Hospitals risk being overwhelmed because of holiday COVID-19 rule-breakers

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With COVID-19 cases still rising and hospitals nearing capacity, intensive-care doctors in Quebec and Ontario are bracing for the worst, as they start to see the impact of people flouting pandemic rules during the holidays.

Michael Warner, medical director of critical care at Toronto’s Michael Garron Hospital, said he expects a bad situation to get worse in coming weeks. His hospital has started seeing an increase in COVID-19 patients linked to holiday gatherings.

Dr. Warner said the first wave of the pandemic, and part of the second, affected largely racialized and marginalized people, essential workers and those who didn’t have the ability to self-isolate.

“What we have now is people with privilege who think that they are somehow different, and rationalize to themselves that it’s okay that they get together over the holidays with one, two, four, five people because they deserve it,” he said. “What has happened is now those people are getting COVID-19.”

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François Marquis, head of intensive care at Montreal’s Maisonneuve-Rosemont Hospital, said that out of nine patients recently admitted to his ICU, seven admitted to breaking lockdown rules during the holidays, one wouldn’t say and only one caught it while in hospital.

“What we thought was unfathomable, having triage as they had in Italy or in New York, it’s not science fiction for Canada, and even less so for Quebec and the Montreal area,” Dr. Marquis said. “The next few weeks will be decisive.”

He said hospitals are on the edge of being overwhelmed. “All it will take is one major outbreak in one of Montreal’s main hospitals for things to derail.”

Mathieu Simon, head of intensive care at Laval University’s Heart and Lung Institute, a specialized cardiopulmonary hospital in Quebec City, also saw cases caused by the failure to heed pandemic restrictions.

“Often when they arrive they are no longer in shape to admit anything because they are intubated but some relatives make an act of contrition and say they did get together to play cards or for a family gathering. It’s not big things; it doesn’t take three-day raves. It’s stuff that used to be considered mundane.”

In Ontario, capacity for adults in acute care hospitals is at 85 per cent, ICU beds are at 78 per cent and baseline ventilator beds are already at or over 100 per cent, according to the Ontario Hospital Association (OHA).

However, such measures can be misleading as capacity varies greatly across the province. Cities such as Thunder Bay, Ottawa and Kingston may have vacancies, for example, but the area to the west and north of Toronto is already at 90-per-cent ICU capacity. Over the holidays, the province hit a high watermark of 352 patients in ICU, according to the OHA.

“Hundreds of patients are being moved from ward to ward, from hospital A to hospital B,” Dr. Warner said. “Every day, patients are being moved from ICU A to ICU B. Some hospitals have been five beds over capacity, with five patients waiting in the emergency department, waiting to go to other hospitals.”

There were 329 people in intensive care in Ontario on Sunday, and he fears that that could climb to 500 or 600 people in the next month or two.

On Jan. 1, the Ontario government directed hospitals to prepare to increase intensive-care capacity to 115 per cent – a move that will put additional pressure on health care workers already stretched thin.

COVID-19 patients tie down more hospital resources because they typically need two weeks in ICU, compared with less than two days for heart-bypass surgeries or four to five days for pneumonia cases, Dr. Simon said.

The Heart and Lung Institute’s staffing has also been whittled down by the pandemic. About 70 staffers are no longer able to work because they are immunocompromised and dozens tested positive after getting exposed to the coronavirus in the community.

Quebec recorded 2,819 new cases on Saturday, with 1,225 coronavirus patients in hospitals. In Ontario, 2,964 new cases were registered, with 998 people hospitalized.

At the current pace of transmission, there is a risk Montreal hospitals would be overwhelmed within three weeks, according to INESSS, the institute that monitors the performance of the health care system for the provincial government.

Also, the emergency wards of Montreal’s major hospitals were overflowing on the weekend, according to the IndexSante.ca website, which tabulates real-time government indicators.

At Maisonneuve-Rosemont, the ER was filled at 154 per cent of capacity, with 72 patients waiting one or two days on stretchers, while the Jewish General Hospital was at 132-per-cent capacity, with a backlog of 140 patients on stretchers.

The backlog in the emergency units stems from the inability to transfer to other wards, either because they are curtailed by outbreaks or because they had to be reserved for COVID-19 patients, Dr. Marquis said.

He added that hospitals cannot reach their theoretical capacity because they have lost staff to coronavirus exposure, burnout and chronic understaffing. He questioned the Quebec government’s decision to begin vaccination on residents of elder-care homes rather than health care workers.

Dr. Simon concurred, noting that Quebec’s plan to vaccinate 650,000 people by the end of March would not even cover one-tenth of the province’s population. “The health network will need to remain robust until the spring.”

Anthony Dale, president and chief executive of the OHA, said health care workers are dedicated to caring for patients but have been fighting the pandemic for 10 months and are now mentally, physically and emotionally exhausted.

The latest figures tell what happened weeks ago and hospitals are still waiting to see the consequences of out-of-control community spread over the holidays, he said.

“It won’t show itself in hospitals for several weeks still,” Mr. Dale said in a statement provided to The Globe and Mail. “Our fear is, the rates of increase will continue the way they are and the months of January and February will be absolutely brutal.”

British Columbia, meanwhile, continues to have capacity in its hospitals. As of Dec. 31, acute care beds were at 84.8-per-cent capacity, and 66.7 per cent including surge beds. Critical care was at 74.7-per-cent capacity, and 51 per cent including surge beds.

Health Minister Adrian Dix said while the province still has a “significant” number of people in hospital – 374 as of Dec. 31 – it is equipped to treat them.

“This is, to a degree, the difference between British Columbia, on the acute care side, and other jurisdictions,” Mr. Dix said. “We continue to have substantial capacity.”

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