Ontario hospitals, despite an unprecedented strain from COVID-19, will likely escape the third wave of the pandemic without resorting to a triage protocol that would have forced doctors to decide who lives and who dies, according to a note obtained by The Globe and Mail.
Doctors and hospital officials warn weeks of severe public health restrictions are still needed to continue to slow the spread of the virus. Hospitals will also need to continue to ramp up their already swollen intensive care capacity, postponing elective operations and helicopter patients from facilities stranded in hot spots to other beds in the province.
Ontario had 881 COVID-19 patients in its intensive care units on Monday, more than double the total from just a month ago. But the rate of increase appears to be slowing. (In all, there were just over 2,000 patients of all kinds in ICUs across the province.)
In a message to hospital CEOs dated May 2, Andrew Baker, the province’s COVID-19 intensive care command center incident commander, says recent provincial modeling is still “of concern,” even though it shows a lower estimated number of COVID-19 ICU admissions than two weeks ago.
The memo calls on hospitals to put into service an additional 284 ICU beds, already identified as ready for use in the short term, and to prepare to receive more transferred patients. And it says the command center will monitor staffing levels and the effects of recent moves to move more elderly patients to long-term care homes, to determine whether hospitals should try to build even more capacity for nursing home. intensive care.
But the memo adds that it now seems that the worst can be avoided: “I also wanted to share with you and your teams that we are increasingly convinced that we will not need to activate the standard of care of emergency or recommend the use of the triage protocol. “
Requests for comment from Dr Baker, who heads the intensive care unit at St. Michael’s Hospital in Toronto, were referred to Ontario Health, the government agency that oversees health care in the province.
Ontario Health executive vice-president Chris Simpson, also a cardiologist in Kingston, said the worst-case scenario of the province’s most recent COVID-19 external science table – which projected the potential for more than 1,400 COVID-19 patients in the province. Intensive care units by month’s end – would mean triage may be needed.
But the province appears to be following the mid-range modeling scenario, in which ICU admissions peak at around 1,000 before gradually declining.
“I think that scenario, if it were to play out, takes us away from triage tool territory,” Dr. Simpson said. “But only because of the additional capacity we were able to bring online.”
He warned that the constraints on the system were already having effects on the quality of care for patients. He also expressed concern that there could be “enormous pressure” to reopen the province too quickly if cases continue to level off or decline. This could, he warned, plunge the province into a fourth wave.
Kevin Smith, president and CEO of the University Health Network, which includes Toronto General, Toronto Western and Princess Margaret Hospitals, said that while the numbers appear to be leveling off, hospitals and their staff are above normal limits. To avoid the worst, he said Ontarians must continue to follow strict public health rules, get vaccinated as quickly as possible and not let their guard down over the long weekend in May.
“I would definitely hate anyone who thinks this is the time to relax,” he said. “This is absolutely not the case.”
Anthony Dale, president and CEO of the Ontario Hospital Association, said the science table’s forecast is a source of hope, noting that the daily number of new infections has moderated. (Ontario recorded 3,436 new cases on Monday, up from a high of over 4,800 in mid-April.)
But he said nothing about COVID-19 could be taken for granted. Even if these encouraging trends continue, he said, the healthcare system will still be in a state of massive disruption for months, noting that more than 250,000 operations have been postponed in the pandemic.
“There is nothing natural or normal about all of this,” Dale said.
Ontario’s triage protocol has been clouded by secrecy. A draft was only made public after a leaked copy was obtained by a disability rights group. According to the plans, incoming patients would be assessed for their likelihood of survival after 12 months. Those with the best chances would be given priority for intensive care beds.
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