Thread by @NeejaB

State of affairs: Healthcare edition.

With every wave, there is the peak and then the steady decline, where for a moment or two, it feels like the pressure cooker has settled. Where we feel like maybe things are over and the worst is behind us. /1

The reality is that with each wave, the cumulative healthcare effects from March 2020 are more dire, with this current reality the worst we have faced as a province./2

COVID: cases have come down, and hospitalizations are down. All true. BUT any internal medicine service can tell you that our ward COVID patient numbers have plateued, unlike any other wave. Previously, we would see a fast decline as soon we saw cases go down./3

This is the longest we have had to continuously keep COVID teams activated with no predictability of when we can decomission. This equates to blocked beds, extra nursing and physician staff above and beyond normal pressures. /4

Non-COVID: As with every wave, as soon as we peak and start to come down, the non COVID fall out presents themselves at ERs and hospitals. Internal medicine (the largest admitting service in AB) is seeing volumes of 30-80% over normal bed base./5

Patients are sick, and therefore staying in hospital longer than previous times. This makes overall bed resources scarce./6

Why does this matter? We haven't even begun to discuss the severe surgical backlog. We know that just in this wave alone, we have 15,000cases cancelled or postponed. We also know that for routine cases such as hip and knee replacements, the wait time is in magnitudes of years./7

ICU numbers have reduced enough for many of the large hospitals to "give back" the OR spaces that were used for surge ICU. So- we should just be able to pick up where we left off right? Surely, since we are declining steadily in COVID ICU spaces, we should be able to catch up./8

Except remember those 30-80% above bed base non-COVID admissions that we are seeing now? Those patients need hospital beds. Those beds are coming from where?
/9

Surgical wards. Many of our internal medicine patients are on borrowed Ortho wards, urology wards, general surgery wards. So even if we wanted to begin routine surgeries, we have no where to place patients after their ORs. /10

Finally, the mental exhaustion of healthcare workers is incredible. There has been zero repreive, with this wave being the hardest, longest, filled with outstanding moral injury. And now, as we face a huge surge of non-COVID, the end isn't in sight. /11

In coming days, I'll highlight the massive fall out the above has on outpatient practice, which is having to pick up the pieces from a strained inpatient system. /12

But for now, I sincerely hope our policy makers are pragmatic in continuing current public health measures. Any lifting would be premature and crumble us beyond repair. /fin