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The mathematical modeller who produced the coronavirus hospitalization forecasts for The Globe stressed his projections offer a glimpse of what could be, not what has to be

A COVID-19 testing facility at Scarborough Health Network's Centenary hospital, in Toronto on Nov., 28, 2020.Christopher Katsarov/The Globe and Mail

Canada is on track to have 4,000 coronavirus patients in hospital by Christmas, a figure that would eclipse the peak of the first wave and put tremendous pressure on a health-care system already pushed to the brink by nine months of battling the pandemic.

A new analysis conducted for The Globe and Mail by researchers at British Columbia’s Simon Fraser University projects that the number of Canadians admitted to hospital for treatment of COVID-19 will continue to grow, with the steepest increases in the West, particularly in Alberta.

If Alberta stays on its current trajectory, the province’s physicians and nurses will be caring for more COVID-19 patients – as many as 1,300 in the worst-case scenario – than Ontario, which has three times the population. There were 435 COVID-19 patients in Alberta hospitals on Sunday.

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By contrast, Ontario and Quebec, the twin epicentres of Canada’s spring wave, are expected to see slower growth in the number of COVID-19 hospital admissions over the next four weeks, but growth nonetheless.

Meanwhile, the number of new cases reported daily across the country has increased by more than 2,000 since the beginning of November and is closing in on 6,000 a day.

Jens von Bergmann, the mathematical modeller who produced the hospitalization forecasts for The Globe, stressed that his projections offer a glimpse of what could be, not what has to be, even though the lag between infections and admissions mean part of the trend is already baked in.

COVID-19 hospitalization projections

Total number of COVID-19 patients in hospital per day

B.C.

800

Past three months

Mean projection

Range of uncertainty

600

400

200

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ALBERTA

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

QUEBEC

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ONTARIO

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

THE GLOBE AND MAIL, SOURCE: JENS VON

BERGMANN, MOUNTAINMATH; CAROLINE COLIJN,

SIMON FRASER UNIVERSITY

COVID-19 hospitalization projections

Total number of COVID-19 patients in hospital per day

B.C.

800

Past three months

Mean projection

Range of uncertainty

600

400

200

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ALBERTA

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

QUEBEC

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ONTARIO

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

THE GLOBE AND MAIL, SOURCE: JENS VON BERGMANN,

MOUNTAINMATH; CAROLINE COLIJN,

SIMON FRASER UNIVERSITY

COVID-19 hospitalization projections

Total number of COVID-19 patients in hospital per day

B.C.

800

Past three months

Mean projection

Range of uncertainty

600

400

200

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ALBERTA

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

QUEBEC

1,500

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

ONTARIO

1,250

1,000

750

500

250

0

Sept.

Oct.

Nov.

Dec.

Jan. 2021

THE GLOBE AND MAIL, SOURCE: JENS VON BERGMANN, MOUNTAINMATH;

CAROLINE COLIJN, SIMON FRASER UNIVERSITY

Recently imposed government restrictions and individual choices could turn the tide, he said. “The key is that in all of these models, we are actually still in control of what’s going to happen at the end of December.”

Over the past week, there has been an average of just over 2,000 COVID-19 patients being treated in Canadian hospitals, 420 of them in critical-care units, according to a Globe and Mail tally of provincial data. Both figures have nearly doubled since the end of October.

The national totals aren’t as high as the peak of the first wave, when the seven-day average of cases in hospital topped 3,000 in mid-April. But the geography of the second wave is different.

Gone are the days when COVID-19 was primarily a Central Canadian scourge. Hospitals in Manitoba, Alberta and B.C. have long blown past their spring peaks. Manitoba hospitals were treating an average of 285 coronavirus patients a day last week. They averaged 11 at the height of the first wave. While Quebec and Ontario are generally in better shape, hospitals in their hot zones are struggling.

Canada’s hospitals held up well during the first wave, thanks to the staff and space freed up by halting elective procedures and a collective effort to bend the curve. This time, hospitals are caring for COVID-19 patients and trying to keep scheduled surgeries running at the same time, all while staff are experiencing existential levels of exhaustion and the public has grown weary of physical distancing.

