Good morning. It’s James Keller in Calgary.
As the COVID-19 pandemic continues to strain healthcare systems across the country, healthcare officials have developed triage plans for the worst-case scenario in which hospitals are overwhelmed and doctors need to choose who should receive life-saving care.
Until now, the problem has been theoretical – some provinces, including Alberta and Manitoba, experienced severe second waves in the fall and winter but managed to find enough resources to treat their COVID-19 patients.
In the pandemic’s third wave, infection numbers have skyrocketed and in several provinces surpassed what happened just a few months ago, both in terms of infections but also hospital and intensive-care admissions. In Ontario, the province is setting up field hospitals and installing makeshift ICUs as doctors brace for the possibility that the worst-case scenario could soon become a reality.
In Alberta, the province’s health authority has now released its own triage document, a 50-page guide designed to help teams of doctors evaluate patients to ensure the care goes to those with the best chance of survival.
Alberta Health Services and the province’s Chief Medical Officer of Health, Deena Hinshaw, maintain that the system has capacity to meet the expected demand and they don’t anticipate ever needing to use the protocol. But they say it’s prudent disaster planning that is needed in the unlikely event that the worst-case scenario materializes.
Curtis Johnston, the deputy medical director for the Edmonton health zone, who worked on the document, said if the province ever found itself in a scenario in which the health care system was completely overwhelmed, doctors would be forced to make these decisions anyway. The triage plan provides an objective tool for health care teams to work together to make “distressing” decisions.
“The reality is that if you ever got to that point, you wouldn’t have a choice but to make choices,” Dr. Johnston said in an interview.
The triage plan (which you can read here) prioritizes care for patients with the highest likelihood of survival in the next year. Initially, patients with an 80-per-cent chance of dying would be excluded from ICU care. If capacity were further strained, that would drop to 50 per cent.
There would be no chance for a patient or family to appeal such a decision.
The document was released the same week Premier Jason Kenney enacted new regional health restrictions in the face of record-breaking new case counts. The province is closing junior schools and high schools in several hot spot areas; shutting down gyms, which were limited to personal training; shutting down indoor sport and recreation; and opening up the possibility for curfews in particularly hard-hit regions if a local government requests it.
But for much of the province, not much will change. Older grades are already learning from home in Calgary, Edmonton, Fort McMurray and in several other places. The new school restrictions don’t apply in places such as Banff, which has among the highest per capita infection rates in the province but not the threshold of active cases – 250 – required to be considered a hot spot. And Fort McMurray, the only place in the province that would qualify for a curfew, says it doesn’t want one.
In those places, unless you have been seeing a personal trainer or participating in indoor team sports, you won’t be affected by the new rules.
Many doctors and health researchers say the measures announced Thursday still won’t be enough to stop a wave of hospital and ICU admissions.
Noel Gibney, professor emeritus at the University of Alberta’s medical school and co-chair of the Edmonton zone medical staff association pandemic response committee, said the new measures were merely “theatre” – designed to make it seem as though the government is acting even though the restrictions don’t amount to much.
Dr. Gibney said the provincial government failed to put in strong measures as cases accelerated during the third wave, just as it waited too long to step in during the fall as infections skyrocketed at rates not seen in any other province.
“This is a conscious decision by the Alberta government to let large numbers of people become infected and become seriously and critically ill,” he said.
He said the Premier should have returned the province to the type of widespread shutdown that was in place last spring during the initial wave. Instead, he said, the measures announced on Thursday won’t be enough to stop the coming wave of hospital and ICU admissions.
Michelle Bailey, president of the Alberta Medical Association’s pediatrics section, said this week’s announcement does not go far enough. Dr. Bailey was among the signatories of a letter to the Premier released on Thursday that called for a series of measures such as shutting down non-essential businesses and providing increased supports such as paid sick leave.
“We remain very concerned that these measures aren’t enough to bend the curve,” she said. “They did not seem to be a particularly major addition to what was already happening.”
This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.