Ontario has reached a crucial threshold during the fall pandemic wave with 150 COVID-19 patients now being treated in hospital intensive care units, a number experts say will trigger some hospitals to cancel elective surgeries, including cardiac and cancer procedures.
The milestone, reported Thursday after a jump of 20 new COVID-ICU cases from the previous day, was reached earlier than was predicted by provincial modelling and represents a 41 per cent increase over the last seven days.
Data from Critical Care Services Ontario shows hospitals outside Toronto, Peel and other COVID-19 hot spots are starting to admit more COVID patients into intensive care, yet another sign the virus is continuing its unrelenting spread.
“We are seeing COVID-ICU occupancy growing in all regions of Ontario,” Anthony Dale, president and CEO of the Ontario Hospital Association, told the Star. “There are new cases in the west, the east and now one new COVID-ICU case in the north. The province will sit up and take notice of this; we all are.”
At a Thursday press conference, Premier Doug Ford again warned that Toronto, Peel and York regions could see further public health restrictions announced as soon as Friday, citing the continued alarming rise in COVID-19 infections in the provincial hot spots and the recent acceleration in COVID cases in the ICU.
Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, told reporters Thursday afternoon the 150 COVID-ICU case threshold was calculated to determine the number of ICU beds required to continue with elective surgeries and support patients who arrive to hospital through emergency departments.
“If it goes over 150 (cases) for COVID, then it will impact negatively on people requiring ICU care for other reasons.”
According to provincial numbers, there are 146 COVID-19 patients in critical care, while the Nov. 19 update from Critical Care Services Ontario reports 150. Yaffe said the discrepancy is likely due to a reporting delay.
Provincial COVID-19 modelling presented Nov. 12 projected hospitals would hit the 150 COVID-ICU case mark by late November. The projections were made before the province announced modifications to its colour-coded pandemic framework on Nov. 13 that included lowering thresholds for imposing further controls on public health regions.
Dr. Kari Barrett, a critical care physician at University Health Network and scientist with the COVID-19 Modeling Collaborative, said while COVID-19 case counts receive much of the attention for gauging the pandemic, hospitalizations, the number of patients admitted to intensive care and deaths are “better metrics of how much trouble we are in.”
In early September, as COVID-19 cases started to rise, hinting at a second wave, there was still complacency among the population because infections were primarily in younger people who are less likely to become severely ill, Barrett said.
“However, we have seen from other jurisdictions that with time, the infections would spill over from the younger population into the more elderly and vulnerable segments of our population,” she said. “This rising number of ICU admissions for patients with COVID-19 is an indicator that the spillover has happened in Ontario.
“The fact that the hospital numbers are climbing as they are is an indicator that the rate of spread of COVID-19 among the most vulnerable in our society is now at a very alarming level.”
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Among the main concerns as COVID-ICU cases rise is the additional pressure that puts on Ontario’s hospitals, already stretched thin, as they catch up on the backlog of elective surgeries that were cancelled or postponed during the spring pandemic wave.
The 150 COVID-ICU patient threshold reached today is the estimated buffer needed to protect the health system from starting to be overwhelmed, Barrett said.
“When the number of patients with COVID starts to exceed that 150, it starts to eat into the beds that are needed by other patients in the health system,” she said. “It’s like they are displacing resources that are needed by other patients. And you can’t prevent people from showing up to the hospital with strokes and sepsis and heart attacks who will need critical care.
“The only way to meet the demand of these additional critically ill patients is to cancel elective surgeries.”
William Osler Health System is facing crushing pressures during the pandemic and has already postponed some elective outpatient surgeries at its Peel Memorial Centre for Integrated Health and Wellness. Osler, which includes Brampton Civic Hospital, is caring for 58 patients with suspected COVID-19 and 62 confirmed COVID-positive patients, nine of whom are in intensive care.
Dale of the Ontario Hospital Association said Ontario hospitals typically run at very high levels of occupancy, with the province “having some of the lowest hospital beds per capita in the western world.”
On Nov. 13, the OHA submitted a report to the province with recommendations for how the provincial colour-coded pandemic framework could better incorporate health system capacity in its triggers for more public health measures, Dale said.
Currently, the framework does not clearly define health system capacity, said Dale, noting capacity considerations are different across hospitals and across the province.
In addition to occupancy levels and ICU admissions, Dale said the criteria should include other health system metrics, such as wait times in emergency departments, surgical and diagnostic wait times, and the number of alternate-level-of-care (ALC) patients waiting to be discharged to other institutions, often long-term-care homes.
Other health system indicators need to be included, he said, such as pressures faced by primary care; mental health and addictions services; and health-care staffing resources.
“That’s important because that’s what’s lying at the heart of the risk facing Ontario when it comes to the COVID-19 pandemic,” Dale said. “There is the risk of a COVID surge and the impact on our critical care capacity. But the risk right in front of us is that hospitals may have to cancel all these other services to care for COVID patients.”
The OHA also recommended there be “better alignment between provincial and local medical officers of health,” Dale said, pointing to how Peel and Toronto have instituted public health measures beyond provincial controls.
“This would reduce unnecessary conflict between public health officials, as well as lessen confusion for the general public.”
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie
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