As COVID-19 case numbers continue to soar and the health-care system is stretched to its limits, concerns are being raised that exhausted hospital staff are being left in the dark about how they'll handle a surge in critically ill patients.
There are already more patients in Manitoba's intensive-care units than during the peak of the pandemic's second wave last winter, and as officials expect an as-yet-unknown surge in the most serious virus cases, front-line staff need to be involved in plans to expand capacity, a Winnipeg ICU doctor says.
"Most of us feel that it's been almost day-by-day planning. And if there is better planning — you would hope — then it has not been clearly communicated. I think that's where we're having, I think, almost unneeded trouble," said Dr. Eric Jacobsohn, an intensive-care physician and cardiac anesthesiologist at Health Sciences Centre and St. Boniface Hospital.
Nurses, doctors and health-care aides who work in the ICU need to be part of the plans to meet the unprecedented third-wave surge, Jacobsohn said. They're being stretched to their limits, taking on extra shifts and working mandated overtime without knowing how long they'll be expected to keep up this pace.
Officials publicly released modelling data Friday that revealed Manitoba is already beyond the projected worst-case scenario for ICU admissions and is expecting to see a peak in two to four weeks.
It was the first time ICU doctors and nurses learned of the projections.
"Until we saw the modelling data, which was released last week, I don't think anybody in the health-care field had an idea really how long we were going to be in for this," Jacobsohn said.
The province's ICUs are fast approaching the second-wave peak number of 129 total patients and have surpassed the previous high point for COVID-19 patients in the units. There were 120 patients in ICUs as of midnight Monday, including 73 COVID patients (nine of whom are under the age of 40).
Shared Health chief nursing officer Lanette Siragusa said she expects ICUs to hit a new peak shortly, but doesn't know what the current maximum capacity is.
"Our capacity is dependent on our staffing," she told a news briefing Monday, adding the province is recruiting 60 additional nurses to work in the ICU and will consider cancelling more surgeries to move those beds to COVID wards.
Ages of ICU patientsClick to Expand
● 10-19: 1
● 20-29: 2
● 30-39: 6
● 40-49: 15
● 50-59: 16
● 60-69: 26
● 70-79: 7
Source: Shared Health, data current as of Monday morning.
Anyone who needs a ventilator and ICU care has received them, thus far, and Siragusa said she hopes not to have to develop a triage protocol. No Manitoba COVID-19 patients have had to be transferred out of province to receive care, but she said the possibility that could happen is not off the table.
On average, six patients are admitted to the ICU every day, Siragusa said, but didn't know how many are being transferred out at the same time. There were 79 Manitobans on ventilators Monday, 50 of them infected with the virus.
Manitobans don't need to worry about getting the care they need from dedicated doctors and nurses who see it as their personal responsibility, Jacobsohn said.
But he said that commitment carries a psychological cost, contributing to burnout. A sense of control amid so much tragedy and uncertainty would help, he said, which could be as simple as informing staff how many extra beds are expected to be needed for the next week, and planning ahead to fill extra shifts.
"People step up to the plate, for sure they do," Jacobsohn said. "But the least we can ask of our leaders is be clear, be transparent and, in fact, involve your front-line staff in helping you make decisions.
"But the least we can ask of our leaders is be clear, be transparent and, in fact, involve your front–line staff in helping you make decisions." – Dr. Eric Jacobsohn
"This is not to impugn anybody, but I think we need to step back and say, 'What can we be doing better when we're asking the troops to go the extra mile?'"
Siragusa encouraged ICU staff to talk to managers and make their voices heard on this planning.
"I really believe that it's the people working on the front lines who know the challenges, they also know the solutions," she said at the news briefing.
"So we want to hear from them, and we want to be proactive, if there's things that we can do to help the situation, to help the staff, to help the patients and families, we have to hear those voices, so please speak up.
"We certainly want to work together, we have to work together in order to meet this demand."
This week, Manitoba became Canada's COVID-19 hot spot, with the highest per-capita infection rate in the country. On Monday, 430 new cases were announced in the province, along with one death of a man in his 60s. A total of 265 COVID-19 patients were hospitalized.
NDP Leader Wab Kinew questioned where the staff will come from to meet the demand in the ICUs.
"At this point in the pandemic, I think Manitobans can legitimately ask, why weren't we better prepared for this?"
— With files from Carol Sanders
Katie May reports on courts, crime and justice for the Free Press.