Note from Michael, Jan. 20, 2022 | Updated bed surge plan

From the desk of Dr. Michael Gardam, Health PEI CEO

Hi Everybody:
 
One of the questions that keeps coming up is when is Health PEI moving to “essential services”?  I know this was a big part of the original pandemic plan and some are wondering why we don’t seem to be following it, or at least perhaps it isn’t clear if we are following it. Are we dropping the ball? [we haven’t!]

This is a great question as it gets to the heart of what we have learned about COVID responses over the past two years. We spoke about this at a Townhall with leaders today (see below video).

 

I don’t normally quote boxers, let alone Mike Tyson, but he did say something that I think is highly relevant to this situation: “Everyone has a plan ‘til they get punched in the mouth.” 

Plans are great things, but they need to be evergreen and reassessed regularly as new information comes in. At the start of COVID, essentially every province approached health care services planning the same way—we needed to prepare for a wave of a disease we knew little about, so we scaled back to essential services, meaning all sorts of services, such preventative cancer screening, just stopped. My hospital did this in Toronto in March 2020, as did Health PEI.

As many of you know, the impact of those changes we made two years ago are still being felt today. It is far easier to stop something than it is to restart it. In our experience on the Island, closing programs resulted in staff moving on to other areas of the system because we have so many vacancies they could move into: case in point, Unit 9 still isn’t fully staffed two years later!

After March 2020 though, PEI followed a very different strategy from most of the rest of Canada, namely we followed the same “zero COVID” approach as New Zealand and Australia. PEI was extraordinarily successful at keeping COVID at bay. 

Most of the rest of Canada however went through a seemingly never-ending series of crushing pandemic waves followed by some degree of lockdown, then relaxing control measures, and then more waves. As these waves crashed into healthcare systems time and time again, they realized the on/off switch approach they applied during the first wave had caused a great deal of harm to patients and led to huge backlogs in patient care. 

To paraphrase Mike, they got punched in the mouth and had to reassess their plans. 

Ontario became far more sophisticated in what it scaled back and when. The goal became to scale back as little as possible to provide as much care to non-COVID patients as they could, while still managing the COVID cases.  
 
OUR NEW PLAN
When it became clear in mid-December that PEI was not going to be able to follow a zero COVID strategy any longer, we applied those lessons from elsewhere and re-looked at our own plan from 2020. 

We started with some key guiding principles, some of which haven’t changed, such as, given the complexity of these patients, they will need to be primarily cared for at QEH.

Many other original principles did change. For example, the idea of decanting long term care patients to Rosedale went out the window because a) we couldn’t staff it; b) we are already using it for vaccines and testing; c) we now have highly effective vaccines which dramatically decreases the morbidity and mortality in that population; and d) experience elsewhere once vaccines were available showed that this wasn’t necessary.

In March 2020, PPE shortages and staff safety were huge concerns, but now with greatly improved supply, experience with PPE, and highly effective vaccines, COVID is far more manageable.

As I have said before, the leadership team of Health PEI has been working on this COVID wave since before Christmas.  We meet twice a day and have a close eye on how this response is going.

What has emerged is a new surge plan that has incorporated the experience from elsewhere and the new realities of the effect of vaccines. (Please note the new plan will be available on MedWorxx as of tomorrow for anyone who is interested in the detail).
 
In a nutshell, under the new plan:

  • We will continue to house COVID inpatients primarily at QEH, but every Emergency Department is capable of assessing patients who have or might have COVID.  
  • If we have outbreaks in long term care, we will be caring for residents on site, and not trying to move them elsewhere. 
  • Rather than having black and white thresholds that result in concrete actions, thresholds are meant to trigger discussions with different parts of the system regarding what is the best solution at that time given the circumstances.  
  • Everyday we predict what capacity at QEH we will need for the next 48 hours and create that capacity by possibly moving a few patients to other facilities or applying very selective small reductions in services. This approach is far more nuanced and has  less of a negative impact on patients than across the board service reductions.  

The ironic challenge with this approach, from my perspective as CEO, is that it is not nearly as dramatic as a widespread service reduction and therefore, not nearly as noticeable. I don’t want any of you to think we are not focusing on COVID because we haven’t shut down large parts of QEH.  COVID is literally almost all we are working on right now! But we are doing it carefully, with great thought and input from across the system, and with a gentle touch to maintain as many services as possible.

I have said many times that we have a great team here at Health PEI.  We are a month into this wave and we all should be extremely proud of how we have stepped up to the challenge. I know I am very proud to be your CEO.

Please send questions, comments, or submissions for these notes to emclean@gov.pe.ca, subject line “Notes for Michael”.

Last Updated
Fri, 01/21/2022 - 10:53