will continue to fluctuate in the days and weeks to come.
New Brunswickers might reasonably ask if the hospital system is truly threatened by fewer than 20 critical cases after 18 months of a global pandemic. Unfortunately, the province-wide red alert shows that it is.
Why and how is this possible? To this, there is no simple answer.
In less than a month, the number of people hospitalized for COVID-19 has nearly doubled, and the number in ICU has increased by 50 per cent. The current hospitalizations represent more than 20 per cent of the total number of New Brunswickers hospitalized since the beginning of the COVID-19 pandemic. With almost 1,000 active cases in the province, there is potential for hospitalizations to continue to rise. It is wise for the provincial health-care system to prepare for this possibility.
Capacity in terms of both the number of hospital beds and the care providers required to keep them functioning is limited. There are only 142 ICU beds in the province, and 12.6 per cent of them are currently occupied by COVID-19 patients. Most hospitals in the Vitalité Health Network are already over full capacity.
In addition, there are staff shortages putting additional pressure on the capacity to provide care. In August, there were close to 1,000 vacancies for nursing positions among the province's two health authorities (Vitalité and Horizon) and the New Brunswick Extra-Mural Program. Employment in health occupations fell by about 3,800 workers between August and September, according to data from Statistics Canada's Labour Force Survey. This suggests the province is currently short almost 5,000 health workers overall (or about 12 per cent of the provincial total). In the first half of 2021, nurses in New Brunswick logged about 190,000 hours of overtime, compared to 153,000 for all of 2020.
There are currently about 228 health workers off due to exposure, more than three time the number just one month ago. Despite vaccination being mandatory for health-care workers since Sept. 13, many workers remain unvaccinated or only partially vaccinated. This leaves them at a higher risk of contracting COVID-19 and with a higher potential for severe disease if they become infected.
The majority of hospital workers are vaccinated, but rates vary. Across Vitalité locations, vaccinations range from 65 to 88 per cent of health-care workers, according to recent reports. However, about 300 nursing home workers will not be vaccinated in time to meet the Nov. 19 mandated deadline for government employees. This outcome could result in these workers being suspended without pay.
With most critical care bed occupied, hospitals at or near capacity and obvious shortages of health-care staff to provide care and keep hospitals running, there is a very real risk that the system could be overwhelmed if COVID-19 cases (and particularly, hospitalizations) continue to increase.
Consider the numbers from early October, as circuit breaker measures were introduced: more than 100 per cent of Vitalité's beds were occupied, and up to 84 per cent of the spots overseen by Horizon Health Network were occupied.
Outside of hospitals, COVID-19 presents a significant threat to seniors, especially those already in ill health and residing in congregate settings. The earlier waves of COVID-19 had severe effects on seniors in long-term care facilities in many provinces, particularly Ontario and Quebec. The Atlantic provinces have thus far been quite successful in avoiding and preventing outbreaks in long-term care homes (with some notable exceptions, such as Northwood in Nova Scotia, where the vast majority of the pronvince's deaths in the early stages of the pandemic took place). While vaccination rates are high for seniors in residential care, the infectiousness of the Delta variant means that community spread remains a significant risk to residents in long-term care.
While the hospital system in New Brunswick can handle a surge of 20 critical care patients, it has extremely limited capacity to handle anything beyond that. The presence of community transmission in much of the province and active outbreaks in the long-term care facilities show that more critical capacity might be needed in the near future.
"Red alert" and emergency measures at hospitals are not ideal, but this is a necessary step to ensure there is capacity to treat critical cases as they arise (either from COVID-19 or other causes). The suspension of non-urgent surgeries, diagnostics and other procedures will add to backlogs and put continuing pressure on capacity following the threat of the fourth wave, and could result in delayed diagnosis or treatment for affected patients. As much as possible, the continuity of care should be maintained.
Following the current wave, the provincial government should address some of the factors that contribute to limited health-care capacity, relative to population needs, and improve the ability to manage surges in demand. Investment may well be needed, as New Brunswick spends less per capita on physicians, other professionals and other institutions than its neighbours in Nova Scotia and Quebec. New Brunswick spends more per capita on hospitals than Quebec, but slightly less than Nova Scotia. Prior to the pandemic, it had an average amount of health-care professionals relative to population size.
All in all, the New Brunswick health-care system appears to have similar resource levels to other provinces, but is currently suffering from shortages of staff. Many other provinces have also suspended various hospital services, or redirected care to outpatient and other facilities such as private clinics during pandemic surges.
Following the current COVID-19 surge, New Brunswick can learn from its own experience and those of other provinces. After all, the challenge of better preparing the health-care system for an infectious disease crisis is ongoing across the country.
It is a multi-facetted challenge and will require a broad and strategic modernization of health-care systems across the country. Systemic and organizational factors can address the efficient use of limited health resources and improve surge capacity through planning and preparing for such events.
A more fundamental challenge, however, if how to address shortages of care providers. For both the current surge and the healthy functioning of the system over the long term, recruitment and retention of health human resources should be a priority.
Rosalie Wyonch is a Senior Policy Analyst at the C.D. Howe Institute.