Surgery uncertainty: How Manitoba's 4th wave is spoiling the new premier's backlog-clearing pledge

To prepare for an expected surge of COVID-19 patients, Manitoba hospitals are once again postponing some surgeries and other medical procedures.

At the same time, Manitoba Shared Health is trying to whittle away a backlog of postponed surgeries and diagnostic procedures that started piling up 20 months ago, at the start of the pandemic.

You don't need a master's degree in health administration to see how postponing surgeries complicates the task of getting more of them done.

But this is the situation Heather Stefanson's Progressive Conservative government finds itself in only weeks after the new premier was sworn in.

The fourth wave of COVID-19 is stubbornly sticking around. It's currently infecting more than 140 Manitobans every day on average and sending a fraction of them weeks later to hospital, where they require the attention of medical staff who might otherwise be deployed to surgical and diagnostic units.

"We did not want to be here again," Monika Warren, Shared Health's COVID -19 operations chief, said on Nov. 12. She explained how some staff were being redeployed into intensive care units to avoid a repeat of the nightmare scenario during the peak of the third wave.

In late May, the provincial health-care system ran out of people with the skills to care for severely ill COVID-19 patients. Almost five dozen were airlifted to intensive care wards in other provinces. A quarter of those patients died.

The overarching priority for hospitals right now is to avoid running out of capacity again, even if that means creating more misery for the tens of thousands of Manitobans awaiting some form of medical procedure.

"We want to express our disappointment that your ability to access care is once again being affected," said Warren, addressing Manitobans in general. 

"We hope that these reductions are short-lived and that we will be able to send our nurses back to their home units and reschedule those patients as soon as possible."

It is unclear how long Shared Health will have to ramp up ICU capacity.

Officials in the health-care system say they have no choice, given what they know about their workforce and what they expect to happen in the coming weeks, based on painful lessons learned only months ago.

Flu fears

For starters, Shared Health has roughly the same number of people qualified to work in intensive care wards right now as they had during the first wave — but some of these workers are new and have less experience, Chief Nursing Officer Lanette Siragusa said on Monday.

While some nurses have just been trained to work in ICUs, other have left these intense jobs, which require nurses to constantly monitor multiple life-support metrics on every patient and make adjustments on the fly. 

The time of year is also a concern. In the fall of 2020, there was effectively no flu season, as pandemic-mitigation measures prevented Manitobans from passing on respiratory viruses less contagious than the one that causes COVID-19.

This year, with so much more of society open, there's a fear flu cases will mount to the point hospitals will experience simultaneous waves of multiple respiratory illnesses.

The mounting number of COVID-19 cases is also a source of uncertainty, as it's no longer clear how many cases Manitoba can handle before hospitals are overwhelmed.

During the pandemic's third wave, the proportion of COVID-19 patients who required hospitalization was so high, health officials and politicians were caught off guard.

Part of the problem was younger COVID-19 patients winding up in ICUs. Now, the COVID patients are getting even younger.

"When you get people in their 20s and 30s in the ICU, the ability to recover for those patients is there, but it often takes weeks and weeks of investment and lot of critical-illness care for these patients," said Dr. Eric Jacobsohn, a Winnipeg ICU physician.

Each one of those patients takes up resources that would otherwise be used elsewhere in the hospital system, Jacobsohn said.

"So the domino effect on other patients is profound," he said.

Task force members yet to be announced

In other words, the continuing COVID crunch won't make it easy for Stefanson to live up to a swearing-in pledge to whittle away at the mountain of postponed surgeries.

"There is work … that is going on right now as we speak to address these backlogs," the premier said Wednesday during a news briefing, referring to a surgical and diagnostic backlog task force.

It's been granted a portion of roughly $50 million her government says it has dedicated to the task of getting more echocardiograms, cataract surgeries, hip replacements and other procedures done.

Last week, Health Minister Audrey Gordon said members of that task force would be named this week. But when Monday rolled around, Gordon pushed the announcement back until some time after the provincial throne speech, slated for Nov. 23.

While this delay suggests a lack of urgency, it's not a big deal to put off announcing the members of a task force that is already at work.

It's a bigger deal to give Manitobans hope the surgery backlog can be whittled down at the same time surgeries are once again being postponed.