Dr. Carl LeRoux, a doctor working in Arviat, Nunavut, spent five hours calling pediatric hospitals until he found a physician in Edmonton willing to admit an infant patient suffering from a serious respiratory infection.Fred Lum/the Globe and Mail
Critically ill children and babies from central Nunavut are being flown as far away as London, Ont., after Manitoba enacted a policy that effectively bars them from the packed pediatric intensive-care unit in Winnipeg where they are usually treated.
The temporary Manitoba policy, which has already been in place for more than two months, also applies to northwestern Ontario. But unlike Ontario, Nunavut has no intensive-care units of its own.
Doctors in fly-in communities north of Manitoba have subsequently been scrambling to find beds for Inuit children who have long suffered higher rates and worse outcomes from the viral respiratory illnesses that are now overwhelming pediatric hospitals across the country, including in Winnipeg.
In Arviat, a hamlet of 2,800 on the western coast of Hudson Bay, the community’s lone doctor recently waited nearly 30 hours for a medical evacuation plane to pick up a sick baby who, in normal times, would have been transferred to Winnipeg.
After discovering that the city was closed to his patient, Carl Le Roux spent five hours calling pediatric hospitals until he found a physician in Edmonton willing to admit the baby, who was suffering from a serious respiratory infection. Only then could Dr. Le Roux call for a medevac.
“To wait that long is just unreal,” he said in a recent interview.
Manitoba’s health care system usually treats the 11,000 residents of Nunavut’s Kivalliq region no differently from residents of the province’s own remote communities, said Francois de Wet, chief of staff for the territory and its only hospital, located in the capital of Iqaluit.
“We have always had a very supportive relationship with Manitoba,” Dr. de Wet said. Manitoba’s hospitals have closed to Nunavut patients for a few days during extraordinary surges in the past, he added, “but an extended period like this, where it’s been ongoing for almost two and a half months now? I’ve never seen it.”
After confirming the Edmonton hospital admission, Dr. LeRoux waited nearly 30 hours for a medical evacuation plane to pick up the sick baby who, in normal times, would have been transferred to Winnipeg.Fred Lum/The Globe and Mail
Shared Health Manitoba, which oversees the operations of the province’s largest hospital, HSC Winnipeg, said the temporary policy was enacted in August for patients under the age of 18 from Nunavut and northwestern Ontario who are highly likely to need intensive care. It requires doctors from those places to consult HSC Winnipeg’s pediatric ICU attending physician, who is allowed to turn away children from outside the province if the unit is full.
“The change was made due to abnormally high occupancy rates in the unit that were being caused, in part, by a disproportionate number of patients who live outside the province,” said Kevin Engstrom, a spokesperson for Shared Health, in a statement.
He added that the change doesn’t apply to out-of-province children travelling to Winnipeg for scheduled care, infants bound for the neonatal intensive care unit or children facing “immediate threat to life and limb,” where flying to a hospital farther afield would put them at risk.
On Friday morning, there were 11 patients in HSC Winnipeg’s PICU, the only unit of its kind in Manitoba. Before the pandemic, the unit’s baseline capacity was nine beds. From April to October, the daily patient average was 9.6 patients, however, capacity sometimes surged as high as 20 patients before the policy change was put in place.
HSC Winnipeg is hardly alone in struggling with an unprecedented surge in sick children as run-of-the mill seasonal viruses, suppressed by COVID-control measures, re-emerge at the same time.
Although children’s hospitals are seeing some influenza and COVID-19, the pressure on pediatric intensive-care units comes mainly from respiratory syncytial virus, or RSV, a leading cause of severe bronchiolitis and pneumonia in children younger than two.
“The burden absolutely has been respiratory illness,” said Sonny Dhanani, chief of critical care at CHEO, a pediatric hospital in Ottawa. “There’s been a ton of viruses out there this year, raging back. I would say it has not been COVID directly, but COVID related in that everyone was home and isolated and not exposed to viruses and now they are.”
CHEO’s ICU was operating at 186-per-cent capacity on Thursday. The day before, there were 246 visits to an emergency department built for 150 visits a day, according to CHEO spokesperson Paddy Moore.
Despite that, CHEO stepped up to accept Nunavut children shut out of Winnipeg. The Ottawa facility is already the main referral centre for patients from eastern Nunavut. Since Sept. 1, CHEO has admitted 48 patients from Nunavut, five of them from the region that would normally transfer children to Winnipeg.
Dr. Dhanani said CHEO agreed to help after physician leaders at Winnipeg’s PICU reached out in August because they were feeling “a lot of moral distress” at the prospect of turning away Nunavut children.
When its own PICU is overrun, CHEO has helped patients from central Nunavut find beds in other Ontario cities, including London and Kingston.
Dr. de Wet, Nunavut’s chief of staff, said that although he is grateful for the help, sending Kivalliq patients to southern Ontario causes other problems, including tying up crucial medevac planes for longer than would be the case if the planes were flying their regular routes to Winnipeg. As well, southern Ontario cities don’t have Inuit medical boarding homes or regular access to Inuktitut-speaking interpreters and case managers as Winnipeg and Ottawa do.
Nunavut has some of the highest rates of hospital admissions for lower respiratory tract infections in the world, owing to poverty, overcrowded housing and high smoking rates. RSV is a top cause of those severe infections.
The territory of about 40,000 people saw 1,043 children under the age of 15 sent out on medevac planes for severe respiratory illness between January, 2019, and last month, according to Dr. de Wet. This year has been especially bad, with 398 pediatric respiratory medevacs as of October – more than the 374 in all of 2019, the last year before the pandemic.
The Globe and Mail’s health reporter Kelly Grant is taking an in-depth look at health care in Nunavut and the challenges its residents face accessing it. Over the course of 2022, she’ll examine why the territory’s residents have some of the worst health outcomes in the country and what changes are needed to deliver better care.If you have information to help inform The Globe’s reporting on Nunavut, please e-mail kgrant@globeandmail.com