1) Ontario Needs Plan To Deal With Staff Shortages Behind ER Closures: Auditor Report

Courtesy of Barrie360.com and Canadian PressPublished: Dec 6th, 2023

By Liam Casey in Toronto

Ontario has no central plan to help hospitals tackle nurse shortages that lead to temporary emergency department closures, the province’s acting auditor general found, while a significant portion of ER patients are only there because they don’t have a family doctor. 

The findings are contained in the annual report released Wednesday by the Office of the Auditor General of Ontario, which urges the government to develop a plan to address ER closures.

There were more than 200 unplanned temporary emergency department closures in 23 Ontario hospitals between July 2022 and June 2023 due doctor and nurse shortages, the report found. 

Amid that strain on the system, one in five patients who visited ERs were only there because they did not have a family doctor, and they did not need urgent care, it found. 

Acting Auditor General Nick Stavropoulos said the government had no central plan to help hospitals maintain nurse staffing levels to avoid ER closures, nor was there a provincewide strategy on staffing issues in long-term care homes.

“Instead, the ministry and Ontario Health generally relied on hospi­tals to manage these situations independently, typically by closing their emergency department or using more-expensive agency staff where possible,” said the report.

“A provincewide strategy to help hospitals and long term care homes maintain appropriate staffing levels is critical for the sector’s success moving forward.”

In looking at patients at emergency departments, the auditor’s report found about one in five, or or 1.29 million people, were deemed less urgent or non-urgent cases, which further exacerbated a stretched system.

“The lack of primary care is another major factor” contributing to increased wait times in ERs, Stavropoulos said.

The lengthy annual report contains 12 value-for-money audits. Four of the audits focused on health care, including an examination of emergency departments, health care in northern Ontario, the state of long-term care homes and Public Health Ontario.

Neither the health ministry nor Ontario Health — which oversees the health system — collected or tracked information on staffing shortages,  Stavroploulos said. The lack of a strategy continues to put a “strain on hospitals,” he said.

“This means that patients are less likely to receive timely care when they need it,” he said.

Health Minister Sylvia Jones did not answer questions about the lack of a plan to deal with the hospital and long-term care staffing crunch.

“Our pressures continue to remain on the nursing side, which is exactly why we have the programs like learn and stay,” she said. “We’re building a stronger health-care system, but it does take time.”

Jones cited changes to a temporary locum program that sees out-of-town doctors fill shifts in largely rural and remote northern Ontario hospitals that has helped decrease unplanned closures. She also said 15,000 nurses were registered in the province last year, calling it a “historic” number. 

The staffing shortages have left patients waiting longer in emergency departments. Some patients are waiting for more than 24 hours for an in-patient bed. And 5.3 per cent of patients who go to emergency departments give up and leave, the report found.

Stavropoulos found hospitals are becoming more reliant on nursing agencies to fill staffing gaps, which comes at a significantly higher cost. 

Nurses at private, for-profit nursing agencies can get paid more than $75 an hour compared to the $35 to $50 per hour that full-time hospital nurses make.

“There has been no legislation that caps the amount for-profit staffing agencies can charge to hospitals,” the report said.

Jones did not commit to capping fees nursing agencies charge and said the province is seeing the opposite, “a decrease in the use of staffing agencies.”

“We’re looking at many different pathways,” Jones said. 

“We do not want to limit hospitals and operators in home and community care the ability to actually provide the staff and the services that they need.”

A lack of triage nurses for patients coming in by ambulance prevents paramedics from returning to the road quickly, leading to what’s known as off-load delays, Stavropoulos said.

Some hospitals have worked with paramedic services to improve turnaround times, but not all hospitals have done so.

“Unique diversion practices that have helped some emergency departments handle patient flows more efficiently were often not shared with other hospitals,” the report said.

“What’s more, the ministry and Ontario Health also did not have a framework in place to track, evaluate and encourage the use of these effective strategies.”

Within an hour of Stavropoulos’s news conference about his findings, the government announced a new auditor general, Shelley Spence. 

