Politic?

Awaiting the COVID Surge, on Tenterhooks, in Hospital ICUs

"In my centre, we have still a lot of empty beds in the ICU. That is a surprise. We changed all our schedules, our ICU schedules three weeks ago, to be on call."

"We cancelled all the teaching classes, all other administrative activities... So far, today, I'm at home."

"It's not what we expected."

Dr.Frederick D'aragon, University of Sherbrook, spokesman, Canadian Critical Care Society, Quebec

"Is Sunnybrook right now being stressed by the number of COVID patients? ... I would say 'No'."

"I'm cautiously optimistic we're not going to see the giant surge and nightmare that we've seen in Italy and New York."

Dr.Gordon Rubenfeld, critical-care physician Sunnybrook Health Sciences Centre, Toronto

"I'm cautiously optimistic that we are going to see a sort of slow trickle with this concept of flattening the curve."

"We'll still see patients getting admitted to our ICU, but not that surge like we saw first in Wuhan, then in Italy, Iran, Spain, New York City -- and now some other U.S. cities."

Dr.Michael Detsky, Mount Sinai Hospital, Toronto

The Ford government says it is working to expand capacity at hospitals across the province; new models suggest a surge in COVID-19 patients is quickly approaching. (Evan Mitsui/CBC)

According to the 'best case' scenario for the Ontario modelling, the number of COVID-19 cases of extreme reaction in intensive care would be between 800 and 1,000 by last Friday. As for the lamented shortage of ventilators whose capacity had been expanded in an effort to meet the anticipated pandemic demand, almost 78 percent remain available, according to a Critical Care Services Ontario document.

This was a report on ICU admission in Ontario that detailed a positive trend in cases that included confirmed and suspected cases, indicating a peak on April 2 of 538 COVID-19 patients in critical care. Since that time, the number between 500 and 535 has remained consistent, with a total of 1,321 ICU patients last Thursday. As for Quebec, as of Friday there was a reported less than 200 COVID patients in the ICU out of a capacity of 1,000 available critical care beds.

The situation is that patients are being admitted to hospital at an ever greater rate, but those whose conditions are seen as sufficiently critical to move them to the Intensive Care Units have diminished. A theory has developed of the possibility that the numbers dying in hospital from COVID-19 outstrip new admissions, appearing to keep the occupancy rate depressed, allowing a brighter picture than actually prevails.

A sense of panic had entered hospitals where medical staff, from doctors to nurses, shuddered at the prospect of their ICUs becoming overwhelmed with more critical-care patients than they could manage. And nor did it escape their notice that their front-line positions made them potentials for acquiring viral loads that would (a) put them out of commission, (b) theoretically overwhelm their own immune systems leading to potential death.

The agony of uncertainty and fear that permeated the medical community came equipped with fears over the shortage of critical safety gear in personal protection equipment, absolute requisites to control the spread of the novel coronavirus and in the process protect medical personnel working in straitened circumstances of fatigue and burnout. Yet, now it seems obvious that at least for the present, the ICUs have been underused.

Michael Garron Hospital Covid-19 assessment centre.

Nathan Denette/The Canadian Press

That dreaded surge has yet to materialize. And there are ample ICU beds to enable handily coping with those who do present for critical care. In Quebec there has been a modest eight to ten admissions daily with COVID to the ICU and none whatever have presented from April 7 to 8. Toronto's Sunnybrook Health Sciences Centre treated the country's first-known COVID patient, and there the intensive-care unit is still awaiting the expected surge.

The general sense of relief is tinged with the reality that what has occurred is merely an anomaly, that before long the full force of the COVID's march to conquest will be realized and that expected surge will eventuate. That critical-care doctors and nursing staff will be put to the test before long with COVID-19 patients spending weeks on ventilators, filling up ICUs.

For each of those admissions, including those of persons under investigation for COVID, staff must use protective equipment, time-consuming to don, and wasteful of materials in short supply.

The current situation fails to reflect the federal government modelling released last week predicting 11,000 COVID deaths in a best-case scenario. Data on seriously ill people being admitted to hospital and to ICU appears to present a more realistic barometer of the severity and path of the epidemic in Canada.

Doctors, while puzzling over the slow numbers of cases appearing in hospital, also mull over the positive effects of the broad social-distancing measures ordered and in practise in Canada, having their effect in slowing the advance of the virus.