Ontario hospital intensive care units are already overflowing. Field hospitals in Toronto and Hamilton are preparing to accept patients. Tents are being installed to expand emergency department waiting areas. Non-essential operations are being cancelled. And patients are being transported to hospitals hundreds of kilometres away to make room for new COVID-19 cases in the hard-hit Toronto area.
The deluge won’t abate for weeks. In fact, it will get much worse, Ontario’s pandemic science advisers say.
The province’s hospitals will continue to see a sharp increase in COVID-19 patients requiring intensive care in the coming weeks, even if strong public-health measures are introduced, Adalsteinn Brown, co-chair of the province’s COVID-19 science advisory table, told reporters on Friday. And not all of these patients may receive the care they need, he said.
Dr. Brown said around 700 COVID-19 patients were in intensive care on Friday – a level that he said compromises the care of all patients in the province. Regardless of any further public-health restrictions, the science table’s modelling data show that number will exceed 800 over the next two weeks, and reach nearly 1,000 in two or three weeks.
“It’s not clear that all those patients would ever be able to enter an intensive unit bed, even with the heroic efforts going on across the province to increase capacity right now,” Dr. Brown said.
At Toronto’s Sunnybrook Health Sciences Centre, a field hospital, or mobile health unit, is preparing to open some of its 84 beds next week. That facility, which can be expanded to 100 beds, will be for patients who are recovering or have recovered from COVID-19, said Debra Carew, in charge of clinical operations of the field hospital.
Similarly, a field hospital that will house 80 hospital beds is under construction in a parking lot near Hamilton General Hospital and expected to be ready for patients next month, according to Hamilton Health Sciences.
Meanwhile, at the University Health Network, tents are being set up, one at Toronto Western Hospital and one at Toronto General Hospital, to accommodate an influx of patients seeking emergency care, allowing them to physically distance while they wait.
“We’re seeing a lot of patients – a lot of patients with COVID, a lot of sick patients – and we are redeploying staff to areas of need and doing the best we can to work with the resources that we have,” said Erin O’Connor, deputy chief of emergency medicine at UHN. “It’s exhausting.”
Staffing remains one of the biggest challenges. At Sunnybrook, for example, Ms. Carew said roughly 30 to 35 clinical staff are needed for just 10 beds at the field hospital – and that’s not counting staff for other non-clinical services.
Ontario is predicting it will be short 4,145 nurses over the next four months and on Friday sent a letter to all provinces and territories asking for immediate aid of 620 health care staff.
The letters, sent by the Ministry of Health’s most senior bureaucrat, asks each provincial and territorial government to detail what if any slack there is in their health systems that Ontario could lean on.
“As Ontario grapples with the need to urgently add more critical care capacity to deal with the continued surge of COVID-19 patients, we are urgently looking for health human resources across the province to assist in staffing these beds,” Deputy Minister Helen Angus wrote.
The province is hoping for 500 nurses with intensive care, critical care, recovery room, and general expertise; 100 respiratory therapists; 10 professionals who operate heart-lung machines; and 10 anesthesia assistants.
However, it’s unclear how many excess staff from other parts of the country are available for Ontario. Several other provinces are also grappling with a devastating third wave of COVID-19.
On Friday, Prime Minister Justin Trudeau did not answer whether Canada’s health care systems have excess staff but he repeatedly offered “any and all supports” to Ontario. The government though was unable to detail whether it could provide any staff to fill the shortage. The offices for the Public Safety Minister and Defence Minister did not reply to requests for information.
Alberta, which has the highest rate of COVID-19 cases in Canada, has said it can’t send anyone.
Newfoundland and Labrador’s Premier Andrew Furey said his province can share personnel and equipment. But his government has not yet given any specifics on how many people it could send. Nova Scotia’s government said it’s looking at what it can offer, but that local needs will be taken into account first.
However, Ontario Health Minister Christine Elliott said Friday afternoon the province has started looking at international jurisdictions “to bring in several thousand more nurses, respiratory therapists, and anesthesia assistants.” Her office said no formal requests to other countries have been made.
But even with additional help, Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario, said it is impossible to safely staff 800 ICU beds.
“There is no way,” she said, explaining nurses need the training and expertise to care for patients with extremely complex medical conditions and cannot be easily redeployed from other areas. “We have put calls to nurses and yes, they are volunteering. But unless you stop the spread, there is no end to this.”
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