The COVID-19 pandemic threatens to overwhelm Canada’s supply of life-saving ventilators for the most severe cases of the disease, as health officials across the country scramble to bolster their inventories by ordering new machines, dipping into stockpiles and preparing to quickly shift resources to hotspots as they emerge.
Public-health officials say they believe resources are adequate, but that the finite supply of such equipment, both in Canada and around the world, underscores the need for escalating restrictions on travel and daily life. The priority now is to slow down the potential flood of serious infections that could far outstrip the health system’s capacity if left unchecked.
“This type of planning is underway," said Theresa Tam, Canada’s Chief Public Health Officer, said during a briefing on Sunday. “What we are facilitating at the federal level is to provide surge capacity or to assist with purchasing of equipment, should they be needed.”
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Questions about ventilators and other supplies are being raised as hospitals and public-health officials across the country prepare to cope with a potential surge of patients. Other measures include asking hospitals to put elective and non-life threatening surgeries on hold, as Ontario has done.
There is limited data available about the current Canada-wide ventilator supply, although a large study published in 2015 after the 2009 H1N1 pandemic put the number at just less than 5,000.
Robert Fowler, a scientist at the Sunnybrook Research Institute who co-authored the study, said it’s too early to predict what the need will be as the coronavirus outbreak unfolds in Canada.
Dr. Fowler said the ventilator supply was stretched thin during the H1N1 outbreak and he believes provinces have since increased their inventories, though it’s not clear by how much. He said most health systems, including Canada’s, are designed to meet peak demand in normal circumstances, not during a pandemic.
“I think we’re better than we were back then [in the 2009 pandemic], but the potential for an increase in certain places over a short period of time makes everyone concerned that we haven’t grown as much as we need to meet the demand that might be coming,” he said in an interview.
“Canada, probably because of the SARS experience, is probably a bit more prepared than most places in the world. But there’s a very narrow sweet spot and it could easily be overwhelmed.”
The 2015 study found the availability of ventilators and ICU beds varied across the country. Canada-wide, the study found 14.9 ventilators for every 100,000 people; the number was as low as 10.1 per 100,000 people in Alberta and as high as 24.4 in Newfoundland and Labrador.
Mr. Fowler said the disparity can be mitigated if health officials are nimble in shifting resources – whether that’s between hospitals in the same city or from one end of the country to the other.
Canada has a National Emergency Strategic Stockpile with equipment including ventilators, medicine and social-service supplies, such as beds and blankets. The stockpile has been used to respond to health emergencies such as the H1N1 outbreak in 2009, as well as during major natural disasters including the Fort McMurray wildfires in 2016.
The Public Health Agency of Canada declined to provide details on the stockpile’s inventory, citing national security concerns.
Prime Minister Justin Trudeau said the federal government’s recently announced $1-billion pandemic plan is intended to help ensure equipment is available when, and where, it is needed. He said officials are currently doing “careful accounting” of available supplies.
“That is an ongoing challenge that we are addressing; we’re going to make sure that people have the support they need,” he said during an interview Sunday on CTV’s Question Period.
Data from the Organization for Economic Co-operation and Development indicate Canada ranks near the bottom of OECD countries when it comes to availability of acute-care beds, which includes intensive care. Canada had 1.95 acute-care beds for every 1,000 people in 2018, and that number has been decreasing steadily since the early 1980s.
British Columbia has 1,272 ventilators distributed across its health regions, according to recently released government statistics. Within that figure, there is a mix of surgical ventilators, devices for transport and home use, and extracorporeal membrane oxygenation machines, which oxygenate a patient’s blood outside of their body. The province has ordered additional ventilators.
In Alberta, the province says there are 477 adult critical-care ventilators with another 50 currently on order, and 78 pediatric critical-care ventilators.
Kevin Smith, president and CEO of University Health Network in Toronto, said most of Ontario’s 1,700 critical-care beds also have ventilators. In addition, the Ontario government has ordered about 300 more, he said, and another 100 are stockpiled.
Sohail Gandhi, president of the Ontario Medical Association, said his team has been in contact with the government daily about planning for an increase in the need for ventilators.
He said that’s why the OMA has recommended that elective surgeries be put on hold so resources are available to those who need them most.
On Sunday, Ontario Health Minister Christine Elliott confirmed the province is requesting all hospitals implement a pandemic plan that includes ramping down elective surgeries and non-emergency activity. “In doing so, hospitals can preserve capacity as cases of COVID-19 continue to grow in Ontario,” she said.
Regarding ICU beds, Dr. Gandhi said “it’s no secret” that hospitals have been stretched to capacity over the past decade.
“I am concerned about a potential increase in the number of beds that are required," he said. "That’s why I’m grateful that we’re doing all of this planning now.”
Deena Hinshaw, Alberta’s Chief Medical Officer, said measures such as the province’s ban on large public events and recommended self-isolation for international travellers are designed to ensure the health system can cope.
“The most important determination of whether we have adequate capacity in our acute-care centres is not the total number of cases that we see over the entire outbreak; it’s the time span in which those cases come,” she said during a briefing on Saturday.
Her counterpart in B.C., Bonnie Henry, said her office is working to ensure it can quickly redistribute supplies. She added that another priority is to protect staff so there enough physicians, specialists and nurses to operate ventilators and life-support machines.
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