2) Covid-19 And Flu Set To Peak Over Holiday Season In Ontario; Moore Urges Vaccinations

Courtesy of Barrie360.com and Canadian PressPublished: Dec 4th, 2023

By Allison Jones in Toronto

There is a lot of COVID-19 circulating in Ontario right now, and levels of both that virus and influenza are on the rise, set to peak over the holiday season, the province’s top doctor said Monday.

This is a key week for immunizing against both viruses, Chief Medical Officer of Health Dr. Kieran Moore said, as it takes 10 to 14 days for protection to take effect.

“I want to acknowledge that many people are tired of COVID, but it’s not tired of us,” Moore said in an interview. 

“Certainly we’re seeing lots of COVID activity across Ontario. Our metrics for last week were that we had 1,700 people in hospital, around 100 of them requiring intensive care.”

That level is lower than at this time last year, but at that time COVID-19 activity was on a downswing, whereas now, it’s on the rise, Moore said.

About 1.8 million Ontarians have received the updated COVID-19 vaccine this fall, but that’s just 13 per cent of the eligible population and 40 per cent of people over 65. 

“Of the hospitalizations both for influenza and COVID, the risk is really associated with age the older that you are, the better protected we need you to be from those two infections through immunizations,” he said. 

“That leaves 60 per cent of our adults over 65 not protected at present and that’s got me anxious as we head into the holiday season.”

The rate of people getting COVID-19 vaccinations peaked three weeks ago, he said.

Flu activity is also on the rise, Moore said.

“It’s anticipated, unlike last year, that influenza is following a more traditional pattern where it will be most active over the coming holiday and New Year’s season, and so it’ll be most transmissible in those social settings that are coming up,” he said.

Moore does not intend to enact any public health measures. “I think we’ll just continue the risk communication and the measures that people can take in terms of layers of protection, and access to medications,” he said. 

For COVID-19, there were 6,000 doses of Paxlovid dispensed last week, he said. 

When it comes to the triple surge of COVID-19, the flu and respiratory syncytial virus that hit children hard last year and put pressure on children’s hospitals, authorities have worked to ensure there won’t be any shortages of children’s Tylenol, Moore said.

“The system at large, I think, is prepared for this surge,” he said. “I do worry, though, as we head into influenza, that will be an extra burden on those hospitals.”

There are also more than 200 people in hospital with RSV, roughly half of them children four years old and under and half people over 65. 

Health Canada has approved an RSV vaccine for people aged 60 and older, but it is only available free of charge to people in that age group living in long-term care homes, Elder Care Lodges and retirement homes licensed to provide dementia care services.

The out-of-pocket cost for the medication can be over $250.

The government is looking at expanding public funding for the vaccine to alternative level of care patients in hospital — people who can be discharged to a long-term care home, for example, but don’t yet have a spot — and/or dialysis patients, Moore said. 

3) 1 In 9 Canadian Adults Have Had Long-Term Symptoms From COVID Infection, StatCan Says

Courtesy of Barrie360.com and Canadian Press Published: Dec 8th, 2023

By Nicole Ireland

About one in nine Canadian adults have had long-term symptoms from COVID-19 infection, according to a Statistics Canada report issued Friday. 

That amounts to 3.5 million Canadians, it said. 

Almost 80 per cent of those people with long-term symptoms have them for six months or more, the report said, including 42 per cent who had them for a year or more. 

That’s “significant” not only for affected patients but also for the country, said Manali Mukherjee, an assistant professor of medicine at McMaster University who specializes in respiratory diseases and immunology, in an interview on Friday.

“(These patients) have compromised daily productivity. So it’s affecting their quality of life and therefore has a direct effect on the socioeconomic situation in Canada,” said Mukherjee, who is a long COVID researcher and also spent about 18 months recovering from her own symptoms.

Long COVID, also known as post COVID-19 condition, is defined by the World Health Organization as symptoms that persist for three months or longer after infection and that can’t be explained by anything else.

More than half of those who ever had long-term symptoms still had them as of June 2023, according to the StatCan report. 

“Among Canadians who reported ever experiencing long-term symptoms, those who continue to experience these symptoms (58.2 per cent) outnumber those who have reported them resolved (41.8 per cent),” the report said. 

