While most British Columbians spent the last few days of 2021 safely at home, the situation inside Victoria’s two major hospitals grew more and more dire as we entered the third year of the pandemic. 

Ashley, a nurse who works at both Royal Jubilee and Victoria General Hospital, reached out to Capital Daily on New Year’s Day with a tip: a surgical ward at Royal Jubilee was operating with just two nurses for 30 patients.  

“Normally on that unit, each nurse would only have three or four patients,”  she said. 

Patient care was already being compromised, but it all came to a head for Ashley when, she says, a patient at Royal Jubilee Hospital died in a surgical ward staffed by only two nurses—all others were out sick.

“We’re scared for our patients and our licenses right now,” she said. 

Ashley, who is not authorized to speak publicly, requested to remain anonymous. “All week, units have been working short [of] nurses, aides, clerical staff, to the point that surgeries and procedures have been cancelled,” she said.

Within just five days, things had gotten even worse. According to Ashley, at least three anesthesiologists at Royal Jubilee had tested positive for COVID-19 as of Jan. 5. Patients who come in with other issues but are suspected COVID-positive aren’t tested for the virus or told to isolate in a separate room. 

Through it all, the message from higher-ups has remained the same: keep working. A colleague, Ashley said, who reported COVID-19 symptoms partway through her shift was told by their supervisor that she needed to finish her shift, and wasn’t allowed to go home.

Island Health did not respond to requests for comment sent Friday and Monday. This story will be updated if the health authority responds.

“We’re being told now by supervisors that COVID is just everywhere, we’re all going to get it, [and] there’s nothing we can do,” Ashley said. “So even in the hospital, they’ve given up taking any real precautions and they’re just letting rip.”

On Friday, Island Health Chief Medical Health Officer Dr. Richard Stanwick said the number of healthcare workers who are out sick or in isolation varies on a day to day basis, but generally the health authority has been witnessing between 7-15% absenteeism in recent weeks. 

“As Dr. Henry said, healthcare is a business just like every other business and we all should be preparing for these absentees [and finding] opportunities to anticipate and respond,” Stanwick said, referring to the provincial health officer’s warning that all businesses should prepare for up to 30% of their staff being out sick during this wave of the pandemic.

Those working in hospitals aren’t given a clear sense of exactly how bad the situation is. According to Ashley, nurses and hospital staff aren’t told when a colleague is out sick due to COVID-19, but are left to figure it out for themselves. 

“I worked one day this past week at Royal Jubilee and we were missing half our staff,” she said. “I am so fed up and honestly scared to go to work right now… We’re still wearing silly medical masks at work, not N95s.”

Unlike other provinces that changed their guidance in mid-December, BC still requires  healthcare workers to wear surgical masks—loose fitting and disposable blue masks—when attending to COVID-positive patients rather than N95 masks known for efficient filtration of airborne particles.

An internal email leaked to Capital Daily shows physicians in Island Health being told they can choose what type of mask they can wear. Testimonies from Ashley and other healthcare workers confirm that N95 masks are still not consistently provided to nurses and staff who regularly interact with COVID-positive patients. 

The situation inside hospitals closely mirrors that in other sectors across the province: workers feeling their safety is secondary to their employers’ needs, authorities providing incomplete data, and centralized communication keeping the public largely in the dark.

A vicious cycle

Whatever end to COVID-19 we eventually see will not be the end of its effects on healthcare staff. The impact this pandemic has had on nurses in BC and across Canada will be felt for at least the next four years, says Marilou Gagnon, a professor in the school of nursing at UVic.

“We have treated the nursing workforce as a disposable workforce—and an easily replaceable workforce—for many years,” Gagnon said, adding that the pandemic has exacerbated a vicious cycle of novice nurses quitting the profession, which leaves few nurses who accrue the experience needed to train the next cohort.

“I've heard that a lot during the pandemic: newer nurses who realize that it's not too late to change careers,” she said. “And why not? Why would they stick around [when] there is no indication that they actually matter?” 

While there’s no official count of how many nurses and healthcare workers have left the industry in BC, the latest Statistics Canada data shows that as of September 2021, there were 108,800 job vacancies in the healthcare and social assistance sector nationally. Last year the industry saw the biggest increase in job vacancies of any sector compared to 2019, led by vacancies in hospitals, nursing, and residential care facilities. 

In addition to being overworked and left with no adequate protection in a high-risk environment, nurses are also kept from speaking publicly about their experiences through internal mechanisms that threaten their livelihoods. 

