B.C. pediatric surgeries cancelled amid staff shortages, surge in respiratory infections

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Staff shortages and a surge in respiratory infections have forced the cancellation of dozens of surgeries at BC Children’s Hospital which, as of this week, is also limiting scheduled operations as it grapples with hours-long waits in its emergency department.

The Vancouver hospital, which provides care to British Columbia’s most seriously ill or injured children, is just one hospital facing a recent increase in admissions for respiratory illnesses including influenza, enterovirus/rhinovirus, respiratory syncytial virus and COVID-19. Early Wednesday morning, the waiting time to see a doctor at BCCH reached 12 hours.

Sanjiv Gandhi, a cardiac surgeon at BCCH, said that dozens of pediatric surgical operations have been cancelled in the past couple of months because of increased numbers of children with respiratory illnesses and staffing shortages.

“It’s routine that my cases have been cancelled over the past several weeks,” he told a news conference Wednesday. “It’s actually unusual for me to do an elective cardiac case.”

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Provincial Health Officer Bonnie Henry and B.C. Health Minister Adrian Dix told a separate news conference Wednesday the province had activated its dedicated provincial pediatric table, led by BCCH, to co-ordinate pediatric resources, and is working with health authorities to respond.

But, like officials in other provinces, B.C. officials stopped short of reintroducing broad public health measures such as a mask mandate. Several advocacy groups that together comprise doctors, health policy specialists, teachers and parents, had called for a return of universal masking in all indoor public spaces to slow the spread of respiratory infections and ease the pressure on hospitals and health care workers.

Dr. Henry said last year’s mandate came when immunization levels were still insufficient, and were part of important and necessary measures including restrictions on gatherings and travel. A high level of immunity has now put B.C. in a different situation and changed the value of masking, she said.

“I think we all need to recognize we are all humans and masks are protective equipment, but they are only as effective as we make them, and that can be a challenge, especially for children sometimes,” Dr. Henry said.

“I do not believe we need that heavy hand of a mandate to send a clear message that masks are an important tool that we can all use during this time and in every respiratory season.”

BCCH has historically allowed five or more beds per day for children who have surgery and need to stay one night or more (referred to as same-day admission, or SDA), along with two pediatric intensive care beds per day.

The Globe and Mail has learned that, effective this week through the rest of the year, the hospital is capping SDA beds at four per day, and intensive care beds at one per day, to accommodate respiratory patients. The pediatric intensive care unit, which recently reached 120-per-cent capacity, had diverted at least five patients in recent weeks. Cardiac surgeries have been reduced to three days per week, from four, according to a person familiar with surgical schedules at BCCH. The Globe and Mail has agreed not to identify the person, who was not authorized to speak publicly.

A statement from B.C.’s Ministry of Health, provided to The Globe and Mail on Monday, said the province was not yet seeing a surge in respiratory hospitalizations that would necessitate surge plans that include cancelling scheduled surgeries.

Asked Wednesday how many pediatric scheduled surgeries have been cancelled in response to respiratory infections, Dr. Henry said she was not aware of any in the province. Mr. Dix said “there are, on a daily basis, occasionally, surgeries that are cancelled,” and that numbers were expected on Thursday.

Dr. Gandhi noted that scheduled surgeries, also called elective surgeries, can include issues such as holes in the heart, an obstruction of blood flow to or from the heart, or a scoliosis operation on the spine – issues that are not critically urgent, but still time-sensitive, as there’s always a risk a child’s condition can deteriorate.

“Our goal is never to operate on children when they’re sick; our goal is to operate on them when they’re well, before they get sick – kind of like putting a mask on before you get the virus,” Dr. Gandhi said in an interview.

“Especially when it comes to the heart, you don’t want their circulatory system to be further compromised, for them to sustain further damage to the heart, to the point that they are sick, because that leads to A, a more difficult operation, B, the risk of more complications post-operatively, and C, the potential for a longer post-operative stay, which has the downside of occupying a bed even longer.”

BC Green Leader Sonia Furstenau is among those calling for a reinstatement of a mask mandate in indoor public spaces.

“I come back as I have, for many years on this issue and many more, about the need for governments to be pro-active,” she said. “I don’t want to wait until we see the levels we’re seeing in Ontario before we take action in this province.”

BC Liberal Leader Kevin Falcon said he is opposed to bringing back any mandates on masking, saying that the public has “good enough judgment” and it is a decision that people should make with their households and physicians.

“Frankly, it would be very, very difficult to enforce,” he told reporters Wednesday. “Whether we like it or not, I think a lot of the public is just really tired of all this.”