Boundary Trails physicians fear lower vaccine uptake could lead to COVID-19 surge at rural health centre

Rural doctors in the health region with Manitoba's lowest vaccination rates are bracing for hospital surges and staff shortages as the Omicron variant takes off in the province's south.

Throughout the pandemic, the Southern Health region has accounted for a disproportionate number of cases and hospitalizations. 

Until very recently, the Delta coronavirus variant remained dominant there. So far places like Boundary Trails Health Centre, between Winkler and Morden, have yet to experience the kind of massive uptick in hospitalizations and staff shortages seen in Winnipeg due to the more contagious Omicron strain.

Two doctors fear that could soon change.

Dr. Dan Hunt said capacity at Boundary Trails depends on the ability to immediately transfer intubated patients to intensive care units in Winnipeg hospitals, which are currently dealing with record-high COVID-19 patient numbers. 

The Boundary Trails special care unit doesn't have enough respiratory therapists to manage ventilated patients for more than a few hours, said Hunt. It doesn't have an on-site respirologist, cardiologist, nephrologist, neurologist or other positions often needed for consultations in intensive care unit settings.

"Our capacity can fairly quickly be overwhelmed," said Hunt, who works at the C.W. Wiebe Medical Centre in Winkler and Boundary Trails.

"It very quickly runs into a very challenging scenario, and that assumes that there are ICU beds for people."

Trends from some heavily vaccinated jurisdictions outside of Canada suggest Omicron may cause less severe illness than Delta. But Hunt said that narrative runs the risk of lulling people into a false sense of security in a region where vaccination rates are 63 per cent.

He believes Omicron will transmit just as widely in the south as it has in Winnipeg, where over 85 per cent have been vaccinated and hospitals have more COVID-19 patients than any previous wave.

"It's going to find a whole lot more unvaccinated people than it has in Winnipeg," he said. "That's a concern because they are obviously far more likely to end up in hospital and ICU."

Losing some specialized workers to isolation during a hospitalization surge would have a domino effect, Hunt said.

As an example, losing the lone respiratory therapist on staff at Boundary Trails for five days would mean a nurse and doctor might get pulled into doing inter-facility transfers, removing two more staff from the emergency room, he said.

They could intubate someone if necessary, but hooking that patient up to a ventilator "is not really possible" without a respiratory therapist, said Hunt.

'Extra pressure'

One of Hunt's peers shares his concerns.

"If we go further down, I just don't know how we're going to do it," said the physician. CBC News is not naming the other Boundary Trails doctor because of concerns it could impact their job.

"We have some capacity now, but once our numbers start rising, that's going to disappear quickly."

The physician said Boundary Trails recently started taking in Winnipeg COVID-19 patients because the facility had some capacity. Work is underway to potentially open 10 more COVID-19 patient beds, for a total of 20.

But if those beds end up full, Boundary Trails will need another three or four physicians to manage the patient load, as well as more nurses.

It could mean local family physicians have to work more hospital shifts, furthering a pandemic trend in the south that's seen doctors who work in both settings become less available to see their family practice patients, the doctor said.

"I absolutely don't want to sound like alarmist or not wanting to help. I think we really need to, but it does create extra pressure on us," the said.

Having staff isolating would exacerbate existing shortages, particularly in nursing, the doctor said.

The emergency room is already 25 per cent short of its regular nursing contingent, the physician said, though Boundary Trails has benefited from the redeployment of nursing staff normally stationed at hospitals in Carman and Portage la Prairie to the area.

Southern Health also leads Manitoba's five health regions in the number of unvaccinated health-care workers on unpaid leave who refuse routine testing accommodations. Of 125 such workers provincewide as of last week, 82 work in Southern, according to Shared Health. Shared Health has not provided breakdowns of what sectors those staff work in.

The region said staff are being redeployed or reassigned where needed.

"We are grateful to our dedicated staff who continue to provide patient care despite very challenging circumstances," a spokesperson from Southern Health said in a statement. 

Staff have also been offered payment in lieu of time they have scheduled off in January.

Hunt said there still isn't enough staff to have a "backup system" if things really go wrong.

"There's no cavalry to call, so I think we'll just sort of have to do the best that we can with whatever comes at us."

Staffing concerns into future

The staffing concerns extend beyond the next couple months.

The demands of the pandemic have seen Boundary Trails' emergency department schedule five physician shifts per day — up from four — to be covered by the same number of doctors on staff pre-pandemic, said Hunt.

Boundary Trails' special care unit has four beds currently. The special care unit doctor on shift manages those beds, plus 10 more in the medical ward.

Hunt's colleague said there used to be eight physicians working in that unit. Now there are seven, but one is leaving by summer, another plans to do a residency in another field soon and one more will be on paternal leave this year.

Boundary Trails has also seen a decrease in the number of new doctors opting to stick around in recent years. From 2014-19, the family medicine residency program had seven of 14 staff take permanent positions in the community, according to the Hunt. Only two of eight graduates, plus one taking a term position, opted to stay in 2020-21.

Recruiting more staff could be also be a challenge post-pandemic due to reports from health-care workers facing pandemic denialism and anti-vaccine sentiment in the region.