Strategy for dealing with surge in ICU patients 'not sustainable,' infectious diseases expert says
The current strategy for dealing with an influx of COVID-19 patients in Ontario intensive care units is “not sustainable,” one infectious diseases expert says, as about one fifth of the province’s critical care beds are occupied with patients infected with the novel coronavirus.
According to the latest data from Critical Care Services Ontario (CCSO), there are currently at least 411 COVID-19 patients in ICUs around the province, occupying approximately one fifth of all available ICU beds in Ontario.
In some GTA hospitals, COVID-19 patients are occupying as many as one third or half of all available intensive care beds.
According to the latest CCSO report, at Mount Sinai Hospital in Toronto, about 10 of the hospital’s 24 ICU beds are occupied by COVID-19 patients and Markham Stouffville Hospital, 12 of its 20 ICU beds have been given to COVID-19 patients.
When releasing the province’s latest modelling numbers earlier this week, Dr. Adalsteinn Brown, chair of the province’s science table, said about one quarter of Ontario hospitals currently have no ICU beds free while another quarter only have one or two beds available.
Last week, Ontario Health President and CEO Matthew Anderson warned all hospitals to be prepared to accept COVID-19 patients from across the province.
“I stay in touch with a lot of my ICU colleagues around the province and I am increasingly getting worried about what's happening to them,” Dr. Abdu Sharkawy, an infectious diseases expert, told CTV News on Thursday.
“Simply finding beds and spaces for patients sounds like it should be easy enough but this is an enormous undertaking. It's not a safe thing to have to send patients potentially 100 kilometres away to another ICU when they are critically ill.”
He said the practice appears to becoming commonplace across the province as community transmission of the novel coronavirus continues to surge.
“This is not sustainable. It is something that really needs to be addressed and our surge capacity is only going to go so far and it is going to harm people and limit the care we can provide for people who are having heart attacks and strokes or coming to the emergency room (after) a serious car accident,” he added.
“We don't want to be in that position where we can't offer the most ideal and safe form of care because our ICUs are full.”
According the province’s latest modelling, with just one per cent case growth, there will likely be 500 COVID-19 patients in intensive care by mid-January and with three per cent case growth, ICU admissions could exceed 1,000 in less than one month.
"I know that the people working in our hospitals will do everything to help cope with this crisis. Hallways will be used to house makeshift intensive care beds, field hospitals will hold patients throughout the winter,” Brown said when speaking about the modelling data on Tuesday.
“But as we climb closer to 1,000 intensive care beds, about half of our capacity filled with COVID-19 patients in February, we will have to confront choices that no doctor ever wants to make and no family ever wants to hear.”
Stay-at-home order nothing more than ‘symbolic gesture’
A new round of public health measures aimed at curbing the widespread transmission of COVID-19 officially came into effect in the province at 12:01 a.m. today.
The measures, which were announced by the Ford government on Tuesday and will remain in place for 28 days, include slightly reduced operating hours for some non-essential businesses and a reduction in the size of allowable outdoor gatherings from 10 people to five.
A stay-at-home order was another component of the new provincial restrictions, forcing Ontario residents to only go out for essential purposes, including accessing health care, getting groceries, and exercising.
Sharkawy said he is “disappointed” with the new measures the province has implemented, including the stay-at-home order.
“I’m not sure that this provides anything but a symbolic gesture and frankly I think we are beyond that at this point in time,” he said of the order.
“There is all kinds of uncertainty and confusion around how enforceable this will be… Frankly, I'm disappointed that this is the approach we are taking rather than looking at helping people and helping the essential workers and those that are trying to do their best but have no choice but leave home.”
Sharkawy said he is particularly concerned about a lack of support for essential workers in hard-hit communities in the province.
“They are not getting paid sick leave, they are not getting access to testing, they are not getting isolation facilities and support that they need and I think that that would be entirely more helpful and more constructive then telling people that they just need to stay home,” he said.
“I think people have known that they should be staying at home for weeks now.”