Front Burner - Stories from inside Canada’s hospital crisis

Episode Date: September 29, 2021

Even with 80 per cent of eligible Canadians fully vaccinated, hospitals in many parts of the country are facing an unprecedented crisis. Today, we speak to doctors and nurses about how the fourth wave is pushing Canadian health-care systems to their breaking point.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. So 80% of people eligible for a vaccine in Canada have had both shots now, and obviously that is so great. It means less sickness, less suffering, less death, and that our hospital system should not have to be on life support. Except they are. Even with this many people vaccinated, hospitals in many places in Canada are in crisis.

Life-saving surgeries are being delayed. Hospitals are the targets of protests. One doctor we spoke to had his life threatened. Doctors in Alberta could soon have to decide who lives and who dies through triage. Today I'm handing the mic over to our producer Ali Janes. She's been speaking to doctors and nurses across the country about the crisis they're facing in this fourth wave and how it could have long-term consequences for Canadian hospitals. So you probably remember back in the first wave of the COVID-19 pandemic, how people would go out on their balconies at 7pm and bang pots and pans to thank the doctors and the nurses and the paramedics risking their lives to fight this mysterious, terrifying virus. Maybe you were out there with your pots and pans yourself. Thanking healthcare workers.

Thanking our healthcare heroes. You heard these refrains everywhere. I want to recognize all of the people on the front lines of our healthcare system. You are doing an incredible job. Thank you for your dedication. Thank you for your courage. Thank you for your professionalism. Thank you for your perseverance. You know, your professionalism. Thank you for your perseverance.

You know, you guys are really heroes to all of Canada right now. So keep up the hard work and just know that we really appreciate it. Thank you forever for what you're doing. Thank you so much. Merci. And a lot of those healthcare workers say that they really felt that support. It kept their spirits up through the long days and nights and the heartbreaking losses of patient after patient. It meant a lot to Dr. Samina Ali. She's an emergency room pediatrician

at the Stollery Children's Hospital in Edmonton. I think healthcare providers in March of 2020, April of 2020, we had a lot of personal and family security fears because we were fully unvaccinated and had no idea how virulent, how bad this virus was. But we were also really hopeful and banded together like, you know what, we're going to get through this together. And the public support was behind us literally banging pots and pans. Same goes for Dr. Mario Francis Pergassum an ICU, ER, and chronic pain physician in Vancouver. You know, in the first and second wave, there was this like, okay, we can get through this, there's support, like, clearly people will get vaccinated, because not doing that would be dumb, right? And clearly we're working this together, right? But now, here we are.

80% of eligible Canadians are vaccinated now. And for so many of us, life is actually feeling closer to normal than it has since March 2020. And the moment these doctors were waiting for should be here. But somehow, the scene at many hospitals in this country is rougher than ever. Health systems have never been pressured to this degree in the history of Medicare. They've never been this close to the edge of collapse or in the process of collapsing. Dr. Alika Lafontaine is an anesthesiologist in Grand Prairie, Alberta. The province that's really the epicenter of this fourth wave. And he's also the president-elect of the Canadian Medical Association. And healthcare

providers are working in environments that we were not only not trained to work in, but couldn't have imagined could have happened in Canada. But up here in the north, it has gone to hell in a hand basket. It's by far the worst I've ever seen. Tracy Jonker is a nurse in Prince George in northern BC, where their case rate is twice as high as anywhere else in the province. It's almost as high as Alberta's. It's like something you see in a movie, and there you are playing a part in it. You're like, where am I? This is the real world?

We have been up and down so many times that I think we feel abused. Dr. Darren Markland, an ICU doctor and nephrologist at the Royal Alexandra Hospital in Edmonton, echoed what I've heard from every healthcare worker I've spoken to. He doesn't have much gas left in the tank. We feel tired. We feel lost. We feel that we've lost leadership and direction. You can only do that for so long before you wear out. And I think many people have already. Dr. Samina Ali, the pediatrician. To put it in the simplest of terms, I don't know how much longer I can do this.

