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Gauges to regulate oxygen on a ventilator are seen at a lab run by the University Health Network in Toronto, in this file photo.

Chris Helgren/Reuters

Health ministries across Canada are unearthing unused ventilators from government stockpiles and rushing to buy some of the few still for sale as they work to put to rest doubts about whether Canada has enough intensive care beds and ventilators to cope with the coronavirus pandemic.

Even in British Columbia, where detailed modelling released last week showed the province would likely manage comfortably, Provincial Health Officer Bonnie Henry said she will remain confident as long as people stick with the restrictive social-distancing measures that she credited with keeping the case numbers from exploding.

“We feel that the planning that is being done should allow us to adequately care for everybody who needs it,” she said at a briefing where the province released the models, which compared the growth of cases in B.C. with those of Hubei province in China and northern Italy.

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Other modelling has raised questions about whether Canada has enough intensive-care capacity and ventilators. A report from Toronto’s University Health Network says if cases in Canada increase at the rate seen in Italy, Ontario’s critical-care wards could be overwhelmed.

If the numbers progress more slowly, with 25 per cent daily increase in cases, capacity would also soon be exhausted, said one of the report’s co-authors, Beate Sander, a UHN scientist.

But under the second scenario, capacity would return because the peak of the pandemic would be spread over a longer period. If physical distancing keeps the rate of growth at 15 per cent a day, resources will be sufficient.

The effectiveness of closing schools and distancing measures will determine which path we end up on, Dr. Sander said. Her calculations are based on assumptions such as the number of beds and ventilators, which can change as health-care systems adjust capacity.

“I feel like I’m holding my breath for what will happen in the next seven to 10 days,” Dr. Sander said.

Provinces are doing what they can to find more ventilators. Alberta, which has 477 adult critical care ventilators, expects to receive another 50 from suppliers by April 8. Ontario recently ordered 800 ventilators, and has an unallocated surplus of 210 that will be deployed where needed. Canadian companies are being enlisted to help build ventilators quickly.

Kevin Smith, chief executive officer of the UHN, estimates that Ontario could have more than 3,000 ventilators once additional sources are tapped.

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“I think it will be enough,” Dr. Smith said.

As of last Friday, British Columbia had 914 ventilator-capable critical care beds. But the number available for COVID-19 patients in the province’s main hospitals is 348 – the others are in use, are designed for children or transport services, or are in smaller regions. That would be enough to meet the peak demand of 271 adults that would require ventilation under the Hubei model.

B.C. is also preparing for the numbers to surge as they have in Italy, a scenario that would require other patients to be moved from hospitals to alternate facilities. The province ordered 120 new ventilators on March 5, but so far has secured just 15. In the meantime, it has refurbished old machines.

Dr. Henry said the most likely scenario in B.C. would look more like that of Hubei than the surge of cases that has overwhelmed hospitals in northern Italy.

Number of ventilators across provinces

Per 100,000 population

Currently in use

On order

B.C.

18

2

Alta.

11

1

Sask.

8

21

Man.

20

1

Ont.

15

3

Que.

35

N.B.

21

10

N.S.

28

14

PEI

12

N.L.

30

THE GLOBE AND MAIL, SOURCE: STATISTICS

CANADA; HEALTH MINISTRIES

Number of ventilators across provinces

Per 100,000 population

Currently in use

On order

B.C.

18

2

Alta.

11

1

Sask.

8

21

Man.

20

1

Ont.

15

3

Que.

35

N.B.

21

10

N.S.

28

14

PEI

12

N.L.

30

THE GLOBE AND MAIL, SOURCE: STATISTICS

CANADA; HEALTH MINISTRIES

Number of ventilators across provinces

Per 100,000 population

Currently in use

On order

B.C.

18

2

Alta.

11

1

Sask.

8

21

Man.

20

1

Ont.

15

3

Que.

35

N.B.

21

10

N.S.

28

14

PEI

12

N.L.

30

THE GLOBE AND MAIL, SOURCE: STATISTICS CANADA; HEALTH MINISTRIES

That’s because the province emptied more than one-third of its acute-care beds over the past two weeks, and because of social distancing.

“I’m starting to see some glimmers of hope that we’ve flattened out our increase, our trajectory has leveled off a bit,” she said.

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Robert Fowler, a physician and senior scientist at Toronto’s Sunnybrook Health Sciences Centre, co-wrote a research paper on Canadian ventilator capacity in 2015. He said supply has improved since 2015, “but not as much as we might need in the weeks ahead.”

Dr. Fowler said critical-care ventilation can probably be increased by 50 per cent to 100 per cent by cancelling elective surgery, ensuring all ventilators are used, repurposing machines that are capable of performing ventilation and drawing on emergency supplies.

The government of Canada maintains an emergency stockpile of ventilators in warehouses around the country, but the number is considered a security secret.

Intensive-care doctors are also contemplating the possibility of placing more than one patient on a single ventilator, which would be unusual for a Canadian hospital.