“The situation with nurses and speaking about their realities at work and what they're facing throughout COVID has been a challenge, like, across the board,” said Gagnon, who is currently working on a study about nurses who blow the whistle, with a particular focus on Quebec. 

Across Canada, employers create internal barriers—like needing approval from communications departments at hospitals and health authorities—before a nurse is allowed to speak publicly about what they’re seeing at work. 

If they do so without jumping through those hoops, they must contend with professional sanctions or be targeted by superiors in the workplace—measures that have long been used to keep healthcare workers quiet, and the uses of which have only increased during the pandemic, according to Gagnon.

Things have changed in Quebec, Gagnon says, as the demands of the fourth and fifth waves drove home the fact that the healthcare system would collapse without nurses.

“They have understood quite a while ago that they actually hold the power in terms of the current market,” Gagnon said. “They [feel] they have a duty to speak out, and they do so and then realize that they're not facing sanctions… because the system is not in a position to lose nurses.”

One of the reasons why a similar freedom hasn’t been realized in BC is the lack of a culture of whistleblowing, cultivated over many years, according to Gagnon. She adds that the healthcare system in BC is structured differently, with fewer, larger, more centralized health regions, and nurses fear being unable to find a job within the entire health authority if they break the rules.

The province regularly reports on hospital bed capacity—as of Jan. 7, 95% of hospital beds across the province are full, as are 89% of ICU beds—but Gagnon says that’s becoming less relevant when the limiting factor is actually staff. “You could have all the beds and no nurses. It means absolutely nothing. It's a kind of empty indicator of the state of things,” she said.

Like others, Gagnon calls for more transparency in BC and says the health ministry should be reporting how many nurses and healthcare workers have left the system during the pandemic, the extent of overtime they’re expected to do, and whether hospital units are being run with half the required staff. 

Catastrophic predictions for BC’s healthcare system

Over the past week, British Columbians accustomed to scanning daily COVID-19 case counts to get a sense of how and where the virus is spreading may have noticed a seemingly positive change: daily case counts are starting to decline across the province.

However, PCR testing has been severely limited since Christmas, and those who have mild symptoms and are fully vaccinated are told they do not need a test or are given take-home rapid tests. People are then encouraged to self-report the results of these rapid tests online if they test positive, but these are not included in the daily case counts disclosed by the health ministry. 

As a result, COVID-19 case counts no longer paint an accurate picture of how and where the virus is spreading. Modelling shared by the BC COVID-19 Modelling Group reveals that the number of people infected with the virus—particularly the highly transmissible Omicron variant—doubles every three to four days. 

Dr. Dean Karlen, UVic professor and member of the modelling group, explains that his models now rely on more guesswork than ever before. “The best that we can do is use the case data that we had from early December to tell us how fast Omicron is growing [and] match that data to our model,” Karlen said. 

For example, on Jan. 3 the province reported 2,230 new COVID-19 cases. But testing has become rare for people under 70, given the new guidelines around who can be tested and which results are reported. So, assuming spread was just as high among people under 70, but going publicly unreported, Karlen and his team applied what they knew about the virus’s growth rate in the over-70 group to all age groups. 

They came to the conclusion that on Jan. 3, the estimated actual number of cases would’ve been 8,115—3.6 times higher than the reported number. 

One piece of potentially good news from the group’s latest modelling report is that the Omicron wave appears to be nearing its peak, and new infections should reach their maximum within the next few days before starting to decline. 

“The reason you're having that turnover…is simply because so many people are being infected,” Karlen said. “Once infected, they're presumed not to be susceptible to another Omicron infection. With a large fraction of the population infected and then immunized, the virus has nowhere else to spread.”

But with a steep curve comes a steeper price to pay. The impacts of this wave, already being felt by fatigued healthcare workers across the province and on Vancouver Island, are expected to be catastrophic. 

Even after assuming the risk of hospitalization from Omicron is 30% less than it was for the Delta variant, experts predict that at its peak there could be 4,000 people requiring hospitalization due to COVID-19 by late January or early February. In the worst-case scenario, that number could go up to 10,000. 

The previous record for hospitalization during the pandemic was 515 people, set in April 2021. At the moment, there are 349 hospitalized with COVID-19 across BC, and the rate of hospitalizations has already started to rise, with a particularly sharp uptick seen in the Island Health region. 

At the moment, daily admission to hospitals is not a piece of data that BC shares regularly but it’s one Karlen says could be the main indicator of how the virus is being spread in the weeks to come—a particularly important indicator given the recent unreliability of testing data.

