“At this point, I would not trust my family to be brought to St. Boniface General Hospital for anything” says Jacquelyn*, a nurse at Winnipeg’s second-largest health centre. The COVID-19 pandemic has been a known concern and threat for over eight months. Yet, like many of her colleagues, Jacquelyn wonders why her hospital was not prepared for the city’s most recent surge of cases.
The failure to contain multiple preventable COVID-19 outbreaks in the hospital (which is currently experiencing the worst of three hospital outbreaks in Winnipeg) is attributable not only to mismanagement by the hospital’s executive staff, but also to years of austerity under Premier Brian Pallister’s Conservative government. The effects are—and will continue to be—devastating.
According to Jacquelyn, St. Boniface General Hospital (SBGH) executives directed some managers to work from home for the first two weeks of the outbreak when it began in October. Not being present at the hospital predictably led to a string of bad decisions. This meant that Jacquelyn’s manager was at home and largely unable to respond effectively to the fast-moving conditions inside the hospital—damage control done remotely is reactive and leaves little room for preventative action.
It took the hospital up to five days to contact trace some staff after the first outbreak was declared on October 16. To make matters worse, they only found out by word of mouth if they had worked closely with their COVID positive colleagues. Some staff were never even notified. Jacquelyn also stated that following the direction of the Infection Prevention and Control (IP&C) department, patients have been taken off precautions prior to their swabs being processed. In some cases, the swabs have come back positive. This negligence has led to staff being exposed to COVID positive patients for hours on end.
While hospital management has since returned to work at the hospital, executives’ decision to keep managers at home in the first weeks of the outbreak resulted in a top-down failure that has likely had lethal consequences.
What’s more, Jacquelyn claims the administration continuously and blatantly disregards the concerns of their frontline staff, most notably regarding access to adequate personal protective equipment (PPE). At SBGH, nurses have been reassured they are allowed to request and wear whichever mask they deem safest while working on COVID positive units. However, because executives have not yet made N95 masks mandatory in impacted wards through IP&C guidelines, Jacquelyn explains that nurses are strongly discouraged from requesting them and have been “cautioned that if they used them frivolously, they would run out.”
Despite this, efforts by SBGH nurses to access adequate PPE were promptly rejected by hospital executives because, according to Jacquelyn, the facility is in short supply. Echoing a widely-read open letter to Manitobans penned by the family of Eric Wheeler, a nurse at Victoria Hospital, healthcare workers at SBGH have been left with no choice other than to wear surgical masks they feel compromise their own health and safety. Our “frontline heroes,” as the Wheeler family letter describes, “are skipping water, coffee and meal breaks because they are scared of being infected with COVID since they are not being provided sufficient PPE.”
And while examples abound of executive-level negligence at SBGH, these issues stem from years of sweeping public service cuts including the shuttering of emergency rooms and liquidation of hundreds of frontline staff positions in the province.
Since being elected in 2016, the Pallister government has imposed a series of cuts to Manitoba’s healthcare system. Adding insult to injury, the Conservatives’ austerity regime has persisted despite the pandemic. How did we get to this breaking point?
The Conservatives began unleashing sweeping and persistent cuts to the healthcare system in 2017. To date, this has included closing three of Manitoba’s six emergency rooms, five of its six QuickCare clinics, and Misericordia Health Centre’s widely popular Urgent Care Centre. The province’s supply of intensive care unit beds has also steadily decreased since 2017, down from 73 in January 2017 to just 63 beds in July 2019.
By 2020, the Conservatives had overseen a 20 percent reduction in ICU beds across the province. Manitoba Health Minister Cameron Friesen’s stated rationale for decreasing ICU capacity was to improve patient flow and find efficiencies. Yet, as Dr. Daniel Roberts, a critical care physician at Winnipeg’s Health Sciences Centre attests, these objectives have failed on the frontlines.
Jacquelyn and her colleagues at SBGH agree that the ER closures and ICU bed reductions have had a direct impact on increasing patient ratios and acuity (or severity), even before the pandemic hit. She describes the current conditions at SBGH as dire, a reality in which doctors have had to choose which patients go to the ICU because there are not enough beds to meet the hospital’s needs. Pallister’s cuts to healthcare have placed additional burdens on the shoulders of doctors who must now decide who will receive the treatment they need to survive, and who will not.
The shuttering of ERs and QuickCare facilities has shifted the burden directly onto frontline nurses and hospital staff. To make matters worse, in what has been called “the most major changes to healthcare staffing in a generation,” the province not only ‘deleted’ over 500 nursing positions in 2017, but also froze nurses’ wages for over four years. The effects were felt immediately. In 2019, the president of the Winnipeg Regional Health Authority (WRHA) referred to this as the “valley of despair.” Even Manitoba’s Chief Nursing Officer, Lanette Siragusa, admitted that the province’s multi-year healthcare consolidation has had major impacts on the delivery of vital care.
These cuts have resulted in a sharp increase in the number of overtime hours that nurses are forced to work. For example, while nurses were mandated to work overtime 328 times in 2017, that number skyrocketed to 511 in the first half of 2018. Since the arrival of Winnipeg’s second wave of COVID-19, Jacquelyn maintains that it has become even more common for nurses to work overtime at SBGH, resulting in many shifts lasting 16 hours or more. The statistics for overtime mandates since the outbreaks began in October do not actually reflect reality, she says, as the practice of recording additional hours has been neglected in the ensuing chaos.
