“That is a surprise”: Doctors still waiting for feared surge of COVID-19 patients in Canadian ICUs

By | April 11, 2020

They have been bracing for the worst, a deluge of desperately sick patients who strain resources to the limit and lead to desperate choices over how to ration care.

Doctors, nurses and other staff who run the nation’s intensive-care units have feared for their own safety, too, amid shortages of protective equipment.

But, perhaps surprisingly, some critical-care physicians in the hardest-hit provinces say they have yet to face that feared surge of coronavirus sufferers.

So far, at least, there is no flood, and plenty of available ICU beds.

The latest report from Ontario’s critical-care system on Friday showed just two additional coronavirus patients admitted to an ICU anywhere in the province the day before. Despite having to treat over 530 confirmed or possible COVID-19 people, almost 78 per cent of the province’s expanded intensive-care capacity remained free.

Quebec has seen a modest eight to 10 COVID-19 admissions to the ICU over recent days, and none at all from April 7 to April 8, said Dr. Frédérick D’aragon of the University of Sherbrooke, his province’s spokesman for the Canadian Critical Care Society.

We changed all our schedules, our ICU schedules three weeks ago, to be on call

“In my centre, we have still a lot of empty beds in the ICU,” said D’Aragon Thursday. “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.”

At Toronto’s Sunnybrook Health Sciences Centre, which treated Canada’s first-known COVID-19 patient, no one is taking anything for granted, but the intensive-care unit is definitely not over-run, said Dr. Gordon Rubenfeld, a critical-care physician there.

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“Is Sunnybrook right now being stressed by the number of COVID patients? … “I would say ‘No,’ ” he said. “I’m cautiously optimistic we’re not going to see the giant surge and nightmare that we’ve seen in Italy and New York.”

Critical-care doctors are quick to add caveats – that the worst may still be to come, and that even the slow daily accumulation of COVID-19 patients – who often spend weeks on a ventilator – could gradually fill up ICUs and weigh down the system.

“In a month, we may be suffering from not the giant surge that they saw in New York, but basically a very slow filling of the pool,” said Rubenfeld

And the fact every new critical-care patient is treated as a PUI – person under investigation – means staff must constantly don protective equipment, a stressful and time-consuming process, he said.

Physicians also stress it is crucial for people to abide by stay-at-home directives, which they suspect have suppressed the number of patients.

But the dearth of apocalyptic scenes in Canada’s ICUs seems to offer at least a glimmer of hope, especially after the release of federal government modeling Thursday that predicted 11,000 COVID-19 deaths in a best-case scenario.

And while statistics on the total number of people testing positive for the disease varies with the amount of testing a province does, data on seriously ill people admitted to hospital and ICU would seem to offer a more reliable barometer of the epidemic’s severity and path.

“I’m cautiously optimistic that we are going to see a sort of slow trickle with this concept of flattening the curve,” said Dr. Michael Detsky of Toronto’s Mount Sinai Hospital. “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.”

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Doctors say they’re unsure exactly why they have not seen more cases, but point to both the mass, at-home social-distancing measures still in place, and a cancellation of thousands of elective surgeries that freed up space.

A detailed report on ICU admissions in Ontario obtained by the National Post hints at a positive trend. It includes both confirmed and suspected coronavirus cases and shows a peak on April 2 of 538 possible COVID-19 sufferers in critical care. The number has remained at between about 500 and 535 since then – out of a total number of ICU patients that stood at 1,321 on Thursday.

And almost 78 per cent of the province’s ventilator capacity – expanded to try to meet the pandemic demand – was still available, according to the Critical Care Services Ontario document.

Quebec was reporting just under 200 COVID-19 patients in the ICU as of Friday, out of an expanded capacity of 1,000 available critical care beds, said D’Aragon.

Meanwhile, the total number of patients admitted to hospitals does seem to be rising faster in Quebec than the figures for ICUs specifically, he said.

An average of about 50 laboratory-confirmed COVID-19 patients a day have been admitted to hospital in the last week and a half

It has in Ontario, too. An average of about 50 laboratory-confirmed COVID-19 patients a day have been admitted to hospital in the last week and a half, according to publicly available government figures.

After Quebec and Ontario, British Columbia and Alberta have the largest number of confirmed coronavirus cases. A B.C. critical-care representative could not be reached for comment. But one Alberta physician suggested ICUs there have yet to face a surge.

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“We have been very fortunate in Calgary to have not been strained,” Dr. Tom Stelfox, head of critical-care medicine at the University of Calgary, said by email. “The numbers of patients we have cared for in ICUs in Calgary have been manageable and provided us with important experience in caring for these patients.”

Health – National Post