Surgeries at Waterloo region's hospitals threatened by Omicron

Kitchener resident Angela Williams was diagnosed with chiari malformation, a rare brain condition that puts irregular pressure on parts of her brain and spinal cord, at the end of 2019. 

She was scheduled for surgery on Mar. 13, 2020 to address her neck pain, dizziness and migraines, and to prevent her condition from worsening.

Despite tentative surgery dates and multiple visits to the ER, the surgery never came.

"It was scary," said Williams, who has since seen several different doctors, specialists and surgeons beyond the Waterloo region within the past two years. "I didn't hear anything from the surgeon. I didn't hear anything from a doctor. I didn't hear anything."

Now almost two years later, Williams is still waiting for the initial surgery without a date in sight. Except now, she sometimes wakes up choking on her own vomit, frequently loses vision in both eyes and is constantly battling some type of pain.

"I'm just sitting here at a loss," said Williams, who says she's unable to work because of her condition. "I'm hoping and praying for the phone call that never comes."

A buildup of surgeries in hospitals 

Williams is one of 11,000 people who are waiting for surgery in the Waterloo region. Hospital officials have estimated it will take more than a year to clear.

Throughout the past two years, hospitals were forced to stop elective surgeries twice, building on an existing backlog of surgeries that in some cases, existed before the pandemic started.

Lee Fairclough, the president of St. Mary's General Hospital and the regional leader against COVID-19, says the region's hospitals are starting to see the effect of delayed or limited access to other services, such as MRI scans and other diagnostic tests. 

"People are coming in sicker — some of it may be because of limited access to care early in the pandemic, both at hospitals but also with primary care," Fairclough said. 

"We're now seeing people coming forward with more advanced presentations of some of their conditions."

About 80 per cent of the region is fully vaccinated against COVID-19. While this has helped hospitals ramp up elective surgeries at more than 110 per cent to get back on track, Fairclough says the Omicron variant is posing a threat to those short-lived plans.

"We also realize that to be able to respond in January, we will likely need to reduce some of our non-urgent and emergent procedure work again. Right now, we'll be planning for that," she said.

Fairclough says regional hospitals are looking to ramp up services to support people to get their third dose of the COVID-19 vaccine, in addition to preparing resources for the influx of admissions they're expecting due to Omicron cases. 

How to tackle the backlog

Flaircough says the demand for hip and knee surgeries is high, with ophthalmology cases accounting for more than 50 per cent of St. Mary's backlogged surgeries.

To tackle a backlog of more than 7,000 surgeries, St. Mary's partnered with an off-site provider, TLC Vision, earlier this year, to run ophthalmology procedures at 130 per cent capacity. 

Grand River Hospital, backlogged by 2,000 surgeries, has been operating at six operating rooms and will be going to seven in late January and hopefully eight by end of March, according to communications manager Cheryl Evans. Pre-COVID, the hospital would perform almost 10,000 surgeries each year. 

Cambridge Memorial Hospital, which also has about 2,000 surgeries on its wait list, has a partnership with Tri-City Colonoscopy Clinic to help with endoscopy procedures, according to communications manager Stephan Beckhoff.

"We are also in the process of exploring similar partnerships for other procedures," he said, adding while there's been some "promising" talks, nothing has been formalized yet. 

According to an email from the Ministry of Health, Waterloo region hospitals along with hospitals in Ottawa, Kingston, and Windsor are all working with community partners to perform low-risk procedures in new settings to free up hospital operating room capacity.

Despite community care and private partnerships, along with the triage process for surgeries according to need and pain management, people can still fall through the cracks, Fairclough said.

"I think the reality is that the backlog and the wait times are increasing, and with each big wave, we're going to see that same effect."

A reflection of a province-wide problem

The backlog may seem staggering for the region, but it's just a drop in the bucket for hospitals in Ontario.

In November, a report commissioned by the Canadian Medical Association said it would take at least $1.3 billion to return surgical procedure wait times back to a pre-pandemic level.

However, in May, the Financial Accountability Office (FAO) found it will cost $1.3 billion alone to clear the growing surgery and diagnostic procedure backlog and an additional 3.5 years to clear the surgery backlog, assuming hospitals operate above capacity.

The province allocated $610 million – less than half – in the budget, to tackle surgical backlogs. Some of this has already been used by Waterloo regional hospitals to train more nurses and fund surgeries.

But the Ministry has said the FAO's report does not reflect "actual current demands of patients waiting for surgeries and diagnostic imaging procedures."

"Current data demonstrates that the overall number of surgical patients waiting in Ontario is not currently higher than before the pandemic, though as patients proceed through upstream screening, referrals, and diagnostic assessments, more may enter surgical wait lists in the coming months," said an email from the ministry.

The same email also showed that hospitals received $6.2 million in one-time surgical support funding to operate on evenings and weekends to catch up on surgeries. The ministry said that led Cambridge Memorial Hospital to complete 92 per cent, Grand River Hospital to complete 86 per cent, and St. Mary's General Hospital to complete 84 per cent of their funded allocation volume in 2020-21.

Between 2020 to 2022, the ministry said Waterloo region hospitals received a cumulative $2.6 million to support extra MRI and CT scan operating hours.

"Waterloo hospitals will also be eligible for additional surgical recovery supports in 2021-22 based on the level of surgical activity they achieve," the email said.

Preparing for another wave

Fairclough says although hospitals and its community partners in nursing homes, pharmacists and clinics are working together to prepare for another wave, they can't do it by themselves.

"My main message to the community is, we're going to continually work very hard to strike the right balance on these two choices and decisions," Fairclough said. "[If you] haven't got your first dose yet, please get your first dose because I think this variant will move through very quickly in the population that's unvaccinated."

In her experience, Williams believes it's limited and burned out medical staff, combined with the bureaucratic oversight, that's put her at the bottom of surgery wait lists.

But as frustrated as she is with the wait for surgery, she's equally upset with people who aren't making an effort to curb the spread of the virus.

"My frustration lies with the people who aren't getting vaccinated," Williams said. "The people who are not wearing masks, the people who still think that this is a joke, the people who are like, 'Oh, well, whatever, it doesn't affect me. I'm not sick.'

"The more people that don't get vaccinated and treat it like this, the longer the wait is for people who are waiting for surgeries."