“We’ve all seen in the media some cases where they split the ventilator and put four people on a ventilator,” Dr. Smith said. “We just have to make sure that we don’t run the risk of harming patients by doing so. But that work is under way to analyze it.”

Canadian intensive-care units are designed to function at or near capacity with little excess. And the kind of patients who require ventilation in normal times will still be there when the COVID-19 surge arrives.

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So how much of an increase can the system handle?

"You can’t beat a pandemic fight in the ICU, but you can certainly know when you are losing one,” Dr. Fowler said. “It’s not just the [ventilator]. You need people to operate it.”

Canadian ICUs typically have a ratio of one nurse to one or two patients, and an adequate supply of respiratory therapists to help run the machines and ensure patients can breathe. There’s usually one physician for 10 to 15 patients. A surge would severely test those ratios.

Dr. Fowler said the disease may peak in different regions at different times, so people and resources could be moved as needed.

“We have to figure out how we're going to share capacity,” Dr. Fowler said.

Kathleen Ross, president of Doctors of BC, the provincial physicians’ association, said she is more concerned about staffing and physical space for hospital patients right now than the number of ventilators.

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“Will we have enough nurses and physicians, trained to both use the machines to support patients, but also to have the knowledge and experience to respond to the reading on those machines? What we’re trying to do is understand what is our potential workforce, should we need to call upon physicians who are recently retired.”

In B.C., the first Canadian province where the pandemic was felt, Health Minister Adrian Dix said health-care workers need Canadians to do their part to keep the virus from spreading.

“One hundred per cent all-in. That’s how we change the projection to the better, 100 per cent all in. That’s how we deal together with COVID-19 in the coming days, weeks, and months.”

HOW A VENTILATOR WORKS

COVID-19 can cause severe respiratory problems, where the oxygen levels in the blood may drop too low or the carbon dioxide levels may rise too high. Either of these conditions can result in damage to vital organs, including the heart and brain. Under these circumstances, the patient may need additional breathing support through mechanical ventilation. First step in mechanical ventilation is endotracheal intubation

The patient’s head is tilted back slightly and a laryngoscope is inserted through the mouth and down into the throat

With the laryngoscope as a guide, the endotracheal tube is then inserted into the trachea

When the tube is in proper position, a small balloon surrounding the tube is inflated to make sure it remains in place

LUNGS

TRACHEA

LARYNGOSCOPE

The laryngoscope is removed and the tube is taped to the corner of the patient’s mouth. The doctor uses a special bag to inflate the lungs to confirm the tube is in proper position

When it’s determined that the tube is in proper position, it is attached to the mechanical ventilator where oxygen and carbon dioxide levels in the blood are closely monitored

The ventilator delivers well oxygenated air and allows carbon dioxide to escape from the lungs

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: NUCLEUS MEDICAL MEDIA

HOW A VENTILATOR WORKS

COVID-19 can cause severe respiratory problems, where the oxygen levels in the blood may drop too low or the carbon dioxide levels may rise too high. Either of these conditions can result in damage to vital organs, including the heart and brain. Under these circumstances, the patient may need additional breathing support through mechanical ventilation. First step in mechanical ventilation is endotracheal intubation

The patient’s head is tilted back slightly and a laryngoscope is inserted through the mouth and down into the throat

With the laryngoscope as a guide, the endotracheal tube is then inserted into the trachea

When the tube is in proper position, a small balloon surrounding the tube is inflated to make sure it remains in place

LUNGS

TRACHEA

LARYNGOSCOPE

The laryngoscope is removed and the tube is taped to the corner of the patient’s mouth. The doctor uses a special bag to inflate the lungs to confirm the tube is in proper position

When it’s determined that the tube is in proper position, it is attached to the mechanical ventilator where oxygen and carbon dioxide levels in the blood are closely monitored

The ventilator delivers well oxygenated air and allows carbon dioxide to escape from the lungs

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: NUCLEUS MEDICAL MEDIA

HOW A VENTILATOR WORKS

COVID-19 can cause severe respiratory problems, where the oxygen levels in the blood may drop too low or the carbon dioxide levels may rise too high. Either of these conditions can result in damage to vital organs, including the heart and brain. Under these circumstances, the patient may need additional breathing support through mechanical ventilation. First step in mechanical ventilation is endotracheal intubation

The patient’s head is tilted back slightly and a laryngoscope is inserted through the mouth and down into the throat

With the laryngoscope as a guide, the endotracheal tube is then inserted into the trachea

When the tube is in proper position, a small balloon surrounding the tube is inflated to make sure it remains in place

LUNGS

TRACHEA

LARYNGOSCOPE

The laryngoscope is removed and the tube is taped to the corner of the patient’s mouth. The doctor uses a special bag to inflate the lungs to confirm the tube is in proper position

When it’s determined that the tube is in proper position, it is attached to the mechanical ventilator where oxygen and carbon dioxide levels in the blood are closely monitored

The ventilator delivers well oxygenated air and allows carbon dioxide to escape from the lungs

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: NUCLEUS MEDICAL MEDIA

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