Five-year-old Rossy Hipkin was just one week away from a surgery that could have changed his life, according to his mom. That surgery might have, for the first time, allowed him to use his arms.
Then came the email: his Nov. 25 operation was cancelled because of COVID-19, a doctor wrote.
“It was hard. We’d been building him up, … telling him, ‘You’re going to get muscles’ and ‘You’re going to be able to use your arms,’ and things like that,” said Corina Heppner, Rossy’s mom.
“And then we have to say, ‘Well, you’re not going to get your muscle.'”
Over a month later, Rossy still hasn’t had his surgery. And he’s not alone.
Hospitals across Canada have been forced to cancel and delay surgeries as COVID-19 cases fill up hospital beds and strain resources, according to doctors working on the front lines. There’s a risk that if Omicron cases keep trending upwards, emergency care — a hospital’s ability to quickly respond to everything from a sprained wrist to a heart attack — could be impacted too, according to Dr. Gerald Evans, an infectious disease specialist at Queen’s University in Kingston, Ont.
“We’re all afraid that our ability to continue to do that emergent care is really, really being taxed by the staff absences and of course, the large influx of patients with Omicron.”
What does an overwhelmed hospital look like?
When hospital capacity gets strained, one of the first actions hospitals can take is to cancel or delay what they describe as “non-urgent” surgeries. It’s a step that provinces like Ontario, British Columbia, Quebec and Alberta have taken to help reckon with the Omicron wave.
But just because an operation isn’t seen as “urgent,” doesn’t mean it’s not essential for someone’s quality of life, according to medical experts. Elective surgery “simply means that the surgery can be scheduled in advance,” Johns Hopkins Medicine says, and it “does not always mean it is optional.”
“Even stuff that is deemed non-essential is still important,” said Dr. Christopher Labos, a cardiologist and epidemiologist.
“If you’re somebody who’s waiting for a hip replacement and that just keeps getting delayed and delayed and delayed, you’re going to be living with chronic pain for months, if not years.”
Over half a million fewer surgeries were performed across Canada during the first 16 months of the COVID-19 pandemic compared to previous years, according to a report from the Canadian Institute for Health Information (CIHI), published last month. The bulk of that decline happened in the early months of the pandemic.
In Ontario alone, there were 34 per cent fewer adult cancer surgeries, 44 per cent fewer cardiac surgeries, and 93 per cent fewer pediatric surgeries during the first month of the pandemic, according to a letter Ontario Health CEO Matthew Anderson wrote to hospital CEOs on June 15, 2020.
But the latest wave is still having a real impact on non-urgent procedures, Evans said.
“A lot of things that people require for their health that may be not-urgent or not-emergent tend to be a little bit more difficult to accommodate when there are large numbers of patients in the hospital,” he explained.
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That includes surgeries like Rossy’s bid to gain the use of his arms. Rossy suffers from Arthrogryposis Multiplex Congenita, which limits his joints and range of motion. He can’t use his arms from the shoulder down, but surgery would have moved some muscle from his leg to his arm, and that could have helped him regain some movement.
“The hardest part is when you hear, ‘Well, it only affects the vulnerable’ or ‘Only the high risk and the vulnerable are dying,'” said Heppner, Rossy’s mom.
“To us, that sounds like you’re telling us that our kids don’t matter.”
As children like Rossy wait for non-urgent — but life-changing — surgery, doctors like Evans are worried that the rising Omicron cases could start to impact emergency medicine, too. Emergency care can be “as simple as a sprained ankle” or “complicated, like a heart attack or a stroke.”
“That’s the kind of care that you can’t defer,” Evans said.
“That person needs immediate attention.”
How is Omicron overwhelming hospitals?
The Omicron variant of COVID-19 is spreading fast around the world, including in Canada.
On Tuesday, Canada reported over 34,000 new COVID cases and 74 deaths, for a total of over 400,000 active cases. But a number of provinces have restricted their COVID-19 testing as they drown in demand, prompting the Public Health Agency of Canada to warn that daily case counts are likely underestimating the true burden of disease.
As of Jan. 3, 4,106 of these COVID-19 patients were reportedly being cared for in Canadian hospitals — more than double the 1,919 patients reported just one week prior on Dec. 27.
According to Health Canada, 640 of these patients were in intensive care units as of Jan. 3, while 274 were mechanically ventilated.
New data also indicates that 46 per cent of people currently in Ontario hospitals with COVID-19 were admitted for other reasons, meaning their COVID infection isn’t what put them in the hospital — it was just discovered when they arrived.
“It’s pretty clear that as hospitalizations go up and up and up, there will come a point where the hospital system becomes overwhelmed,” Labos said.
“We have to be aware of the fact that unless we can bend the curve in a significant way, we’re going to start to have a major issue in the very next little while.”
It’s not just hospital admissions, either. With the highly transmissible Omicron variant ripping through Canadian communities, health-care workers are getting sick, too.
“As health-care workers get sick and you have less personnel, sometimes you have to close beds simply because you don’t have the personnel to actually staff them,” Labos explained.
“So as more and more people are waiting for fewer and fewer beds that are available, that creates longer lines — and so you may end up waiting in the emergency room to get a bed for days, frankly.”
How do we prevent COVID from overwhelming hospitals?
The main thing Canadians can do to prevent COVID-19 from overwhelming hospitals right now is to follow public health advice: reduce their contacts and get vaccinated.
“If we can keep cases down, it means staffing levels can be maintained at hospitals. It means we will not be stressing out the hospitals as much with COVID admissions. That’s the big thing that we can do at the moment,” Evans said.
“Public health measures, getting third shots into people, are all important parts of it, as well as some of the measures that have been put into place to reduce social contact. And that’s working.”
Canadians can greatly reduce their risk of overwhelming the hospitals if they get their vaccines, according to government data. In its Tuesday epidemiological update, the government reported that compared to unvaccinated cases, fully vaccinated cases were “79 per cent less likely to be hospitalized” and “71 per cent less likely to die as a result of their illness.”
It’s something Dr. Michel Haddad, the chief of staff at Bluewater Health in Sarnia, has witnessed firsthand.
“About 60 per cent of our admitted hospitalized patients are unvaccinated, which is more than the provincial (rate) and 90 per cent of ICU are unvaccinated, which is also much more than the provincial (rate),” he said.
Heppner, who is still waiting for her son’s surgery, says Canadians “shouldn’t wait until COVID affects them directly” before they take steps to protect others, like getting vaccinated or following public health advice.
“I feel like it’s the bare minimum that we can do to possibly help others,” Heppner said.
“Not just my child, but other children.”