Hospitals faced with new capacity crisis as unvaccinated Canadians, reduced public health measures drive COVID-19′s fourth wave

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People who have not been vaccinated against COVID-19 are driving Canada’s fourth wave of infections, raising concerns that some hospitals may need to triage critical-care patients in coming weeks.

New modelling by the Public Health Agency of Canada (PHAC) shows that at the current rate of vaccination, coupled with the easing of public health measures, hospital capacity may be exceeded by mid-January. However in Canada’s three westernmost provinces, where infections and resulting hospitalizations are already surging, worst-case scenarios could arrive much sooner.

“We’re already in a situation where critical capacity is almost maxed out provincewide and our Delta wave is just beginning,” said Alexander Wong, an infectious diseases physician based in Regina. Saskatchewan lifted all remaining COVID-19 restrictions on July 11.

“To be in this position at this point, with no additional mitigation measures in place – no masking, no certificate passport program, pretty much just relying on vaccines – that makes this untenable long term.”

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Alberta and Saskatchewan have the highest per capita rates of COVID-19 patients in hospital, at 11.7 and 11.5 per 100,000 respectively – about five times that of Ontario. Alberta has the highest per capita rate of admissions to critical care.

Alberta Health Services president and CEO Verna Yiu said Friday that intensive care units are at 95 per cent capacity, prompting the agency to postpone elective surgeries across the province, including up to half in the Edmonton zone and up to 60 per cent in the north zone. As well, up to nine patients at Grande Prairie’s Queen Elizabeth II Hospital have been transferred to neighbouring health centres.

The Globe and Mail has requested specifics on acute and critical care capacity, the status of scheduled surgeries and patient transfers from the Saskatchewan Health Authority but has not received those figures. An e-mailed statement provided on Thursday said the health authority is “already seeing significant system flow and capacity pressures in our hospitals, including service disruptions and temporary bed closures due to staffing shortages.”

The statement said the health authority will need to further slow down service and redeploy staff “even with a modest increase in hospitalizations.”

Dr. Wong said there simply is not enough staffing capacity in the province, and that provincial mandates, such as a universal indoor masking and a vaccine passport program, are needed urgently.

“We need help from the policy and decision makers so that we do not have to be in that horrible situation in a week or two where we’re going to have to decide who lives and who dies,” he said.

British Columbia has seen a dramatic surge in cases in both its interior and northern regions. Health Minister Adrian Dix said last Thursday that base beds were at 94.9 per cent occupancy provincewide, while surge beds were at 12.8 per cent occupancy. In critical care, base beds were at 83.3 per cent occupancy, and 12 of 218 surge beds were in use.

However, he noted that some critical care beds must be reserved for other scenarios, such as car accidents, and that there are large regional disparities. The Interior Health region, for instance, represents about 15 per cent of the province’s population and accounted for half of all COVID-19 cases in the last month.

Scott Hughes, an orthopedic surgeon at Royal Inland Hospital in Kamloops, said that all elective surgeries at his hospital have been cancelled for the past three weeks – roughly 300 and counting.

“The only surgeries we’re allowed to continue with are the traumas that come into our hospital, and the very urgent ‘elective’ surgeries, such as the time-sensitive cancers,” he said. “But we’re currently at our third week straight of no elective surgeries at all, in any discipline, including daycare patients. It’s unprecedented.”

Ontario has not seen a surge of COVID-19 patients requiring hospitalization as it did in earlier waves of the pandemic, such as last spring, when patients had to be transferred to other hospitals. However, a Sept. 1 modelling presentation by the province’s COVID-19 science advisory table forecast a “substantial” fourth wave that will affect all age groups and have the potential to exceed critical care capacity.

The body of experts said in light of the high transmissibility of the Delta variant, and to avoid a fall lockdown, vaccination in the province needs to accelerate “substantially” above 85 per cent of the eligible population, and contacts need to be reduced to about 70 per cent of prepandemic levels.

Ontario Health said it is monitoring hospitalization levels and that hospitals are prepared to share capacity again should pressures increase.

National case-level data from more than 640,000 COVID-19 cases between Dec. 14, 2020, and Aug. 14, 2021, show that 88.6 per cent were unvaccinated at the time of their infections, according to PHAC. Just over 5 per cent were not yet protected by the vaccine, as they became infected less than 14 days after their first shot, another 5.1 per cent were partially vaccinated, and 1.1 per cent were fully vaccinated.

Among those in hospital, 84.6 per cent were unvaccinated, 7.2 per cent not yet protected, 7.1 per cent partially vaccinated, and 1.1 per cent fully vaccinated. Among deaths, 82 per cent were unvaccinated, 8.7 per cent not yet protected, 7.7 per cent partially vaccinated, and 1.6 per cent fully vaccinated.

Dr. Laura Sauvé, a pediatric infectious disease physician at B.C. Children’s Hospital, noted that the proportion of COVID-19 cases among children has remained relatively stable throughout the pandemic, despite nearly all cases now being the Delta variant. People under 19 have made up about 17 per cent of cases and 2 per cent of hospitalizations in B.C. – figures that have been reflected across the country.

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In a Sept. 3 modelling presentation, Canada’s chief public health officer, Theresa Tam, said an immediate acceleration of vaccine uptake among young adults aged 18 to 39 – the group with the highest rates of infection, and that is most mobile across work, recreational and educational settings – is required to reduce the risk of overwhelming hospital capacity.

As of Sept. 3, more than 84 per cent of eligible Canadians have received at least one dose of a vaccine, and 77 per cent are fully vaccinated. However, among those aged 18 to 29, only 74 per cent have had one shot and 63 per cent are fully vaccinated. Among the 30 to 39 age group, 77 per cent have had one shot and 68 per cent are fully vaccinated.

Dr. Tam said more than 80 per cent coverage would be needed among this population as fast as possible.

“Because of how fast the mostly Delta-driven cases are escalating, particularly in the west of the country, the window of opportunity to make that impact is definitely narrowing,” she said. “The moment you get people back indoors to access all those important essential things that we need to do, we will see accelerations. We’ve got not very much time.”

With a report from Chen Wang

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