Doctors, nurses and other hospital workers will be all the more burned out – and less able to provide the best care for patients – if the SFU team’s worst-case projections for coronavirus hospital admissions come to pass.

“[People] talk about front-line workers as if there’s somebody waiting in the wings to step in if we fall,” said Meighan Jones, an emergency nurse in Edmonton. “But there is nobody waiting in the wings. We’re all that there is.”

Western hospitals struggling

Doctors and nurses in the Western hot spots of Manitoba and Alberta have, for weeks now, been warning the public that parts of the health care system could collapse under the pressure of COVID-19. At the end of last week, a hospital in Grandview, Man., northwest of Winnipeg, became one of the first acute-care facilities to close as a side effect of the pandemic.

Grandview Health Centre’s hospital and emergency services were temporarily suspended at 8 a.m. Thursday morning. As the sun came up that day, residents in idling vehicles lined Highway 366 and Mill Street, where the facility sits, in part to support patients being transported elsewhere and in part to protest against a temporary closing that they fear will become permanent.

Manitoba’s intensive-care units were operating at 152-per-cent capacity Friday, with COVID-19 patients occupying 46 of the province’s 110 beds in this category. But while Manitoba’s hospitals are struggling to keep up with the influx of patients, the Grandview facility was shuttered because of weakness in the long-term care branch of the health system. Grandview Health Centre’s employees have been redeployed to Grandview Personal Care Home, where 15 residents and two staff members have COVID-19.

Steinbach, a city of about 16,000 people southeast of Winnipeg, is overrun with the coronavirus. Roughly 40 per cent of the area’s COVID-19 tests come back positive. Earlier this month, prospective patients at Steinbach’s Bethesda Regional Health Centre were forced to undergo triage in their vehicles.

The province is shuffling staff around to manage outbreaks and keep hospitals afloat and is aware it may not be able to manage on its own.

“We’re not opposed to having the military come,” said Lanette Siragusa, the Chief Nursing Officer for Shared Health, the co-ordinating arm of Manitoba’s health system. “There’s definitely consideration about when is the right time to trigger that if we need it. We still have capacity left to build and so we will take it day by day.”

Dr. Shazma Mithani outside the University of Alberta hospital in Edmonton on Monday, March 30, 2020.Amber Bracken/The Globe and Mail

In Alberta hospitals, meanwhile, November proved relentless, with 19 hospitals collectively hosting 31 active outbreaks as of Sunday. As a result of these continuing outbreaks, 87 patients and 93 health care workers have contracted the virus while 20 people have died, according to Alberta Health Services.

The province is blowing through AHS’s internal projections for ICU patients. Alberta tallied 95 ICU patients as of Nov. 28. By way of context, AHS’s early warning system, which helps hospitals plan for bed space, last Monday calculated that under the worst-case scenario, Alberta would have until Dec. 1 before it had 95 COVID-19 patients in ICUs.

In Calgary, ICUs exceeded capacity, while occupancy clocked in at around 90 per cent in Edmonton on Thursday, according to AHS spokesman Kerry Williamson.

Alberta’s hospitals house 173 general adult ICU beds, according to the provincial health authority, and serve COVID-19 patients as well as others in need of critical care. Facilities in Edmonton recently created an additional 10 beds, with 10 more planned; hospitals in Calgary are slated to add 20 more ICU spots.

However, Deena Hinshaw, Alberta’s Chief Medical Officer of Health, last week announced plans to dramatically increase the expansion effort. Alberta, she said, will earmark 425 ICU beds and more than 2,250 acute-care spots for COVID-19 patients.

Officials have been vague about how they will make this happen, leaving physicians scoffing.

“I don’t know how those beds are going to be made because we don’t have the people to staff them,” said Shazma Mithani, an emergency-department doctor in Edmonton’s Royal Alexandra Hospital and the Stollery Children’s Hospital. “We can’t even staff the beds that we have at baseline.”

Her emergency department has roughly 50 beds and now, with staffing shortages, sometimes 10 of those are closed. “Almost every single one of my shifts, there are bed closures in the department.”

