As the second wave of coronavirus continues to surge across much of Canada, patients are starting to fill up hospital beds and overwhelm a healthcare system already under strain.
And doctors warn that if the trend continues, healthcare workers will soon have to face a grim decision in the intensive care unit (ICU) — triaging who lives and who dies.
The burden on the health care system is not evenly spread throughout Canada. Some cities and communities are being hit particularly hard with the virus, such as Quebec and Manitoba.
For example, in Steinbach, Man., the local hospital is so overcrowded with COVID-19 cases, that nurses are having to triage patients in their cars because of a lack of space in the emergency department.
Meanwhile, cities in Atlantic Canada are reporting zero cases of the virus.
Over the weekend, Chief Public Health Officer Dr. Theresa Tam warned that the recond number of COIVD-19 cases means the country’s hospitals may soon reach capacity.
“This situation … it is putting pressure on local healthcare resources,” she said in a statement. “Hospitals are being forced to make the difficult decision to cancel elective surgeries and procedures in areas of the country to manage (increases).”
What are Canada’s hospitalization numbers?
Since the pandemic started, 18,304 COVID-19 patients have been hospitalized and 3,724 have been admitted to the ICU across the country, according to Health Canada.
Between Oct. 27 and Nov. 3, the number of hospital beds occupied by coronavirus patients increased to 1,114 from 952 beds. And the number of ICU beds increased to 235 from 228, Health Canada reported.
Although hospitalizations rates are rising, with the number of new cases reaching all-time highs in recent weeks, the second wave is still less of a strain on the health care system (so far). The number of people falling ill enough to become hospitalized is dramatically lower than it was in the spring.
That’s because the demographics have changed with the coronavirus. The age group with the most cases is 20- to 29-year-olds, followed by 30-to 39-year-olds, Health Canada data shows. People between those ages account for a third of all cases overall, but make up only about 7.6 per cent of hospitalizations and only 0.3 per cent of fatalities.
Currently, around 1,780 Canadians are hospitalized with COVID-19, according to provincial government statistics. Earlier this year, there were as many as 3,000 at a time.
What areas have been hit the hardest?
The areas with the highest COVID-19 hospitalization rates in Canada include Alberta, Manitoba, Ontario and Quebec.
On Monday, Quebec had the highest rate, with 591 hospitalizations due to COVID-19.
The province has been grappling with skyrocketing numbers as coronavirus cases — specifically in the Montreal area. Quebec reported 1,218 new cases and 25 additional deaths linked to the novel coronavirus Monday.
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According to recent data released by Quebec’s health and social services institute (INESSS), the province does not expect hospital capacity to be exceeded over the next few weeks in November, particularly in Montreal.
Ontario had 500 new coronavirus-related hospitalizations on Monday.
According to documents from the province’s Long-Term Care COVID-19 Commission released in early October, while the province has plenty of physical spaces set to handle an influx in patients, which include many field hospitals ready to go, there is no one to staff them.
“The challenge is that long-term care homes, hospitals, home care, are all facing human resource shortages right now, and so it is not actually the physical capacity we are worried about right now,” Gillian Kernaghan, the CEO of St. Joseph’s Health Care in London, Ont., told the commission.
Alberta had 262 coronavirus-related hospitalizations on Sunday.
According to the province, as of last week, Alberta’s ICU beds that are dedicated to COVID-19 patients were 77 per cent full, a number that’s sharply risen in the last two weeks.
Alberta Health Services (AHS) said Friday it has a “robust and detailed plan to provide the additional and necessary capacity needed for a surge of additional inpatients.”
“Ensuring capacity is available for COVID-19 patients could involve limiting hospital admissions and ICU admissions by postponing scheduled surgery,” AHS said in an email. “Postponing elective procedures would allow for the potential use of operating rooms and surgical recovery rooms as additional ICU space.”
Manitoba had 234 coronavirus-related hospitalizations on Monday.
At the beginning of November, the province shared details of its plan for expanding hospital capacity during the ongoing pandemic. Health officials said the number of critical care beds available in Manitoba could be tripled if a surge of COVID-19 cases pushes capacity limits.
The plan includes repurposing some existing hospital space for intensive care, bringing in students and retired staff to bolster the ranks and, if need be, securing space in large venues, such as convention centres, and moving some hospital patients there.
What happens when a hospital reaches capacity?
The goal of flattening the curve of coronavirus is to prevent hospitals and intensive care units from being overwhelmed. For example, in the spring, in New York City — when the virus ran rampant in the city — hospitals used convention centres as a temporary location for beds and utilized refrigerated trucks as morgues.
At the beginning of October, when COVID-19 cases started to spike again, the president of the Ontario Hospital Association said it was looking at setting up field hospitals, using hotel rooms for patients and taking over space in long-term care homes, in order to increase capacity.
But the health system is comprised of more than just space — beds and capacity — it’s also carried by human resources such as health workers and support staff.
Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto, said provinces may have extra beds on hand for an influx of coronavirus patients, but the staff and ventilators may not be there.
“It’s a huge worry,” he said.
Dr. Anand Kumar, a Winnipeg critical-care and infectious-diseases doctor, said most hospitals in Canada will make sure they have three resources to help with an influx of patients: equipment, physical space and staff.
Kumar echoed what Furness said — that without staff everything else falls behind.
“You have to bring in the staff, this is the bottleneck,” he said. “You can double your capacity for some period of time, like making nurses work 16 hour days or physicians 24 hours straight, but that’s not sustainable. You can only push people so hard before they start to break.”
He said the staffing in Winnipeg hospitals is limited and Manitoba is “getting close to its capacity.”
This means, elective surgeries will be cancelled, operating rooms will turn into ICUs, and patients who need monitoring (such as cardiac arrest patients) will no longer have the staffing to help them recover.
Once a hospital reaches its ICU capacity, then healthcare workers will be forced to triage, Kumar warned.
“We will have to start making tough decisions on who can be admitted. Will it become a ‘first come, first served’ basis, and basically, once the ICU is full, anyone who comes after does not get life support? Or will the triage be based on, ‘who is likely to survive?’ It’s very scary to think about and it could come very soon,” he said.
Furness warned that if the virus continues to go unchecked in Canada, it’s very “predictable” what will happen.
“Look what happened in Italy and New York, and now what’s going on in Texas,” Furness said. “The health care system will run out of space, doctors and nurses will start getting sick, and patients will die in their beds.”
— With files from Heide Pearson and Shane Gibson, Global News, and The Canadian Press
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