So to take a look at how bad things are, we really need to start outside the hospitals. Because instead of hearing people banging pots and pans from their balconies, now health care workers are hearing a lot of this. None of this makes any sense to me. I believe in full freedom, absolute freedom. Protesters on Hospital Road today expressing their anger at vaccine mandates and other pandemic public health measures. No vax pass! No vax pass! I attended one of these rallies on September 13th, what protesters were calling a silent vigil outside of Toronto General Hospital.

The sheep is following! The ship is following. It's one of many Ontario hospitals that's now requiring employees to get vaxxed or they'll either be fired or suspended. And that's already happening. A week after this rally, 172 staff members at Windsor Ontario Hospitals were suspended without pay for not getting their COVID-19 shots. If they don't get their first shot by early October, they'll be terminated. Well, we're organizing this because there's thousands of nurses that are being

coerced across Canada to take the jab or lose their job. And also we're doing this to bring awareness to the censorship. Sarah Shijunian is a co-founder of an anti-vaccine group called Canadian Frontline Nurses. They're the organizers of many of these hospital protests across the country. The hospitals are now the ones enforcing the policies, and so that's why we're here, like to support, but also to bring awareness. Shijunian is a registered practical nurse, but she's been fired from both of her jobs. And the College of Nurses of Ontario told me they're currently investigating her. And her group has been condemned by nursing organizations across Canada

for promoting unsubstantiated claims about COVID. But also I think those people are not aware that there's actually easy, natural, better treatments for COVID. And so if they were informed of these treatments, our hospitals wouldn't be overwhelmed at all. There's hydroxychloroquine and there's ivermectin, but there's also like taking care of your body and drinking lots of fluids. But also we're very concerned masks are harmful and decrease your immune system. Social distancing and isolation is really unhealthy for people. Okay, let's just pause here for a quick fact check.

A huge body of very high quality research from around the world has now shown that hydroxychloroquine and ivermectin are not effective at preventing or treating COVID-19. There is some evidence that taking general care of your health can sometimes prevent really severe COVID cases, but that is not a guarantee at all. And you could still infect other people. And I'll just say this one one more time for the people in the back. There's still no evidence that masks weaken your immune system. So this rally I attended was fairly small, but some of the protests organized by Canadian frontline nurses are massive.

One on September 1st in Vancouver brought out an estimated 5,000 people. Dr. Mario Francis Pergossum had just left the GF Strong Rehabilitation Center, where he was supporting COVID patients, and he was making his way to the Vancouver General Hospital when he saw this giant crowd blocking the path of an ambulance. It was just very confusing and upsetting. Like, do you actually know what you're screaming about? Like, how could you guys have been so off base? Dr. Francis Ferguson was worried, you know, for patients who had to wade through this angry crowd just to get to the hospital.

And he was also worried for the people in the crowd who seemed pretty disenfranchised and who appeared to have bought into some very misguided ideas. And at the same time, he was frustrated, especially as a doctor who happens to have chronic leukemia, which means that he's been working through this pandemic while he's on immunosuppressive chemotherapy. I know myself and some other docs who have immunosuppressed conditions that are on immunosuppression and still work. You kind of are like, well, why am I even doing this? Like, why aren't I going home and putting my feet up and, you know, recovering from this really rough year? That same day at the University Hospital of

Northern British Columbia in Prince George, nurse Tracy Jonker looked out in disbelief. That was really disgusting to look out the window of the COVID ward to see those people out there protesting. Why protest out of a hospital where people are literally dying from COVID? Literally dying from COVID. I never would have imagined in my wildest dreams as a nurse that, you know, because we were so well respected, we don't feel respected anymore. At some rallies that Canadian frontline nurses have organized around the country, health care workers have been spat on and verbally abused. The Canadian Medical Association came out with a statement today condemning the escalating bullying its members are facing. Hospital access

was affected and health care workers were verbally attacked. It's really hard to understand why people would hurdle that kind of hatred and abuse towards people whose entire profession is the service of others. I'm going to go. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people, and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo.