To make room for COVID-19 patients Alberta in early November axed 30 per cent of elective surgeries in Edmonton, which translates to about 600 a week. Calgary is preparing to pull back, too.

Matthew Douma, an emergency nurse in Edmonton and adjunct professor of critical-care medicine at the University of Alberta, says increasing hospital capacity is not just a matter of opening up more beds to make more space.

“The sticking point for us most commonly is having enough regulated health care professionals…. Not every nurse can staff an emergency department or an intensive-care unit.”

Darren Markland, a critical-care physician and nephrologist at the Royal Alexandra, said the severity of illness in new ICU admissions is increasing and doctors are more conservative when considering treatment options in light of the backlog.

“Before, there was elasticity in the system, where you could go for the long shot,” Dr. Markland said. “But we’re not doing that any more.”

GTA hospitals under pressure

In Ontario, the government’s modellers have been warning that some hospitals would have to start cutting back on scheduled surgeries when the number of COVID-19 patients in ICUs exceeded 150. The province crossed that threshold about a week and a half ago.

By that point, William Osler Health System, which oversees three hospitals in the coronavirus hot zone of Brampton and in neighbouring Etobicoke, had already postponed all-day surgeries, including orthopedics, gynecology procedures and general surgery, at its outpatient site, the Peel Memorial Centre for Integrated Health and Wellness.

Kiki Ferrari, the network’s chief operating officer, said she doesn’t expect day surgery at the site to resume until well into January. Staff had to be redeployed to the Brampton Civic and Etobicoke General hospitals, which together were treating 55 confirmed coronavirus patients – 12 of them in the ICU – and another 50 suspected coronavirus patients on Friday. For a few weeks, Osler’s bursting-at-the-seams sites were transferring patients to other hospitals, but they managed to keep their heads, “above water” last week and avoid transfers.

Medics enter an ambulance at William Osler Hospital, in Brampton, Ont., on Nov., 27, 2020.Christopher Katsarov/The Globe and Mail

Staffing has been a constant challenge, Ms. Ferrari said. Many front-line workers are ill with the virus or self-isolating because they’ve been exposed to a confirmed case. Some 192 of the network’s staff have tested positive since the start of the pandemic. “They’ve been doing this now for months,” she said. “And we don’t know how long it’s going to continue.”

In northeast Toronto, another hot spot, the three hospitals that make up the Scarborough Health Network have been struggling with one of the highest COVID-19 burdens in the province. In mid-November, SHN began postponing non-elective inpatient surgeries and diverting some new arrivals to neighbouring hospitals. The network has set up a satellite emergency department in a portable near the ambulance bay at its Centenary site to cope with demand without compromising physical distancing.

The second wave has been far tougher on SHN and the community it serves than the first, according to Bert Lauwers, acting chief of staff and executive vice-president of medical and clinical programs. “I can tell you that in the first wave, the maximum number of patients that we actually had in the entire hospital system was about 64. Today, I think we’re at 137,” he said on Wednesday.

Ontario hospitals outside the hardest-hit corners of the Greater Toronto Area are holding the line. By the end of last week, the seven-day average of hospitalizations in Ontario had reached 515, an average of 150 in ICU, according to The Globe’s tally. The total number of COVID-19 patients in hospital was only half as high as the spring peak, but it was up 89 per cent from the end of October.

Change in COVID-19 hospitalizations,

7-day averages

Nov. 26

Oct. 26

0

100

200

300

400

500

600

700

+269%

B.C.

+185%

Alberta

+494%

Manitoba

+89%

Ontario

+17%

Quebec

DANIELLE WEBB AND MURAT YÜKSELIR /

THE GLOBE AND MAIL, SOURCE:

provincial governments

Change in COVID-19 hospitalizations,

7-day averages

Nov. 26

Oct. 26

0

100

200

300

400

500

600

700

+269%

B.C.

