Health system races to make contingency plans as front-line workers are sidelined by coronavirus

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When the new coronavirus began sweeping the globe, Mike Chatenay made the difficult decision to cancel non-urgent surgeries at his Edmonton practice, clearing more space in the ward and intensive-care unit for the COVID-19 patients that would inevitably come.

The move meant scaling down the office, temporarily laying off a half-dozen staff members and a lot of financial uncertainty – a choice that the general surgeon found tough but necessary in extraordinary times.

But weeks later, with cases climbing, Dr. Chatenay has one outstanding concern. Surgicorp, the practice of which he is managing director, employs 14 surgeons, whom he estimates to collectively provide around 80 per cent of scheduled and emergency surgeries at the Grey Nuns Community Hospital where they are based.

“All 14 of us are in one hospital, and in one office,” he said. “So if we have COVID-19 go through our office, it’s going to be pretty devastating for the hospital.”

Across Canada, contingency plans are being put in place as the virus that first consumed nursing homes – and continues to affect those facilities – is now infecting health-care workers in other workplaces such as hospitals and dentists’ offices.

National data on health-care workers being infected is incomplete, but regional numbers provide snapshots of what’s playing out on the ground.

In British Columbia, for example, around 60 health-care workers at long-term care homes alone have contracted the virus. In Saskatchewan, at least a dozen health-care workers have tested positive, with 11 of them linked to a bonspiel in Edmonton. Ontario reported 91 health-care workers infected, with at least 13 of them in Toronto. Alberta and Quebec were unable to provide data on infected health-care workers.

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To meet the increased demands of the health-care system, and to ensure adequate staffing, provinces have enlisted medical residents, recruited recently retired doctors and redeployed existing front-line staff to other jurisdictions.

The Federation of Medical Regulatory Authorities of Canada, a body consisting of the 13 provincial and territorial medical colleges, announced recently that it would be waiving the final certification exams for more than 2,000 new doctors after the pandemic postponed the tests. These residents, who are finishing up two years of on-the-job training if they are a general practitioner and five if they are specialists, will be allowed to take up positions across the country and pass their final certification exam at a later date, the body stated.

The Royal College of Physicians and Surgeons of Canada, which certifies all new specialists, called the current fight against the virus a “truly an unprecedented occurrence” in an update issued Wednesday.

“We anticipate that as this pandemic evolves, the care residents provide will be essential,” the statement said.

Medical students weeks away from finishing their fourth and final year at school will also be able to backfill some of that cohort of resident doctors starting July 1, without first taking their qualifying exam, the medical regulators also confirmed. These students will have to finish the exams at a later date.

Roger Wong, the University of B.C.’s executive associate dean of education, said that the school will graduate this year’s class of medical students in May.

“Students in all years are stepping up as volunteers to support the response to COVID-19, for example by responding to 8-1-1 calls and participating in other public-health-related activities,” Mr. Wong wrote in an e-mailed statement.

In B.C., Provincial Health Officer Bonnie Henry said officials would look at triage systems in deciding where to place any retired doctors who step forward to begin practising again. So far, 26 doctors and 246 nurses have rejoined the workforce.

“There are many sources of work that a physician can do other than actual one-to-one patient contacts,” she said. “So we may not have older physicians, for example, provide patient care, but they may be able to provide virtual care and help with managing people who are in isolation at home.”

As well, thousands of elective surgeries have been cancelled, freeing up hundreds of hospital beds, B.C. Health Minister Adrian Dix said. Those surgeons, anesthesiologists, nurses and cleaning staff are also being moved over to support urgent needs in critical care.

BC Nurses’ Union President Christine Sorensen said nurses were stretched thin prior to the pandemic and are under even more pressure now. Cancelling elective surgeries means that those patients who remain are among the sickest in the health-care system.

Outbreaks are already happening at nursing homes in different provinces, some of which are relying on local health authorities and even volunteers from the community to help out.

The slow initial response by the local health authority and management at North Vancouver’s Lynn Valley Care Centre exacerbated the crisis there and led to serious staffing shortfalls as well as a drop in the level of care, according to staff members who recently spoke to The Globe and Mail. To cover for the many workers still in self-isolation, the nursing home and its subcontractors are offering to double the wages of anyone who comes in, according to a recent recruiting post shared with The Globe.

After the outbreak, Vancouver Coastal Health also put an urgent call out to its base of volunteers to see if anyone was willing to go to Lynn Valley to help with “delivering meals and probably feeding residents” of the smaller lodge building. The e-mailed plea reassured potential volunteers that they would only be assisting residents “not affected by the coronavirus," but cautioned that helping out at the facility would disqualify them from other volunteer opportunities until further notice.

“They would like to have volunteers ready to start tonight if possible and continue for a few days,” stated the March 9 e-mail from the volunteer co-ordinator, which was obtained by The Globe.

Jennifer Whiteside, secretary-business manager with the Hospital Employees’ Union, said staffing in many private nursing homes was already stretched because workers are not paid as much as those in unionized facilities and she expects the situation to get worse as more nursing homes face outbreaks.

Last week, Dr. Henry, B.C.’s top health official, ordered all workers across the health-care sector at both public and private facilities to stick to working at only one of these locations for the duration of the COVID-19 pandemic.

Neasa Coll, a general physician who works in the community as well as at a Vancouver hospital, said colleagues are leaning on one another for camaraderie and support unlike ever before, offering up tools for coping with the stress and workload that are working for them. The now-nightly ritual of Vancouverites clapping from their high-rise balconies in support of health-care workers has also meant a lot, said Dr. Coll, who added that she teared up when she saw the public show of support on a recent stroll.