50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. Beyond the protests, some health care providers are facing other safety concerns. Like Darren Markland, the ICU doctor in Edmonton. It was Friday night, and I got a knock at my door, and there was a man with a gun. He was a plainclothes police officer, and he told me that he was there to inform me that

there was a credible threat against my life. Dr. Markland is very vocal online in favor of public health measures like vaccine passports, and he's pretty sure that's why he was targeted by a death threat. But he doesn't know anything more than that. The officer said he couldn't give him details. Which leaves you feeling incredibly exposed and almost like waiting for lightning to strike like I'm looking up in the sky right it's incredibly distressing you know to the point where you know hospital security is involved and during the last protest I had a security guard who was in my office just there to make sure nothing happened.

How concerned are you feeling for your own safety right now? Ah, you know, I don't know. I honestly don't know. I take different routes to work. I ride a bike, so I have this dark sense of humor because I know that if you want to kill someone and get away with it, you run them over with a car. I really struggled with whether or not I should continue speaking out. I was really worried about fanning the flame. But if you believe in something and it's important, then I guess it's okay to stake your life on it.

It also just really strikes me that both outside the hospital walls and inside, you're really coming face to face with the realities of unvaccinated people, both the people who are protesting against you and your colleagues and the people whose lives you're fighting to save. You know, I'm just wondering what that what that fact is making you think about. I purposely don't ask vaccine status, one, because it doesn't make a difference at this point. And two, I have to control my feelings about it. It's easy to be empathetic when you are at the bedside, when you are face to face. I mean, that's human nature. I think most people are kind that way. but you know when someone tells you when you get the call from the emerge that they have someone you know and they're unvaccinated you reflexively you know judge and you can't you're not supposed to but when you're tired and your defenses are down it can happen it really adds a layer of stress and anxiety to an already worn out healthcare population. Birgit Umaygba is an ICU and ER nurse in Toronto and a clinical instructor at Centennial College.

And she says these protests are making it harder and harder for some of her colleagues to summon that compassion. I see a lot of anger. like some colleagues are just done. They're just fed up. Like, really, these are the same people that we're going to see in two, three, four weeks as our patients. So where are we going to get that, you know, compassion for them? And whereas other people just feel so sorry for them, feel so bad because they might die from that. It's so difficult to see those same people that are protesting outside of hospitals or outside of schools come back to the ICU as patients that are critically ill and at that moment asking for vaccines, but we're unable to. So it's just sad, honestly. I

feel this, is this? So healthcare workers I spoke to wanted to make it clear that not all of their unvaccinated COVID patients are anti-vax. I mean, they might be, for example, like a single parent working multiple jobs who just hadn't found the time, and that no matter what, they'd be equally deserving of care. But setting motivations aside here, the simple fact is that people who have not had the jab are maxing out space in hospitals across the country. In August, the Public Health Agency of Canada found that there were 39 times more unvaccinated COVID patients admitted to hospitals than vaccinated patients.

Alberta Health Services tells us in a statement they've opened up 42 ICU surge spaces in the last week to help meet demand. In Friday's COVID update, there are 243 people in the ICU, 210 of them unvaccinated. And in the past couple of weeks, hospitals in Western Canada have been breaking their own records for numbers of COVID patients in ICU. The average number of COVID ICU admissions have been more than 23 per day. It's tragic that we are only able to keep pace with these sort of numbers because in part some of our ICU patients have passed away. Last week, Dr. Verna Yu, the head of Alberta Health Services, said a key reason that the province even has ICU beds still is because so many patients are dying. Every day

the teams are working so hard to create additional capacity so that we actually don't have to move to the steps of out of province or, you know, as a last resort, the critical care triage. And across the country, the lack of beds or even equipment isn't even the only problem. Because as this pandemic drags on, hospitals are getting shorter and shorter on staff, especially nurses. order on staff, especially nurses. Never did I think that I would be experiencing the shortages that we have right now. And never did I think that the level of care that we could provide to patients would be as low as it is. The pandemic is pushing many nurses to retire early or take leaves of absence or change professions altogether. According to Statistics Canada, in the first quarter of 2021, the jobs with the biggest increases in vacancies were in nursing and other patient care roles.