+185%

Alberta

+494%

Manitoba

+89%

Ontario

+17%

Quebec

DANIELLE WEBB AND MURAT YÜKSELIR /

THE GLOBE AND MAIL, SOURCE: provincial governments

Change in COVID-19 hospitalizations, 7-day averages

Nov. 26

Oct. 26

0

100

200

300

400

500

600

700

+269%

B.C.

+185%

Alberta

+494%

Manitoba

+89%

Ontario

+17%

Quebec

DANIELLE WEBB AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE:

provincial governments

Hospitals in Quebec, the national pandemic hot spot in the first wave, were holding this week despite nearly two months at a steady plateau in new cases, but a constant slow rise in hospital admissions.

Earlier this fall, hospitals in Quebec City started cancelling elective surgeries and non-urgent appointments after a spike in COVID-19 cases and serious illness. That hot spot subsided, replaced by the more rural Saguenay-Lac-Saint-Jean region where small hospitals with tiny intensive-care units were full this week. The region has started sending serious cases to Quebec City.

In Montreal, where 207 of about 1,000 COVID-19 beds are full, officials still warned that the slowly growing caseload, chronic staff shortages, growing burnout and the normal winter increase in hospital patients still pose a threat. Hospitalizations in the city and province have doubled since Oct. 1.

Quoc Dinh Nguyen, a geriatrician and epidemiologist at the CHUM university hospital network, spotted another worrying sign. The province’s caseload, with about 1,100 new cases, 550 people in hospital and 30 deaths a day, is slowly shifting from the under-30 population toward the 60-plus – who are much more likely to get seriously ill and die from COVID-19.

“We seem to have grown content with 1,000-plus cases a day. It’s still 30 deaths per day, and this will increase with the holidays and winter,” Dr. Nguyen said. “As long as the bigger proportion is in younger adults, the health system can take it. We can keep up with it. If we have 300, 400, 500 cases among the 70-plus, the system won’t take it.”

What the models show

When it comes to forecasting the number of coronavirus-infected patients likely to end up in hospital, demographics are key. As the virus moves from the young to the old, hospital admissions rise.

To make his projections, Dr. von Bergmann, the head of MountainMath, a Vancouver data-analytics and modelling company, examined data from the past few months on COVID-19 cases by age group to see how many were admitted to hospital. Then, he drew on short-term projections of new cases produced by Caroline Colijn, a professor at Simon Fraser University and Canada 150 Research chair in mathematics for evolution, infection and public health. After that, he ran the numbers forward.

Along with his national projection of 4,000 COVID-19 patients in Canadian hospitals by Christmas, Dr. von Bergmann projected that B.C., Alberta, Ontario and Quebec would all continue to see growth in hospitalizations, with Quebec growing the least and Alberta the most. (Only the country’s four most populous provinces publish suitable up-to-date demographic data for hospital modelling, Dr. von Bergmann said. To come up with the national estimate, he drew on Statistics Canada data about coronavirus cases from earlier this fall.)

William Osler Hospital in Brampton on Nov., 27, 2020.Christopher Katsarov/The Globe and Mail

The models, which have wide bands of uncertainty, show that at the mean of the projections, B.C. can expect to have 350 COVID-19 patients in hospital, or as many as 700 if the worst-case scenario comes to pass, by Christmas, unless the growth rate changes. The seven-day average as of Friday in B.C. was 260 patients in hospital.

In Alberta, the projection at the mean was 900 beds in use by COVID-19 patients by Dec. 25, nearly triple the current seven-day average. The worst-case scenario was a whopping 1,300 COVID-19 patients in hospital. However, it’s too early for the model to reflect the impact of new restrictions that the Alberta government imposed last week, so the numbers could come down, Dr. von Bergmann said.

The model predicted Quebec would see 750 cases in hospital at the mean, with a worst-case scenario of 1,300 by Christmas, double the current seven-day average of 644. Ontario, meanwhile, could see 800 cases in hospital at the mean and 1,100 in the worst case.

The purpose of these models is not to predict the future, Dr. Colijn said. “Our aim is to say this is the path we’re on. If we don’t want to be on this path, we need to change our direction.”

With reports from Les Perreaux, Wency Leung and Danielle Webb

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