Regina doctors forced to prioritize surgeries due to a lack of hospital capacity

(File photo/Jayda Taylor)

Even as the province announces a return to family visits at some long-term care homes, the situation in the province’s intensive care units continues to deteriorate.

Saskatchewan currently has 96 patients in ICU. Pre-pandemic, the province had a total ICU capacity of 79.

Not all of those patients have COVID-19. According to Thursday’s statistics, 48 COVID-19 patients are in intensive care, or about half of the province’s total ICU population.

Saskatchewan has managed to add 38 beds to its ICU capacity, but even with the expansion, it’s getting close to running out.

“We are currently running within a high level of capacity,” Saskatchewan Health Authority (SHA) CEO Scott Livingstone said Thursday.

“We’ve already aggressively expanded beds. We will continue to try to do that.”

The province has enough beds, equipment and space. The issue, though, is a lack of staff with the training needed to work on an intensive care unit.

“We’re not going to have unlimited ICU capacity. The challenge we’re having is to have the right number of skilled staff. We are stressed more than we have ever been throughout the pandemic,” Livingstone said.

The situation is at its worst in Regina.

Regina’s in a bypass situation, where serious patients are sent somewhere else. Of the province’s 48 ICU COVID-19 patients, 34 are in Regina.

The Regina region has been hit hard by COVID-19 variants of concern. Of the 5,521 variant cases detected in Saskatchewan so far, 3,206 have been in the Regina zone.

Livingstone said staff in Regina are having to make difficult decisions, such as who to operate on, because of the overflowing ICU.

Serious or complex surgeries, such as open-heart surgeries or brain surgery, require an open ICU bed for the patient to recover once their operation is complete. In Regina, there isn’t any capacity available.

“Surgeons are making a decision on a daily basis of who we can take to the OR,” Livingstone said.

“We’re not able to maintain our daily usual surgery, because we don’t have the ICU beds on a daily basis to accommodate that.”

The situation is already having real-world effects. One reporter spoke briefly about a patient with spreading cancer who can’t access surgery because there aren’t any beds available in the ICU for a post-operation recovery.

Thursday morning, the NDP shared the story of Richard Baron, an oncology patient diagnosed with brain cancer that has spread to his lungs. He needs surgery before he can state treatments. But he has been told his urgent surgery is no longer possible as Regina’s ICU is too full.

“My question to those listening is, why is this happening? Why have there not been measures put in place to increase staff and ICU bed capacity in the province to deal with the waves of COVID that we have been told all along would without a doubt come?” asked Ashleigh Woytuik, Richard’s daughter in a press release. “Why has the Sask. Party not used its resources to ensure that doctors would not have to pick and choose who receives treatment? My family is the fallout of a lack of planning and inaction, we are not the only ones and there will be more to come.”

“What I’m trying to say (is) we are already in a situation where we’re making those decisions on a day-to-day basis and triaging the most high-priority patients we can,” Livingstone said.

Regina hospitals aren’t at the point yet where they have to make decisions as to who they can care for and who they can’t, based on who will respond to care the best, but if the situation worsens in other cities, Saskatchewan could find itself in that unenviable situation, much like what has been seen in some Ontario centres and in Europe in the early days of the pandemic.

“Every day, decisions are being made to appropriate triage patients and provide surgery when we can safely do so,” Livingstone said.

“There are still some options available to us because what Regina is experiencing is not the case in Saskatoon.”

That means, he said, if patients are stable enough, they can receive treatments in other parts of the province. If case numbers and hospitalizations keep rising, though, that will change.

“Based on the pressure of Regina, if that were to spread to other parts of the province, we would be in a position where we are struggling to care for COVID and non-COVID patients in an emergency situation,” he said.

“If we were in one of those situations we move into a unit where … decisions are made to tirage care to patients who are more likely to benefit.”

That wouldn’t just apply to COVID-19 patients, but non-COVID emergencies, such as heart attacks and strokes, accidents and trauma.

Ontario has warned it would reach a situation where that happens in two weeks if current trends continue.

In Ontario’s triage outline, CBC reports, anyone with a greater than 80 per cent chance of dying within 12 months is de-prioritized for an ICU bed.

Saskatchewan isn’t at that point yet, but SHA Chief Medical Health Officer Dr. Susan Shaw told Global News Wednesday that the province is examining its so-called ethical framework to ensure it is ethically and medically sound. That framework will be used if Saskatchewan enters a situation where there are more ICU patients than available beds province-wide.

In the interview, Shaw warned that other centres, such as Prince Albert, Saskatoon and other sites, will start seeing more patients with COVID-19 admitted in the days to come.

Saskatchewan’s chief medical health officer Dr. Saqib Shahab said the best way to avoid such a situation is to closely follow public health orders and recommendations, including wearing a mask in public, only going to the store when necessary and staying home, including working from home, wherever possible.

“If we want to reduce the pressure, we have to take specific measures today,” he said.

“Many people have reviewed the work they do or the work their employees do, and many have started working from home. Reduce your visits out and about. All these actions today can result in reduced ICU pressures next week.”

Saskatchewan’s seven-day average of daily new cases fell slightly Thursday to 248 from 253 the day prior. Thursday’s mark, which equates to about 20 new cases per 100,000 population, is far above Saskatchewan’s stated target of 10 new cases per 100,000 population. The daily new case count has decreased slightly in the past week.

Thursday saw 254 new cases of COVID-19, along with 299 recoveries. One resident who tested positive for COVID-19 died. The resident was in their 50s and was from the South Central Zone.

North Central had 12 new cases Thursday. Of those, eight were in Prince Albert.

In addition to the 48 residents in intensive care, there are 129 COVID-19 patients receiving inpatient care, for a total of 177 people in the hospital.

Saskatchewan processed 3,706 COVID-19 tests Wednesday and administered 7,333 vaccines.

The weekly COVID-19 monitoring report for children aged 19 and younger showed a total of 704 active COVID-19 cases in youth. The weekly test positive rate among youth was 10.6 per cent.

North Central has 29 active cases among children and youth, of which 12 are in Prince Albert. Test positive rates among youth ranged from 1.3 per cent in Prince Albert to seven per cent in North Central 1 and 21.6 per ent in North Central 3.

That was the highest test positive rate among youth in any sub-zone.

North Central 3 includes communities such as Duck Lake, Rosthern, St. Louis, Wakaw and Waldheim.