16,000 more unfilled jobs than the year before. care rolls. 16,000 more unfilled jobs than the year before. Alberta needs nurses so badly that the government has been asking other provinces and Ottawa for help. But the thing is, other provinces don't really have people to spare. They're desperately looking for nurses too. It's a problem across the country, and nurses unions in several provinces held demonstrations today demanding government action. In Ontario, the amount of overtime nurses have been working during the pandemic has skyrocketed by 137 percent. Quebec is dealing with a critical shortage of at least 4,000 nurses. Officials say the emergency department at the Halifax infirmary need more help immediately. It's bad enough the Saskatchewan Union of Nurses is calling

for a temporary slowdown of services. Years and years we have told the government that this was going to happen, that we were going to be short nurses and nobody has listened to us. BC's northern health region where Tracy Jonker works had been dealing with brutal staffing shortages for years before the pandemic. And now in wave four, the crisis is so severe that some COVID patients are being flown as far as Vancouver Island for treatment. And now with the short staffing, there's no extra time to spend with them. Sometimes a person might not get fed. Sorry.

A brief might not get changed. It's, it's, you're literally running with your hair straight back, trying to, to just survive the day and get your patients through the day. It's, it's so morally distressing. Nurses in critical care are used to dealing with pressure and exhaustion and patients dying. But COVID has ramped all of these things up so far that a lot of people are just burning out. At the beginning of wave four, I started having a lot of nightmares and I was just feeling this disconnect in terms of daily activities and not having the energy, the physical strength to do basic things like even get off my bed to start my day, like, you know, regular things that I'll be so excited about. This summer, Birgit Umaygba in Toronto finally hit a wall and ended up taking two months off

from hospital work. I remember talking to a patient who we knew she was dying, I was just crying my eyes out. I just could not take it. And normally, you know, I would be able to, you know, compose myself in a way. I know sometimes we do cry, but I was getting too emotional and I didn't like that. And I said, you know, it's time for me to take a break. So I did take a break.

Meanwhile, in some provinces, provincial governments have been fighting with nurses over pay, even in the middle of the pandemic. Ontario's Bill 124 caps wage increases at 1%. Nurses in Alberta held demonstrations today at 25 health care sites across the province to protest proposed wage cuts. In Ontario, nurses are fighting Bill 124, which caps salary increases at a rate below inflation. And last week, a hospital near Toronto laid off 97 registered nurses because of a, quote, significant financial challenge. In Alberta, the government recently walked back a plan to cut nurses' pay by 3%, but they're still proposing a wage freeze. Yeah, it's sad. It's sad. It just

shows how they don't get the message. You can't cut. You can't cut back on, you know, resources when it comes to saving lives in healthcare and expect good results. Okay, so let's review some horrifying math here. You've got skyrocketing numbers in ICU and eMERGE, plus plummeting numbers of nurses. That adds up to a situation that is now causing problems way beyond the COVID floor. Because with nurses being reassigned to ER and ICU, there aren't enough left to staff other departments. enough left to staff other departments. This month we've seen surgeries cancelled or delayed across Alberta, Saskatchewan, BC, even in some hospitals in Ontario and Atlantic Canada. And we're not just talking knee replacements here, we're talking heart surgeries, brain tumors. I was diagnosed with

glioma. They don't know exactly what type of tumor it is. That's what the surgery would tell them. Then I got a call on Tuesday afternoon and they said that my surgery was cancelled and that took me by shock. Oh, that took me by shock. Last week, when I was speaking to Samina Ali, the pediatric emergency room doctor in Edmonton, we talked about this 52-page triage protocol that Alberta Health has created for critical care doctors. It's a worst-case scenario guideline for how to ration care if resources get too scarce. In a nutshell, who to treat and who to let die. We were not trained for this. We were trained how to save lives. We were trained how to extend lives. We were trained how to make lives more comfortable, not how to decide when a life is not worthy of being supported.

