A policy change that was quietly introduced in Manitoba’s hospitals is seeing non-COVID patients being admitted to hospital units that have active outbreaks of the virus.
To free up acute-care capacity and reduce the number of emergency room patients waiting for a hospital bed, administrators changed outbreak admission guidelines in January, two months before the province lifted all COVID-19 public restrictions.
As of last week, Shared Health said there are two designated COVID-19 hospital units, one in Winnipeg and one in Brandon. All patients are tested upon admission. Those who test positive are grouped together or with recovered COVID-19 patients; those with suspected cases of the virus are isolated until results are confirmed.
A statement from Treena Slate, Prairie Mountain Health’s regional lead of acute care, explained patients with active COVID would not be placed with patients who are not infected with the virus.
"Patients who have tested positive for COVID but are no longer considered infectious [i.e. COVID-recovered] can be moved into a general unit as needed," Slate said. "This guidance allows for increased acute-care capacity at sites and is supported by advice from infection prevention and control experts."
Patients who have active or suspected COVID infections are not necessarily admitted to designated units, but would be placed according to provincial guidelines, which can be found at sharedhealthmb.ca/files/COVID-19-highlights-provincial.pdf
However, Slate said community transmission of COVID has increased over the past few weeks and there have been a number of outbreaks in PMH facilities and units in acute-care facilities. These facilities would follow outbreak management guidelines to ensure safe care for patients and limit virus transmission.
When an outbreak is declared in any unit, infection prevention and control processes are immediately implemented, with measures in place to monitor staffing levels and increase them if needed.
"All these measures mitigate the risk of COVID infection for patients receiving care on units in outbreak," she said.
PMH could not confirm where COVID patients were being housed in Brandon Regional Health Centre.
On Thursday, a Shared Health spokesperson stated in comments to the Winnipeg Free Press that hospitals do not track the number of patients who’ve been transferred into outbreak units.
The Jan. 13 guidance issued to health staff said it’s not always possible to avoid admitting patients who don’t have COVID-19 into areas with outbreaks, particularly if those patients need care in a specialized unit.
The policy recommends health professionals avoid placing unvaccinated patients, patients older than 60, or patients who are immunocompromised in outbreak units because of their increased risk of serious COVID-19 infection. It’s also not ideal, the guidance stated, to place new patients in units that have uncontained or newly declared outbreaks.
Shared Health also stated patients with active COVID cases are kept separate from patients who’ve never been infected with the virus, but may be kept distanced in the same general unit.
The provincial health management organization did not address the January memo, instead referring to a more detailed protocol, updated March 29, that links to the Jan. 13 guidance.
The January memo from Shared Health showed a change in practice from earlier pandemic protocols that aimed to keep non-COVID patients away from active outbreaks.
"It should be expected ward and/or facility outbreaks are going to increase in frequency and are not preventable. The approach being outlined herein is to allow for a balance of staff/patient/resident safety while maximizing our acute-care capacity and permitting ongoing delivery of complex co-ordinated care for patients. Acute-care sites can no longer suspend admissions to a unit/site that is in outbreak," the Jan. 13 Shared Health memo states.
This memo was issued the day before Premier Heather Stefanson spoke publicly about the need for Manitobans to learn to live with the virus.
This policy change is not seen as balanced or good for either patients, families or staff by the nurses caring for them. In a statement to the Sun, the Manitoba Nurses Union decried the policy change as another example of Manitoba’s health-care system failing to manage COVID infections safely and effectively.
"With the continued prevalence of COVID throughout the system, Manitoba is no longer able to cohort COVID positive patients together, in units separate and apart from those that are non-COVID," the statement read. "That poses significant risk, given COVID remains, despite the wishes and proclamations of government, capable of very serious — and even fatal — results for the immuno-compromised and those with other health conditions."
Further, the statement says highly infectious COVID variants are infecting an already dwindling number of health-care staff and nurses. What remaining healthy staff that remain must change PPE more frequently when moving between COVID and non-COVID patients. This creates an unstable workload and further delays in delivering timely patient care.
This policy change does not reflect what the government has been telling the public or frontline staff about their commitment to improving health care in the province, the union stated.
"Despite the billboards and press releases, in the end, those many Manitobans that need proper health care are the ones paying the dearest price, and this latest change is yet another in a long line of unfortunate consequences that land squarely on the shoulders of Manitobans and those that provide care for them in this broken system."
The province’s epidemiological report for April 17 to April 23 showed test positivity rates are increasing for those getting lab-confirmed PCR results. An average of 955 Manitobans per day receive PCR tests, and the test positivity rate is at 23.4 per cent, up from 19 per cent a week earlier.
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