Edmonton emergency doctor Shazma Mithani came off a shift one night this week with a horrifying thought: If this continues, we are going to have kids die in the waiting room.
There were never fewer than 30 or 40 sick, ailing and hurt babies and children waiting to be seen over the course of her 10-hour shift at Edmonton’s Stollery Children’s Hospital which, like many kids’ hospitals across Canada, is being pushed to capacity and beyond. Most of the two dozen ER beds were already filled with children who couldn’t safely be sent home, because most of them couldn’t breathe properly. These children needed to be moved to beds upstairs, but there were no empty beds there to move them to, and so instead they waited, for hours on end, in Mithani’s overrun department with a crammed waiting room just beyond it, full of anxious parents and coughing, fidgeting and feverish kids who had no place else to go.
The doctor tried to see children in the waiting room every chance she could. Each time Mithani went out to check, “It was just this kind of low level of chaos.” Kids crying and worried parents pleading with the triage nurse, “How much longer is it going to be?” Babies breathing rapidly from RSV, the virus driving a freakish and alarming number of respiratory infections, and toddlers with bad asthma flare-ups and croup. Multiple kids with abnormal vital signs and critically low oxygen levels who need immediate action and who would normally go straight to resuscitation rooms, except all the “resus” beds were already occupied. “We had to quickly, like very quickly, shuffle things around just to get them into any sort of care space,” Mithani said. Children with severe anaphylaxis, allergic reactions with swollen airways and tongues, children with back-to-back seizures requiring IV medications, children triaged as “category 2’s,” meaning moderate to serious but not-life threatening illness who should be seen by a doctor within 30 minutes of arrival. “Kids like that were waiting one and a half, two hours.”
Every hour counts, and knowing so eats away at Mithani, as she moves from case to case, fully understanding that the not-super-sick kid who hasn’t been seen in four hours could become super-sick after hour six or eight.
“It’s terrifying, it’s stressful, it’s demoralizing,” she said. “We on the front-lines, on the ground floor, are trying to do everything we can to make sure that kids aren’t suffering and that somebody doesn’t have a bad outcome.”
Edmonton isn’t an outlier, rather, it’s another example of a hospital system that’s been too small for decades now fraying at the seams, and at risk of failing our kids — and those who care for them.
“I hear it from my staff all the time: ‘I’m worried that something is going to happen,’” said Dr. Beth Foster, a pediatrician-in-chief at Montreal Children’s Hospital.
It has been a strange fall in medicine. Children for weeks now have been hit with a weirdly early wave of seasonal viral infections, first RSV, or respiratory syncytial virus, and now influenza A. One prevailing theory is that many children weren’t exposed to the usual bugs over the last two years of the pandemic, and are now getting infected all at once. What is clear, Toronto emergency doctor Kashif Pirzada told Healthydebate.ca, is that the acute-care system for kids needs to urgently “decompress.”
At Toronto’s SickKids on Thursday, the pediatric intensive care unit was at 137 per cent capacity. While ER volumes seemed to be stabilizing, the hospital’s wait-list for non-urgent surgery has now swelled to 6,000 children since SickKids made the decision 10 days ago to reduce all non-urgent surgical procedures.
Hospital president and CEO Dr. Ronald Cohn doesn’t use the word “elective” surgery. Every child that needs surgery, needs surgery, he said. Full stop. “It’s just that we had to make the difficult decision to really focus on our emergency or urgent surgeries only” to create capacity in the ICU.
CHEO in Ottawa, McMaster Children’s Hospital in Hamilton, Vancouver’s B.C. Children’s Hospital. All have resorted to similar measures. Ontario and Quebec teens are being diverted to adult ICU’s, a pivot from the early days of COVID, when kids’ hospitals were taking adults. Doctors are being asked to practise outside their usual scope of practice. On Wednesday, Foster put out a call to her staff: Please come help. Help in intensive care, emergency, the general pediatric wards. Staff who have already been working flat-out on call and on weekends, and who are beyond exhausted.
Kids are being doubled up in single rooms. Wait lists for children with eating disorders and other mental health conditions are growing longer, as those beds are freed up for children coming through emerge. The Montreal Children’s Hospital hasn’t had open beds for weeks. Important surgeries — operations for babies born with heart malformations, a living donor kidney transplant for a young child, a patient of Foster’s, who needs hours of dialysis four days a week — have been cancelled and delayed, over and over, because there’s no place for kids to recover, post-surgery. These aren’t trivial surgeries. “We haven’t seen deaths or major morbidities yet, but there are going to be consequences,” said Foster, who, like Mithani, was among more than three dozen women — medical leaders, hospital board chairs, former provincial cabinet ministers — who called on Prime Minister Justin Trudeau and the premiers last week to hammer out a funding agreement earmarked for children’s health care, warning “kids’ lives are on the line.”
COVID has had a hand in the pediatric crisis, Foster said. “I think there is nobody who will deny that the lockdowns and the lack of viral infections circulating in the community unquestionably played a major role in this,” she said. “However, we have cut and cut and cut over the years the number of beds available, the number of staff available, to care for patients.” There’s no flow, no capacity, she said. When there’s a crisis, it becomes a bigger crisis.
What’s needed, Cohn said, is for everyone — decision makers, bureaucrats, politicians — to first agree that there is a problem “and acknowledge it, then we can work on a solution.”
Nobody would disagree that a surgical wait-list 6,000 procedures long is unacceptable, Cohn said. “But then to make the leap of saying, ‘Ok, it’s actually really unacceptable and we have to now think about how we’re going to change it.’ I think we’re moving towards it, but, without criticizing anybody, I’m not sure we’re there yet.”
SickKids is collaborating with community hospitals “almost like never before,” said Cohn. Twice a day, meetings are held to discuss the bed situation: Which child is safe to be taken care of in a community hospital, and which child needs to be at SickKids?
“I’m always trying to be very careful,” Cohn said. “I want people out there to know what’s happening, but I also don’t want people to panic, because at the end of the day there is no reason to panic.”
Are RSV and the flu really making kids sicker? What emergency room doctors are seeing
Colby Cosh: Kids are paying the health price for COVID measures
Still, little kids aren’t little adults, and concerns have been raised over whether hospitals or ER’s for adults are the best places for children. In Quebec, there’s really no network of hospital care for children, Foster said, and very little primary care for children. Montreal is among the most poorly served regions of the province. Pediatricians across the province are being discouraged, via changes to their billing codes, from regularly seeing healthy babies and to focus on kids with more urgent needs instead, but most kids have no family doctors. “So, if the baby is sick, they go to emergency,” Foster said. “They have no choice.”
Foster and other doctors fear the window is rapidly closing to stem the surge. She’s not calling for lockdowns but believes people should be masking in public spaces. “We need to stretch out this wave of viral illnesses instead of having it happen all at once.” She and other doctors are encouraging influenza vaccines and COVID shots. Flu season has only just begun and is expected to get worse. Omicron’s sub-variant BQ.1.1 is showing an increased propensity for immune invasion, the European Union’s medicine’s regulator warned this week, and COVID cases could spike again this winter.
Mithani used to love her job, but now she finds she doesn’t like going to work, knowing that feeling, almost of helplessness, will be waiting for her there, as she moves from child to child. Her darkest fear is that too many hours will pass, and that one sick kid will become a gravely sick kid and slip away in the waiting room, a victim of a perfect storm.
“I don’t know why this isn’t lighting fires under more people,” she said. “Does it have to be that one child dies before something gets done?”