“For BC, if we could see hospital admission data on a daily basis, correctly assigned to the date of admission—not just every once in a while you get a whole block of data—that will give us the kind of opportunity that we benefited from in the past with measuring cases,” Karlen said.

Data on cases and hospitalizations have formed the basis of the modelling group’s analysis and projections for the past two years. But they can’t predict what public health measures the province will introduce, nor how people change their behaviours accordingly. 

This means the projections don’t factor in another major source of potential COVID-19 transmission: the reopening of schools after winter break.

Masks in schools ‘not the hill to die on’

Before the end of 2021, provincial health officer Dr. Bonnie Henry and education minister Jennifer Whiteside announced a phased return to school for the K-12 system. Return to class for most students (except the children of essential workers) was delayed by one week, until Jan. 10.

"The delayed start will allow public health and education the time to assess the impact of the Omicron variant in our communities and on our education system and it will also provide teachers, staff, and administrators time to prepare for students safely returning to class with enhanced safety measures," Whiteside said on Dec. 29.

But in that first week of January, teachers in Greater Victoria and across Vancouver Island say little was done to prepare for prevention of transmission within classrooms. 

One of the main steps health officials suggested, according to Greater Victoria Teachers’ Association (GVTA) president Winona Waldron, was to make sure students are spaced out as much as possible within their classrooms. 

“I don't have a great deal of confidence that there'll be big changes with that, because honestly, how different can it be, right?” Waldron said. “Teachers have been trying to do that the whole way along.”

Elementary schools in the Greater Victoria School District are also looking at staggering recess times—a measure that hasn’t been taken or at least has not been communicated to teachers in every district. 

“The only thing I've changed in my classroom is I had to separate my tables. I had no other direction about what I could do within my classroom and within our school,” said Mary, an elementary school teacher in the Cowichan Valley School District who requested to remain anonymous. “I just feel like there's very little being done to actually keep our schools safe… and they could be taking measures like they did at the beginning, like cohorts and staggering recess times but we haven't been given those directions at all.”

According to Waldron, most of the week was spent planning for if and when schools will need to shut down due to a large number of students, staff, and/or teachers being out sick. School districts and health authorities will no longer perform contact tracing and thereby won’t report exposures and outbreaks. 

Whiteside said on Friday that, instead, each school will individually determine whether they need to shut down based on attendance: if absenteeism is about 10% higher than what is normal for this time of year, schools will alert public health officials and parents/guardians, which would then trigger an investigation into whether or not there is a COVID-19 outbreak in that school. 

Teachers have been asked to prepare online lessons for five days, and instead of making infection prevention protocols, schools are working on contingency plans to determine who can be called on to run a class when a teacher is out sick. 

Although all students in the K-12 system are required to wear masks except when eating or drinking (or if they have a mask exemption due to behavioural or physiological reasons), teachers have been told that they cannot discipline students who refuse to wear a mask simply because their families tell them not to. 

“We've been told it's not the hill to die on, even though as teachers, it certainly makes us feel unsafe,” Mary said. 

School districts will provide three-ply masks for students and staff, as they’ve done in the past, but according to Mary, teachers regularly supplement this supply by buying their own boxes of masks to keep in classrooms for students to use as necessary.

Despite the fact that schools have been preparing for what now seems inevitable—rapid spread of the virus—Dr. Henry has stuck firmly to her stance that schools are not a major source of transmission.

“We have many, many things in place that make it very unlikely that viruses and other pathogens will be transmitted in schools,” she told media on Friday. “You can’t become infected if there’s nobody with the virus in that setting,” she added, referring to the guidance to perform daily health screenings at home, in which parents and students determine whether they are well enough to go to school. 

She argued that existing measures and layers of protection already in place at schools means students and staff “don’t have to rely on the moderately increased filtration capacity of a respirator versus a medical mask.” 

Mary, who saw her school go through numerous exposure notices in 2021 and whose own classroom had an exposure notice right before the winter holidays, has personally bought K95 masks for herself to wear at school, and says many other colleagues have done the same.

Waldron and the GVTA also disagree with the idea that there are enough protocols in place to prevent transmission, and ask that N95 masks be provided to all school staff. 

“There's real fear that families are going to get sick, and it feels like that's what the government is planning for,” Waldron said. “Not so much prevention, but what to do when everybody's sick. That's very concerning for teachers to be making that plan instead of the plan for how to prevent getting sick.”