Five waves into the pandemic, health-care is far from 'normal,' say Alberta doctors, advocates

As public health officials declare the worst of the Omicron wave is over, Alberta doctors and advocates say the virus continues to hamper access to care, and patients are left dealing with the physical and emotional consequences of nearly two years' worth of surgery and testing delays.

"There is nothing normal about how health care is currently being delivered," said Dr. Kerri Johannson, a pulmonary physician at the South Health Campus in Calgary.

She is increasingly worried about her patients, including people with severe lung disease.

"Beyond surgeries being delayed, there is a large proportion of patients with chronic disease that require diagnostic evaluation, frequent monitoring and initiation of therapy. This can't be done effectively and efficiently in a system that is dealing with widespread community viral transmission," said Johannson.

"Letting this rip through our communities and neighbourhoods is having trickle-down effects at all levels of care."

According to Johannson, many appointments still have to be conducted by phone, diagnoses are being delayed due to limited access to testing, and monitoring of chronic conditions is also impacted.

"Everybody within [Alberta Health Services] is doing the maximum they can to provide the best care for Albertans. [We're] guessing whether somebody's disease is stable over the telephone when they can't access getting in for a chest X-ray, for my patients, for example. Pulmonary function tests access has been reduced. And this is all because of the widespread community viral transmission."

Many staff, she said, continue to be off in isolation or caring for sick family members.

"Our subspecialty programs are running at a fraction of the capacity of what they should be," she said.

The worry is — despite health-care providers working flat out — patients are getting sicker.

Delays diagnosing cancer

Dr. Shahzeer Karmali, a general surgeon working at Edmonton's Royal Alexandra Hospital, has been watching that play out with his patients through five waves of the pandemic.

"We always have had a backlog.… But the problem now is that wait list has now exploded and become unmanageable," said Karmali, who is also the section president for general surgery with the Alberta Medical Association.

People's health deteriorates as they wait, said Karmali, who points to delayed access to colonoscopies as a key example.

"Unfortunately, there's been a large number of patients who've now been delayed in diagnosis for colon cancer," he said.

"I saw three individuals who were about a year delayed from their scope and unfortunately … the colon cancer was metastatic. It had already spread."

And it's unclear how the health-care system is going to catch up.

"When we reassess the pandemic and what happened, this is going to be the major issue that we're going to see — is that delay in diagnostic testing," he said.

Alberta Health Services (AHS) said surgeries are being postponed on a case-by-case basis at each hospital depending on the availability of beds and staff.

"Overall, volumes of cases postponed are small and localized to a site. AHS staff and physicians are doing everything they can to mitigate any impacts due to unplanned staffing vacancies or urgent bed capacity need," spokesperson Kerry Williamson said in a statement emailed to CBC News on Friday.

"AHS has had to modify some other services with small reductions in outpatient clinic visits and endoscopy procedures to date. There have been no system-wide changes to date."

The health authority did not provide data on testing delays but said surgery volumes are roughly 91 per cent of the average in prior years.

Last week, 78,200 Albertans were waiting for surgery, Williamson said. In February 2020, prior to the pandemic, there were 68,000 on the wait list.

'Unease' and 'worry'

Patient advocacy and support organizations are worried about the ongoing impact on patients, too.

"The last thing you want with a cancer diagnosis is for it to go unnoticed, undiagnosed and advancing without any medical treatment. So this is particularly concerning for us at this time," said Natalie Noble, CEO of Wellspring Calgary.

"[It] certainly gives them a feeling of unease and worry with the health-care system at a time in their life when they're going through something horrible," she said.

According to Noble, demand for the group's services — especially peer support phone calls — is higher than ever

"To us, this signals that people are in more need of the human connection to help them through this horrible disease. Does that signal it's not available in the broader health-care system right now? If there's pressure and not enough staff in the hospitals and in the clinics, then that does ripple out."

And fear is also impacting access to care, according to Nina Snyder, chief operations officer at the non-profit, Alberta Lung.

She said some people with chronic lung conditions — who are particularly vulnerable to severe disease with COVID-19 — are avoiding medical care altogether because they're worried about being exposed despite reassurances from health-care workers and AHS that it is safe to do so.

"They're challenged — their emotional well-being — because they don't even have the minimal contact they used to have. They're afraid of having people come into their home for treatment. They're afraid of leaving their home for treatment," she said.

Meanwhile, Johannson worries Alberta's plan to lift restrictions could lead to another surge in cases and further delays.

"What it signals to the public is that this pandemic is over … or the worst is behind us, and that's not necessarily the case."