The consequent exhaustion and burnout experienced by health workers has propelled what was formerly a ‘chronic’ nursing shortage into a ‘critical’ one. Jacquelyn and her colleagues at SBGH have seen countless of their counterparts retire in the last few years to ‘escape’ these conditions. And the timing could not be worse. Lately, Manitoba’s healthcare system is battling compounding crises: the coronavirus pandemic and an acute nursing shortage. In fact, there is currently a record number of nursing vacancies in Winnipeg. According to Jacquelyn, this amounts to a 15 percent vacancy rate for nurses at SBGH, with 68 positions currently unfilled. For context, Minister Friesen previously stated a ‘normal’ nursing vacancy rate is eight percent.
Yet, as SBGH microbiologist Dr. Philippe Lagace-Wiens warns, “Sure, we can add more beds, we can add more ventilators. Those items can be bought, but having staff ready and able to provide that service is a whole other story.” To be sure, of the 63 ICU beds mentioned above, the WRHA said in January 2020 that it has staffing capacities to care for 58 of those beds. As if predicting the disaster to come, 35 of Winnipeg’s top doctors sounded the alarm in November 2019 in a letter sent to Minister Friesen and other high-ranking provincial healthcare officials, imploring that “nursing shortages are not easy to solve. It is imperative, however, that this… be addressed prior to February 2020.”
If left as-is, the letter continued, the “current ICU bed and nursing crises will contribute to significant and avoidable patient morbidity and mortality.” The Pallister government had a prime opportunity to weather this storm well before it even hit the province. Our leaders were warned up to nine months before the pandemic that our provincial healthcare system lacked surge capacity due to unsustainable staffing levels and too few ICU beds.
Minister Friesen and his high-ranking colleagues ignored these early warnings, and the consequences of their inaction have been lethal. Dr. Owen Mooney is an internal medicine specialist at SBGH who recently tested positive for COVID-19. After working around the clock for a week, he is now the sickest he’s ever been in his life. Mooney describes the severity of the conditions at SBGH as a “system on the brink of collapse… We’re truly at a tipping point and may actually be well past it, to be honest with you.” Echoing Mooney, Jacquelyn fears that patient care at SBGH is no longer safe.
Confronted with the compounding, overlapping, and worsening healthcare crises in Manitoba, Premier Pallister and Minister Friesen have chosen to double-down and fight healthcare workers. Rather than addressing these acute problems, Minister Friesen instead accused a group of over 200 Manitoba doctors and scientists of “causing chaos” when they called for immediate emergency funding to mitigate the enormous devastation of the second wave. This is the second of two open letters that has been published by Manitoba doctors in a week. These appeals very clearly outline the need for immediate, aggressive, and drastic measures on the part of the province. And while Minister Friesen claims that “the people in charge have got this,” the Pallister government’s track record on the healthcare file says otherwise.
Refusing to listen to the voices of those who risk their lives every day on the frontlines, the Conservatives announced their plan to funnel $2.5 million and grant “public health enforcement powers” to over 275 additional personnel to help “protect Manitobans.” These funds will also pay for “provincial staff including motor carrier enforcement officers, fire safety inspectors and water resources officers [to be granted additional enforcement powers]. The province will also empower bylaw officers, including municipally contracted officers, to help enforce the public health orders.”
Of course, a public health crisis cannot be arrested away. The announcement of added stimulus for police to carry out enforcement measures has many Manitobans scratching their heads as the premier has simultaneously refused to hire any more healthcare workers. Earlier this week, Premier Pallister urged Manitobans to “step up” and volunteer at healthcare facilities and COVID testing sites.
It is time for Pallister and Friesen to put their ideology aside and accept their role and responsibility in this disaster. The plans have already been outlined for them by healthcare professionals in seven steps, which include (but are not limited to) providing emergency funds for improving contact tracing and turnaround, hiring new staff, consulting with marginalized communities that are disproportionately affected by the virus, offering financial supports to those impacted by the pandemic, and expanding public education.
Among these measures is a plan to institute an immediate province-wide shutdown. In the first open letter to Pallister and Friesen, doctors warned: “We see no real way to avoid that if we continue the current course. We can implement it now and, if we are fortunate, limit deaths to less than double what we have now. Or we can shut down in three weeks and have a death count in the multiple hundreds.”
Contrary to the premier’s belief, it is the duty of government to protect its citizens from the physical and economic impact of the pandemic. As outlined in the second open letter to provincial leaders, “the only formula that has worked elsewhere in the world is decisive action by government, with compassionate and forward-thinking decisions that come with a high price tag. The price of failure is the highest price of all.”
Despite being fearful of the outbreaks continuing, Jacquelyn and her colleagues will continue to show up for work at SBGH. They will continue to be forced to work eight extra hours of mandated overtime with insufficient PPE. They will continue to provide the highest care they can to their patients, whose conditions are likely to worsen. Now, it is time for the Pallister government to honour its end of the bargain.
Jacquelyn is a pseudonym. The nurse agreed to speak with Canadian Dimension under the condition of anonymity for fear of reprisal.
Rebecca Hume is a settler living on Treaty 1 lands, the homeland of the Métis Nation. She recently graduated from Ryerson University’s Master of Arts in Communication & Culture Program. Currently, she is a freelance researcher and community organizer.