The StatCan findings aren’t surprising, Mukherjee said. 

“Long COVID is very much present,” she said. 

The most common long COVID symptoms are brain fog, fatigue and shortness of breath, she said.  

Research shows that getting vaccinated against COVID-19 reduces the risk of getting long COVID, as well as the severity of symptoms, Mukherjee said.

Two-thirds of Canadian adults who have tried to get health-care services for their long-term symptoms say they haven’t received enough treatment or support, the StatCan report said. 

Scientists, doctors and health-care workers across the country, alongside patients with lived experience, are trying to improve that through a huge research-sharing network called Long COVID Web, Mukherjee said. 

“All of us are working towards understanding … the different biomarkers that are indicating that persistence (of symptoms) … and figuring out a way to treat them specifically using targeted treatments,” she said. 

“There’s always hope.”

StatCan compiled its report using data from the 2023 Canadian COVID-19 Antibody and Health Survey followup questionnaire.

4) Flu Season Has Officially Started In Canada, Public Health Agency Says

Courtesy of Barrie360.com and Canadian PressPublished: Dec 2nd, 2023

By Nicole Ireland in Toronto

Flu season has officially begun in Canada, the federal public health agency said on Friday.

“At the national level, influenza activity has crossed the seasonal threshold, indicating the start of influenza season,” the Public Health Agency of Canada said in its weekly FluWatch report posted online.

The rate of tests that were positive for flu stayed above five per cent for two consecutive weeks.

As of Nov. 25, 7.5 per cent of people tested for influenza across Canada were positive.

The number of cases is climbing, said Dr. Allison McGeer, an infectious diseases specialist at Mount Sinai Hospital in Toronto. “If you plan to get a flu vaccine, now is a really good time to do it,” she said in an interview.

“The flu season starting now tells you that there’s going to be a lot of flu at the   end of December and the beginning of January,” McGeer said, noting the flu shot takes about two weeks to prime people’s immune systems.

“That’s when you want to be out with your friends and doing a bunch of things and, you know, flu is capable of making that time quite miserable.”

Not all provinces and territories are reporting a five per cent positivity rate yet. For example, Public Health Ontario’s latest flu surveillance report said the rate was 2.8 per cent as of Nov. 25 in that province.

But Ontario and other provinces will soon catch up and those rates will increase, McGeer said.

The dominant strain now will be influenza A type H1N1, which is a good match for the current vaccine, she said.

Many adults have some level of resistance to H1N1 flu strains, so it “tends to cause a lot of disease in kids, especially unvaccinated kids,” McGeer said.

She added that “emergency departments and pediatrics … take more of the pressure” during H1N1-dominant flu seasons.

Although McGeer said it’s important for people to get their flu vaccines, she’s even more concerned about the levels of COVID-19 that are circulating this year.

Friday’s surveillance report from Public Health Ontario showed a test positivity rate of 20 per cent for COVID-19 in that province.

In addition to test positivity, wastewater surveillance and hospitalizations show climbing COVID-19 cases in Canada, McGeer said.

“Just because we’ve stopped talking about people being hospitalized with COVID does not mean that people aren’t being hospitalized with COVID,” she said.

“At the rate we’re going, there will be more people hospitalized with COVID and more people dying  from COVID this year than last year,” McGeer said, noting that a low uptake of the new COVID XBB-variant vaccine is worrisome.

5) RVH’s Redirect Of Obstetrical And Midwifery Patients Now Over

ReleasePublished: Dec 3rd, 2023 5:45pmLast Updated: Dec 4th, 2023 9:00am

UPDATE – News Release – Royal Victoria Regional Health Centre

Due to a physician shortage, Royal Victoria Regional Health Centre (RVH) in Barrie, was on redirect for obstetrical and midwifery services from Sunday, December 3 at 8 p.m. until Monday, December 4, at 8 a.m.

The redirect order is now over, and regular services have resumed.

“Again, we apologize for any inconvenience experienced by our obstetrical or midwifery patients. Please know every effort was made to mitigate this action and avoid a redirect,” says Dr. Jeff Tyberg, Chief of Staff and Vice President Academic & Medical Affairs, RVH.

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