Aisha Mirza is an emergency physician at the Gray Nuns Community Hospital, a major Edmonton facility with an intensive care unit. She intubated a patient the other day and then, rather than being transported to the intensive care unit, the individual was loaded into an ambulance.
“I had to transfer them quickly – out of the hospital,” she said. “I was like, ‘I can’t believe this. This patient is not going to intensive care because there is no bed. “
Alberta hospital doctors and nurses are spending more time searching for available beds for their patients as coronavirus victims fill intensive care units, emergency departments and COVID-19 wards .
This week, the number of patients infected with the coronavirus in Alberta’s intensive care units hit a new high, exceeding the number of intensive care beds the province typically had before the pandemic. With the prospect of Alberta within weeks of overtaking intensive care capacity and forcing doctors to ration intensive care, Premier Jason Kenney on Tuesday announced new restrictions aimed at “stopping the peak,” the new government slogan COVID-19. He admitted that Alberta Health Services’ 425 intensive care bed capacity, while physically possible, would result in substandard care at all levels due to staff shortages.
If Albertans play by the rules, doctors should be spared from choosing who is most worthy of life-saving interventions such as breathing assistance. But even so, more than 22,000 people are currently living with COVID-19 in Alberta, including 922 First Nations. Of all those infected, 4.1% end up in hospital, although the rate climbs to 7.6% for First Nations. It will take weeks for the occupancy rate of hospitals and intensive care units to drop to a more manageable level, as admissions delay infections by about two weeks.
“You just have palpitations at work because every patient could turn into a disaster,” Dr. Mirza said. His intubated patient was transported to another hospital in Edmonton.
Across Alberta, 659 COVID-19 patients were hospitalized as of Friday, including 150 in intensive care. The majority of them are in Edmonton and Calgary, in part because patients from rural communities are sent to large cities when they need intensive care.
Parker Vandermeer, a doctor who works in rural northern and central Alberta, said the number of patients seeking treatment in his emergency departments has dropped 25 to 50% since the start of the pandemic . However, COVID-19 and the backlog of patients in cities means cases are more complicated and take longer.
Normally, rural patients requiring intensive care are quickly transferred to better equipped hospitals in large cities. Now it can take up to six hours just to find a hospital capable of absorbing another patient, Dr Vandermeer said.
In some cases, patients who would normally be sent elsewhere stay in rural hospitals because either the urban beds are full or doctors try to keep some open as a cushion. This calculated bet is particularly risky for patients with COVID-19 in rural communities.
“COVID patients can die quickly,” Dr. Vandermeer said. “The patient can go from minimal oxygen requirements to death within hours.”
Rebeccah Rosenblum, a doctor in the emergency department at Royal Alexandra Hospital in Edmonton, said her ward was getting busier as many COVID-19 patients arrive, some with relatively minor symptoms and others who must be intubated and transported immediately to the intensive care unit.
During her last shift, she was working in a different area of the emergency department when she was called to help critically ill COVID-19 patients, including one who needed a breathing tube.
“The doctors who were working… couldn’t keep up,” she said. “We just received too many patients at the same time.”
Alberta released its ICU triage protocol last week, which prioritizes those most likely to survive next year.
The prospect of refusing care is devastating, Dr Rosenblum said, but she believes the new protocol is a necessary step to ensure doctors have advice if that possibility arises. She also believes that everyone will do whatever they can to prevent this from happening.
The intensive care unit at the Peter Lougheed Center, a hospital in northeast Calgary, had 18 intensive care beds funded before the pandemic. The facility added 10 additional beds by doubling some patients and expanding into another area of the hospital.
ICU doctor Daniel Niven says it’s not ideal, but they are coping and it hasn’t affected the level of care they can provide. He is also confident that the hospital still has room to grow if, as expected, admissions continue to rise over the next few weeks.
The biggest problem is exhaustion. Doctors, nurses and other staff have been working hard since Wave 2, with only a brief reprieve when admissions plummeted in the New Year before Wave 3 exploded.
COVID-19 patients typically stay in the intensive care unit longer than a typical intensive care patient, in some cases staying in the unit for a few weeks. And Dr Niven said he and his colleagues are spending more and more time searching for available intensive care beds in the city, where space in various hospitals is essentially managed as a single intensive care unit.
“We didn’t really get too far beyond Wave 2 until Wave 3,” said Dr Niven, who is also an assistant professor in the University of Calgary’s Faculty of Medicine.
“We are definitely preparing to welcome more patients. I think everyone had to improve their game.
Dr Niven is optimistic that a combination of increased vaccinations and recently announced restrictions will mean the province will not need to implement a triage protocol.
Almost a third of Albertans have received at least one dose of the COVID-19 vaccine and as of Monday, everyone in the province aged 12 and over will be eligible.
“There are a lot of mixed feelings. It is certainly reassuring to know that there are tips so that you do not make these ad hoc decisions, ”he said.
“At the same time, when you think about how it would actually be for an individual patient, it’s scary and you hope you don’t have to.”
Deena Hinshaw, Alberta’s chief medical officer of health, said Thursday there was a “distinct possibility” that doctors would be forced to ration intensive care if the province did not impose new restrictions this week. With hospitals still under pressure, she said her biggest concern now was the future consequences of canceled surgeries and residents who avoided or were unable to access treatment for health issues other than COVID. -19 throughout the pandemic. In addition, she is worried about the effect of COVID-19 fatigue on her colleagues in the healthcare system.
“Fatigue in those who work in these intense environments day after day, week after week, month after month,” she told reporters.
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