Anxious patients await surgery, but the COVID-19 backlog won't be 'easily overcome in the next year'

Christian Dupont isn't used to staying still.

Normally, he'd be playing hockey twice a week and taking advantage of all the snow by skiing or snowshoeing with his family.

But last fall, what he thought was persistent, painful acid reflux turned out to be blocked arteries.

The 57-year-old is now waiting for triple bypass surgery at the McGill University Health Centre, but has no idea when it will be scheduled.

Everything hinges on the availability of intensive care beds, which in turn is dependent on COVID-19 hospitalizations continuing to drop.

In the meantime, his doctor has told him to avoid exercise and stress.

He's being careful, but knows every day he waits is one where he could have a heart attack.

"You're scared every day, 24 hours a day," said Dupont.

140,000 Quebecers on surgery wait list

Dupont, like thousands of Quebecers, is cautiously optimistic he'll have his surgery soon.

For the past few weeks, COVID-19 infection rates and hospitalizations have steadily declined.

Encouraged by those numbers, the province recently gave hospitals the green light to ramp up surgical activities. Quebec's hospitals have been operating about 50 per cent capacity since December; in the greater Montreal area some are functioning at 30 per cent.

The backlog of cases that has piled up during the first and second waves of the pandemic is daunting. As it stands, the names of roughly 140,000 Quebecers are currently on a waiting list for surgery.

According to the Ministry of Health, about a third — nearly 44,000 people — have waited longer than six months.

"I don't think that's going to be easily overcome in the next year," said Dr. Ruth Chaytor, the chief of surgical services at the Jewish General Hospital. "We've lost a lot of resources, a lot of trained individuals and a lot of experience."

At the beginning of the pandemic, the Jewish General was designated as the primary hospital to treat COVID-19 patients. During that time, its operating rooms were almost completely shut down.

Oncology cases were prioritized, but otherwise only urgent procedures were done. Vascular surgery, gynecology, ophthalmology and orthopedics have some of the longest backlogs, she said.

Despite a relatively quiet summer and early fall COVID-wise, it wasn't possible to return to full capacity because of staffing shortages. If the hospital pushes too hard, it risks burning out the nurses and orderlies it has, said Chaytor.

Just before the second wave hit, some nurses were being trained in the operating room, but they had to be redeployed to help other departments. Chaytor doesn't know if they will come back to finish their training, which generally takes between three to six months to complete.

The hospital has considered training more orderlies as surgical technicians, who assist by handing the instruments to surgeons.

"But again, we are short on personnel, and when you're short on personnel, you are using everybody to run as many rooms as you can and therefore they are not available to train," said Chaytor.

Lack of staff a barrier

To help clear up the surgery backlog in British Columbia, the government there recently invested an additional $250 million a year to hire about 750 more staff.

Here in Quebec, Chaytor says an extra 750 people would amount to a drop in the bucket. Thousands of people have left the system either permanently or temporarily due to burnout.

Money can help hire more people and incentives can be offered to employees to work overtime in the evenings or on weekends, but cash alone won't solve the problem, said Chaytor.

"It's a problem that has no short term solutions, even if the government decided to give us billions of dollars tomorrow," she said. "It's still an issue of personnel. It's still an issue of trying to get through this backlog. You have to remember, we have waiting lists anyway, even in good times when we're running all of our rooms, there's still a waiting list."

To help reduce the wait times for patients, the hospital signed a contract with CMS Rockland, a private clinic, in July 2020 to operate on one-day surgical cases.

Those usually involve general surgery, dental, colo-rectal, ear-nose-and-throat, gynecology, ophthalmology, orthopedics, plastics, urology, vascular and neurosurgery.

To date, more than 1,200 operations have been performed at Rockland by surgeons affiliated with the Jewish General.

According to the Ministry of Health, there are 22 similar agreements with eleven private medical clinics across the province. Between them, about 1,000 surgeries a week are being performed.

Creative thinking needed

While it's great to leverage those resources when the system is playing catch-up, it's not the same as having surgical capacity in the hospital, said Dr. Erin Strumpf, an associate professor in health economics at McGill University.

Although hospitals have done a good job of prioritizing patients based on the severity of their illness, it doesn't mean the rest of those waiting don't need surgery.

"The surgeries that are not urgent today are going to be urgent in a week or a month. The patients are going to be sicker, more complicated. Their chances for recovery are going to be lower," she said.

Once the immediate threat of COVID-19 lessens, Strumpf said it will require creative thinking to recover, both in terms of how staff are used and making the public health sector a more attractive place to work.

It's a formidable task and will involve a major investment by the province.

"It's like trying to fix the plane when you're flying at 30,000 feet and now we've just had a bird strike on one of our engines," said Strumpf.

Hospitals fear third wave of the virus

In tandem with the decision to ramp up surgeries, the province also announced it is loosening restrictions in some sectors. As of Monday, stores, shopping malls and hair salons will reopen.

Although the curfew will likely remain in place for a few more weeks, Chaytor is worried infection rates and hospitalizations will jump back up over March break, especially now, with more contagious variants of the virus floating around.

"I'm living in fear," said Chaytor, "That's how we got into trouble in the first wave."

She is frustrated many people still don't seem to understand the ripple effect their actions can have on the health care system.

"If you travel and you shouldn't be or if you're gathering and you shouldn't be, you are maybe costing somebody their life, not because they catch COVID, but because they're not getting surgery in a timely fashion," she said.

She anticipates there will be higher mortality not just for undetected cases of cancer, but there will be advanced disease found across the board because many people were too afraid to see their doctor or come into the hospital.

"They should be included in the COVID mortality because they are dying, not because of COVID, but because the pandemic is keeping them from getting access to proper care or timely care," she said.

Christian Dupont doesn't want to be one of them.

He wishes the province had held off on reopening until after March break.

He knows some people will take unnecessary risks and hopes it doesn't prevent him from having an operation.

He's slated to go in for pre-operative tests next week, there's still no date for surgery.

For now, he's taking nitroglycerin for his chest pain and is trying to manage his anxiety. But the waiting is terrible.

"I am very positive, but it's very, very difficult," said Dupont.