Manitoba hospital labs rejected more than 5,300 diagnostic-testing requests last fall, as part of an unprecedented rationing of laboratory resources while the maxed-out health system buckled under COVID-19.
Data obtained by the Free Press shows Manitoba hospitals rejected thousands of requested tests from October to December 2020, as lab staff were told to focus on testing patients for the coronavirus.
The data reveals a drop in testing patients for superbugs, which alarmed Toronto specialist Dr. Larissa Matukas.
"Giving that up means that you will have sicker patients coming into hospital; there will be more hospital-acquired infections with these multi-drug resistant organisms," said Matukas, who oversees microbiology for Unity Health Toronto, which runs three hospitals.
Last October, Shared Health curtailed entire categories of diagnostic tests, requiring hospital doctors and infectious-disease specialists to get authorization to test patients for antibiotic resistance or sexually transmitted infections.
Other provinces had resisted suspensions entirely, while some curtailed certain tests for much shorter time periods.
Shared Health says it ended its lab-testing restrictions on Aug. 17. The agency said it could not specify how many times each type of requested test was rejected under the policy.
Yet data for all months of 2020 shows steep drops in certain forms of testing Manitoba had restricted, just as the policy took effect in October 2020.
For example, the monthly number of tests for the MRSA superbug dropped from an average of 3,500 in the first nine months of 2020, to just 2,880 as an average for the last three months of the year. Testing for the CPO superbug halved in the fall, to an average of eight samples per month.
While that could relate to fewer people visiting hospitals during the pandemic’s second wave, Matukas said it’s more likely due to the testing restrictions.
Shared Health’s policy allowed doctors to keep requesting MRSA tests for newly admitted patients, but not for screening people already admitted to hospital whom they suspect might have the superbug.
Matukas was most concerned by the sharp drop in general throat-swab tests, from an average of 1,272 per month to just 364 in the fall months.
Those swabs often test people with sore throats for Group A pharyngitis, a serious bacterial infection.
"If you don’t diagnose it and treat it within the 10 days of its diagnosis, there are significant potential consequences to that infection that can be lifelong," Matukas said.
In a statement, Shared Health said it restricted tests based on scientific evidence.
"Some microbiology testing was identified by clinical leaders as a service that could safely be suspended or delayed on a temporary basis to help increase COVID testing capacity," wrote Shared Health spokesman Jason Permanand.
The union for Shared Health lab employees says the province’s decision to restrict tests shows just how strained the system was before COVID-19.
"It has been a generation in the making, this crisis here," said Bob Moroz, head of the Manitoba Association of Health Care Professionals.
"There has been absolutely no room in the system for any sort of increasing demand like we saw. The system was struggling to keep up, in what we would refer to as normal health-care times.
"How many diagnoses were missed or delayed? Who knows how many adverse patient outcomes could have been avoided."
Matukas said all medical labs have struggled during the COVID-19 pandemic, and those labs plan for situations where they have to ration testing and find efficiencies.
"You need to make these really difficult decisions around what you’re going to keep and what you’re going to stop doing," she said. Some Toronto labs have sent samples to U.S. labs to avoid compromising patient care.
"Even though the turnaround might be longer, it might still be relevant to get those test results back."
Matukas said labs face a shortage of supplies and can’t easily hire people with lab skills. It’s no surprise the military sent medical lab technicians to Manitoba hospitals during the deployment to Winnipeg last spring.
"There’s been a lot of discussion about nurses being burned out and leaving their positions," she said. "The same thing is happening in lab medicine too."
Weeks after hospitals have resumed diagnostic tests, Health Minister Audrey Gordon said there was also a backlog in that testing, which she’s committed to clearing.
"The pandemic has had a significant impact on our health system, and we are looking at ways to strengthen that health system, and diagnostic testing is one of them," Gordon said.
"We have a backlog of diagnostic tests, and we are working with our partners at Shared Health and throughout the province, to ensure those numbers increase in terms of individuals being able to receive their diagnostic tests at the right time and the right place."
That didn’t impress NDP health critic Uzoma Asagwara, who argued the government could have prepared labs for the second and third waves.
"This issue reflects a failure of this government to meaningfully invest in health care with a long-term vision," said Asagwara, who argued hospital testing is crucial for patients from vulnerable groups, who often don’t have any other interaction with the health system.
"We’re going to see folks present more sick, more frequently, into health-care systems that already very burdened."