The December disconnect: Why COVID alone is not to blame for Manitoba's newest ICU crisis

On May 19, during the most nerve-wracking moment of the third wave of the pandemic, Manitoba intensive care wards struggled to treat a record 131 patients.

Never before had Manitoba ICUs had to care for so many humans. It wouldn't happen again during that third wave, thanks to the pragmatic decision that week to begin flying critically ill COVID-19 patients to hospitals in other provinces.

With the benefit of hindsight, Manitoba had no choice. Politicians who banked on the third wave receding were proven wrong. Epidemiologists and medical professionals who pleaded for tougher restrictions were proven right.

When you think back to that upsetting week, most Manitobans had no problem comprehending something terrible had happened to their hospitals after the belated third wave of COVID-19 finally brought the delta variant to this province.

During the leadup to the loneliest Victoria Day long weekend ever, restaurants and many other businesses remained closed. Socializing with anyone outside your household was forbidden, even outdoors. Former premier Brian Pallister was blaming U.S. President Joe Biden for the slow pace of vaccinations instead of comforting Manitobans.

In other words, the crisis outside hospitals mirrored the crisis inside their critical care wards.

But this isn't the case right now, as ICUs lurch into another crisis. 

Almost every Manitoba business is open, at least to people immunized against COVID-19. Restaurants and bars are starting to hum with holiday traffic. Christmas shoppers are flocking to malls and big-box stores. Movie theatres are showing winter blockbusters. Canada Life Centre is hosting hockey games again.

Life has seemingly returned to near normal — with the notable exception of hospitals.

This is not because of record numbers of COVID cases or COVID patients. The fourth wave of the pandemic has been significant, but not quite devastating, thanks to vaccinations.

Instead, hospitals are struggling because they can't find enough people to work in ICUs.

This is happening even as Monday's total ICU patient burden stood at 90 people, which is only two thirds the patient count on that horrible day in May — and one of the lower totals disclosed by Shared Health since the start of the pandemic.

Faced with the task of ramping up ICU capacity to ensure no patient will ever be transferred out of province again, Manitoba has been unable to manage even a diminishing patient load.

"Every day has become an exercise in 'Where do we find the next bed?' " Dr. Eric Jacobsohn, a St. Boniface hospital ICU physician, said on Monday. "This whole morning has been 'Who is going where?' "

The issue is not a lack of space for ICU patients. It's sufficient quantities of people trained to work in ICUs.

On Monday morning, Health Minister Audrey Gordon said this was news to her.

"We certainly have the ability to scale up our ICU capacity well beyond what it is right now," she said.

Hours later, Shared Health conceded it does not have enough nurses to work in ICU and has fallen short of its fourth-wave target to ramp up ICU capacity to 110 beds.

In a statement, Shared Health said Manitoba nurses are refusing incentives to work in ICUs and are refusing to be reassigned there.

The Manitoba Nurses Union refused to accept this explanation.

"Plain and simply put, there was a [nursing] shortage pre-pandemic, and because the employer did nothing to retain or attract new nurses, there is nothing that can magically make nurses appear overnight," Manitoba Nurses Union president Darlene Jackson said in a statement.

NDP leader Wab Kinew, meanwhile, said there is no mystery why some nurses no longer wish to work in ICUs.

"They've either chosen to retire, leave the profession or leave the public system due to the stress, the lack of work-life balance and the way that the government has treated nurses and other health-care professionals throughout the pandemic," he said.

On Twitter on Monday evening, Grace Hospital's medical director, Dr. Heather Smith, went further.

"Let's say you do a job that requires 14 highly skilled people. Suddenly, you only have seven people and three of them are untrained," the ICU physician tweeted. 

"Your working conditions remain like that for months. And you keep getting told you're fine and that you can, in fact, actually increase what you're doing."

Jacobsohn said he and his ICU-physician colleagues would love to know how Manitoba can ramp up ICU capacity.

Several of his colleagues told CBC News they fear cardiac and COVID patient transfers could be coming again.

Again, this is happening with the ICU burden standing at 90 patients while the officially stated capacity is 104. 

It seems like a disconnect, but there was a parallel during that terrible week in May.

On the Tuesday before the long weekend, Heather Stefanson — then the health minister — said ICU capacity could be expanded to 173 patients, even though hospital officials had already said that was impossible.

The very same day in May, the province transferred the first two of what eventually would be 57 COVID patients to other hospitals.

Seven months later, it's fair to ask the current and former health minister why almost everything in Manitoba is open and functioning fairly well right now except for our hospitals and intensive care wards.