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A man walks away from the Foothills Medical Centre in Calgary on Sept. 23, 2021. Alberta’s new health minister, Jason Copping, has pledged to 'permanently' increase the province’s baseline ICU capacity.Sarah B Groot/The Globe and Mail

One month after the coronavirus was first detected in Alberta last year, the province prepared for an onslaught of COVID-19 patients needing critical care. The government counted 295 intensive care beds at the ready and said it could increase capacity by 1,081 by the end of April, 2020.

The projected deluge never came. But now Alberta’s health care system is in crisis and officials are scrambling to increase ICU capacity to about 380 beds. People opposed to public-health restrictions designed to keep COVID-19 in check, including members of the United Conservative Party caucus, have questioned why Alberta Health Services (AHS) is unable to crank up capacity like it once said was possible.

Meanwhile, Alberta’s new health minister, Jason Copping, has pledged to “permanently” increase the province’s baseline ICU capacity. This will not immediately ease the pressure on Alberta’s hospitals but could serve the province well when the pandemic morphs into an endemic and as the population ages, according to experts. Intensive care spaces are expensive and require specialized staff, so adjusting the number of beds available must be managed carefully.

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Alberta arrived at its initial estimate of an additional 1,000 ICU beds after reviewing its physical infrastructure – for example, space and electrical outlets – and calculating how many “monitored beds” were theoretically possible, according to Clint Torok-Both, the president of the Alberta Medical Association’s ICU division.

“But there’s a lot more parts to the actual care of an intensive care patient,” he said. “I don’t think that was necessarily taken into account in that number.”

AHS then tallied its equipment, such as IV pumps and ventilators in storage. In order to meet the 1,000-bed projection, it would have had to shutter almost all other health services.

“When they created the worst-case scenario, they really were doing nothing else but survival mode,” Dr. Torok-Both said. “We do have to realize there are non-COVID patients that still require care.”

The most significant limitation to expanding ICU capacity is staff. The initial projection did not account for staff burnout, illness and isolation requirements after exposure, he said. Indeed, Alberta later said it had “planned capacity” for 425 ICU beds in the first wave.

Alberta’s 1,000-bed estimate came in the early days of the pandemic, when experts only had a scant idea of how the pandemic might unfold, AHS spokesman Kerry Williamson said.

“It was based on worst-case estimates of potential case numbers and disruption of the health care system, a very preliminary understanding of the care needs of COVID patients, and staff availability at the time,” he said. “Such a response would have required the near-complete shutdown of all non-ICU health care services, with every available space being used to provide care to COVID-19 patients.”

AHS last month cancelled all non-emergency surgeries to free up staff, space and equipment as ICU admissions balloon with unvaccinated COVID-19 patients. The province requested help from Ottawa and asked other provinces as well as hospitals in the U.S. whether Alberta could transfer ICU patients to their facilities if necessary.

The Canadian Armed Forces sent eight nurses to Alberta to assist; the Canadian Red Cross is planning to deploy 20 medical professionals; and Premier Jason Kenney has accepted Newfoundland and Labrador’s offer to send a handful of ICU specialists.

Across the province, there were 303 people in ICU on Sunday, according to AHS, and the vast majority were COVID-19 patients. Alberta on Sunday had a total of 374 ICU beds, owing to 201 makeshift spaces.

The province’s baseline of 173 ICU beds lands it on the low end of spaces per capita in Canada. However, the definition of an ICU bed is flexible. Alberta, for example, had 292 ICU beds capable of invasive ventilation, according to a 2015 paper published in Critical Care. Alberta had 7.9 ICU beds with ventilation capacity for every 100,000 people in 2009, compared to 9.5 ICU beds for the same number of people across the country, the paper said.

Mr. Copping said last month that one of his top priorities is to “increase baseline ICU capacity, and do this permanently.”

Steve Buick, his spokesman, said the goal is to “match our surge capacity” to the risk of future waves of COVID-19, by getting more Albertans vaccinated and re-examining ICU options. “The intent is to avoid disrupting the health system in future waves, not change normal (non-pandemic) capacity or occupancy level,” Mr. Buick said in a statement.

Christopher Doig, a critical-care professor at the University of Calgary’s medical school, said it would be reasonable for Alberta to add permanent ICU spots, so long as it is done thoughtfully. He noted the new ICU in the Foothills Medical Centre was designed to accommodate surge capacity.

ICU beds are expensive and if spaces are added, it is important to make sure they are used effectively, he said.

“You may tend to put patients in the ICU to fill capacity,” Dr. Doig said. “The question will be: Will you improve outcomes by putting people in those beds?”

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