The Hospital for Sick Children is preparing to accept critically ill adults with COVID-19, a “watershed moment” that highlights the precariousness of Ontario’s hospital system as it strains under the third-wave surge of patients needing intensive care.
SickKids will open eight critical care beds for younger adult patients, 40 years old and under, who were previously healthy before becoming ill with COVID-19.
It’s the first time the hospital is opening beds for adult patients as part of a provincial response, SickKids president and CEO Dr. Ronald Cohn told the Star.
Patients will be transferred from Greater Toronto hospitals that have surpassed their capacity “after activating their surge plans, and all potential transfers to neighbouring regions have been attempted,” according to a statement late Tuesday by Sick Kids.
Anthony Dale, president and CEO of the Ontario Hospital Association, called the move for a pediatric hospital to accept adult patients a “watershed moment” for the province’s health-care system.
“This shows the extraordinary gravity of the situation,” he said. “Those beds will absolutely be necessary to save lives and keep people alive in the weeks ahead.”
According to the April 5 daily report from Critical Care Services Ontario, 497 COVID-19 patients are in ICU — well above the second-wave peak of 420 patients Jan. 15. Recent modelling by the province’s independent volunteer science table shows there could be 800 COVID ICU patients in Ontario hospitals by the end of April.
This week, Ontario’s critical care command table directed hospitals in virus hot spots — primarily those in Peel and parts of Toronto, including Scarborough and the city’s northwest — to transfer critically ill COVID-19 patients to other GTA hospitals with capacity, Dale said. As of Sunday, 88 patients were scheduled to be transferred over a five-day period.
“The amount of residual ICU capacity in the Greater Toronto and Hamilton area is shrinking by the day,” said Dale, noting some patients are also being transferred out of the region to Niagara, London and Kingston.
“That’s the situation today. But in a situation where we have 600 or 700 or more patients with COVID-related critical illness in ICUs, you’re talking about a crisis of historic proportions in Ontario. Our hospital system … will be tested to its very limit and beyond under those circumstances.”
Cohn, who called the plan to accept adult COVID patients “unprecedented,” said the hospital had developed two strategies to help the health system cope with the surge — one for young adult ICU patients who had COVID-19 and another for younger ICU patients without the virus.
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In the last seven to 10 days, Cohn said it became clear SickKids could offer the biggest help by taking in COVID-positive younger adults requiring intensive care. The hospital, which has two intensive care units on the same floor, will house the eight adult beds in one of these units, separate from all other patients and families.
Compared to a typical year, the hospital has fewer general pediatric ICU patients, and Cohn said modelling shows the hospital can safely accept eight younger adult COVID-19 patients who don’t have any medical complexities. He also said SickKids’ critical care team is prepared and can safely care for these younger adults.
“From a medical point of view, the younger adults currently in ICU in Ontario who don’t have any other medical issues are primarily there because of respiratory problems or because of ARDS — Acute Respiratory Distress Syndrome — a condition we (treat) in adolescents and young adults around 19 or 20 years of age.”
Cohn said accepting adult patients will have no impact on how children are cared for and will not affect how the hospital is working through its surgical backlog from the pandemic. Should the hospital, for whatever reason, require additional space for its pediatric ICUs, Cohn said the adult patients would be transferred out to other hospitals.
In January, Sick Kids started accepting pediatric in-patients from some GTA hospitals that need to make room for adult COVID-19 patients.
Though only eight beds, Cohn said opening a temporary adult ICU unit at Sick Kids will help “take off a bit of pressure” from the system.
“Any capacity helps if it can prevent us from getting into a situation of triaging care.”
Since November, about 1,400 critically ill patients have been transferred to create capacity in Ontario hospitals, Dale said. The large-scale transfer of patients helps to spread out the burden on the system and ensures equitable access to critical care services, he said.
With no sign that COVID-19 case numbers will soon fall, Dale said the system is struggling to both offer life-saving care in its ICUs alongside other hospital services, which are increasingly being “crowded out.”
“We are way over the high-water mark of COVID-19 patients in intensive care from Wave 2 and right now the system is planning and bracing for a remarkable challenge in the weeks ahead as numbers of patients needing intensive care services continues to skyrocket.”
Torstar, the Star’s parent company, is involved in a fundraising and educational partnership with the Hospital for Sick Children. Jordan Bitove, publisher and co-proprietor of the Toronto Star, is a member of the hospital’s board of directors.
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie
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