Phase one of this triage protocol will kick in if 90% of all the critical care beds in Alberta are filled. If they surpass 95% capacity, phase two will kick in. And phase two includes triaging children. Oh yeah, it was really emotional and overwhelming to imagine a scenario where we'd have to triage care for children. It shook me to the core. It really drove home for me. I mean, that we are in trouble. It's scary. It's scary. We're in trouble. We are in trouble.

So last week when I spoke to Dr. Ali, I mean, she talked about phase two as like a horrible hypothetical that she hoped she'd never actually have to use. But now, less than a week later, doctors are warning that Alberta could hit the threshold for phase one any day now. As soon as we move to that triggered, that is indicating that even patients having strokes, heart attacks, maybe a major motor vehicle collision,

that could mean we're in a position where we can't provide them the critical care we normally would, even if it's not COVID related. And for so many people I talk to, the most frustrating part about all of this is that they just don't think it had to be this way at all. They say it's not like we weren't shouting at our political leaders that the Delta variant and the millions of people who hadn't been vaccinated meant that this summer was actually not the time to be loosening up public health restrictions, or to slack on contact tracing, or to disparage the idea of a vaccine passport,

or to frame getting the jab as just a personal choice. And so yet again, these doctors and nurses say, we're the ones dealing with the consequences of their choices. I think many are left feeling abandoned by the public health policies and decisions that were made that led us to, you know, okay, now it's your problem, Samina, and they're going to show up in your emergency and you figure it out. Dr. Alika Lafontaine, the president-elect of the Canadian Medical Association, says ultimately there was a lot of hubris here. I think governments started to get a bit overconfident about how wave one, two and three went.

Within Canada, you can see various jurisdictions that started to think to themselves, oh yeah, maybe we're past the worst of this. And combined with a system that for years has implemented austerity policies. So instead of a question of how do we ensure that hospitals function as well as they can in all situations, how do we ensure that hospitals function as well as they can in all situations, we've instead cut down the number of nurses to patient ratios, the number of doctors to cover different patient populations to a point where we were more or less skimming the very edge of what we could handle. And that anything more than that would likely lead to the situation that we see today.

That's really just the entire system starting to break. Dr. LaFontaine is confident that eventually we will get through this wave. And at this point, many provinces, including Alberta, are starting to bring in some of the health measures that we already know work. But how things look after this, I don't think the health system will look how it did. I think a lot of the faith that healthcare workers had, that governments would provide the right type of leadership to make sure that things kind of stayed together, that's definitely been harmed. And that faith is going to have to be rebuilt. Those relationships are going to have to be rebuilt. And as any critical care nurse will tell you, the people leaving the health care system in droves right now can't be replaced just like that.

It takes years to train a critical care nurse who works as a charge nurse, you know, in charge of the entire unit during the shift. So imagine the years of education, the three new hires, just imagine losing 10, 15, 30 of those kind of nurses. So I can't even imagine the damage, some of the damage we won't even be able to place our fingers on right now. For Dr. LaFontaine, this fourth wave has got to be a wake-up call for governments in Canada. You know, the old approach of austerity overtaking capacity in most health care decisions when it comes to governments,

I think that has to be done away. Otherwise, the next time the health system runs into the situation, whether it's a pandemic or some other catastrophe, we won't be prepared. All right, so a couple of updates before we go today. Yesterday, Alberta Premier Jason Kenney announced that later this week, his government will update the province's Critical Infrastructure Defense Act to include health care facilities. This would make it illegal to protest in front of hospitals.

And Saskatchewan's health minister, Paul Merriam, has rejected an offer of pandemic-related assistance from the federal government. This comes days after the province recorded its highest ever active case count and a death rate almost as high as Alberta's. That is all for today. Thanks so much for listening to FrontBurner. We'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.