In a lull before the dreaded COVID-19 storm, the Canadian health care system is working hard to secure critical supplies


It’s calm before the storm, the fake war or maybe just a piece of luck.

The much-feared increase in COVID-19 cases has yet to overwhelm the Canadian health care system as it did in Italy or New York. But the system only treats this as a respite, and works feverishly to try to gather protective gear, hospital beds, breathing apparatus and other necessary resources if and when the storm hits.

As doctors, nurses and other medical personnel prepare for the potential attack, opinions are divided as to whether Canadian hospitals will in fact be ready.

“We all work very, very hard,” said Dr. Alison Fox-Robichaud of the Canadian Critical Care Society, just after a call with ventilator manufacturers. “What I hope is that we have flattened the curve enough for us to be well prepared if we get a push. “

But at the same time, said the professor at McMaster University, “I would say we plan when we don’t have enough.”

In fact, a leaked Ontario government document spoke of how fans could be rationed if the system was overwhelmed.

Others are more direct in their assessment.

“Doctors, nurses and front-line workers tell us they don’t feel sufficiently prepared,” said Dr. Sandy Buchman, President of the Canadian Medical Association. “We are deeply concerned that the equipment we are trying to put in the pipeline is not there on time. “

A Montreal anesthesiologist complained, who asked not to be named, “We don’t have enough and the government should have dealt with it in January, not now. “

Despite this, there is a wary optimism, in at least some circles, about the preparation of health care for a major spike in critically ill COVID-19 patients.

Some critical care physicians and public health officials in the three provinces most infected with the virus say they think there are enough beds and respirators in the ICU, especially if the epidemic curve is kept flatter than in some of the most affected jurisdictions in the world. All invite the public to help by maintaining social distance.

A healthcare worker outside the emergency department at Vancouver General Hospital, March 30, 2020.

Jonathan Hayward / The Canadian Press

A certain concern is the availability of masks and visors, among the most important personal protective equipment for health workers.

Staff at some hospitals are already limited to using only two disposable masks per day, and Buchman said he has heard of facilities that only have a two or three day supply.

“I have easier access to narcotics than N95 masks,” said Dr. Yoanna Skrobik, professor of critical medicine at the University of Montreal.

When he last checked, his hospital did not have Plexiglas visors, which were used to work near infected patients who could expel aerosolized particles.

Dr. Alan Drummond said that the hospital in Perth, Ontario, where he works part-time in the emergency department, has a limit of two masks per shift, even though the Ontario Minister of Health, Christine Elliott, recently insisted that the equipment was not rationed. .

Government response has been disjointed, progressive and reactive

“I wouldn’t say they lied to us, but they weren’t honest,” said Drummond, spokesperson for the Canadian Association of Emergency Physicians. “The government’s response has been disjointed, progressive and reactive. We receive cross messages from the start, and the government has been slow to respond. “

He recognizes that at the moment there is a kind of lull, at least in an emergency. Many departments across Canada are in fact unusually quiet, he said.

Two factors appear to have temporarily eased the pressure on hospitals: social distancing which, according to some data, has reduced the number of new infections and the cancellation of elective surgeries and other measures which have reduced the patient population in hospitals .

But, said Drummond, “there is a very distinct and palpable feeling of calm before the storm.”

If Canada, or parts of it, experiences a wave of very ill COVID-19 patients like southern Europe or New York, evidence from these locations indicates that the tightening will occur in intensive care units , where the two to three percent of the sickest patients end up.

Overall, this country has more intensive care beds per 100,000 population – about 14 – than some western European countries, including Italy and Spain, and the United Kingdom, but less than Belgium, Germany – 25 – and the United States – 20, according to the Canadian Institute for Health Information.

So to what extent are the three provinces with the most cases specifically prepared, based on the limited data available publicly?

Quebec has 1,100 intensive care beds and 3,000 ventilators, which means that additional respirators could be used to convert ordinary room beds to intensive care beds, said Dr. Frederick D’Aragon, a doctor in intensive care and Quebec spokesperson for the national specialty society.

“I think in Quebec we are in a very good position,” he said on Monday, one day before the number of positive COVIDs in his province jumped by more than 700 cases. “I think we have sufficient resources.”

Ontario has 3,250 fans and 800 more on order. Her overall hospitalization rate has dropped to around 77% of her capacity, about 20% below normal, and her intensive care beds to 68%, which means 400 of them are available, according to a briefing. provincial technique last week.

British Columbia is the only province that has released its projections for various scenarios, with a message of hope. It has 308 intensive care beds and more than 1,270 ventilators. If it faces an outbreak like the one in Wuhan, China, it could accommodate the flood in its current intensive care network. It could also handle a worse scenario like northern Italy by using more hospitals and moving patients, the province said last week.

There is a feeling of very clear and palpable calm before the storm

Prime Minister Justin Trudeau and other government officials have touted various plans to increase the supply of personal protective equipment and ventilators.

Skrobik said Ottawa could do more by speeding up the approval of new, innovative medical devices. It is part of the Code Life Ventilator Challenge, a Montreal-based initiative that challenged designers to offer a simple, reliable and easy-to-manufacture ventilator. The deadline for entries was Tuesday, but current regulatory rules could mean it will take months for the winner to be approved, she said.

Meanwhile, Fox-Robichaud says ordinary Canadians can play a role in wondering if – if COVID-19 makes them desperately sick – they would really like to receive intensive treatment, such as getting a ventilator with a tube stuck in the throat.

“This virus kills not only the elderly, but the young, and everyone must have an understanding … would they want everything we do in intensive care?” she said. “Even on the other hand, people who survive a serious illness are left with significant disabilities. “

((Amended April 1 at 9:20 a.m. to correct Dr. Alison Fox-Robichaud’s first name.)


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