As Ontario hospitals rush to make space in anticipation of a surge in patients sick with COVID-19, one region northwest of Toronto has already exhausted its inventory of ventilators that it had before the coronavirus began spreading throughout the province.
The Central West Local Health Integration Network, which includes hospitals in north Etobicoke, Brampton and Orangeville, is operating at 127 per cent of its baseline capacity of critical care beds with ventilators, according to April 1 data collected by a government body.
This comes at a time when demand for critical care beds across the province is nearing 80 per cent of pre-pandemic capacity, even as experts say the number of new COVID-19 cases in Ontario has not yet peaked.
The data shows there are 33 patients currently on ventilators in the Central West region, but the hospitals within that area only had 26 machines. The data does not include how many ventilators the hospitals have added in response to COVID-19.
The hospitals — including William Osler Health System’s facilities in Etobicoke and Brampton, and Headwaters Health Care Centre in Orangeville — did not respond to questions about their current ventilator capacities by deadline.
That one health network is already under such strain should be a “red alert” for hospitals across the Greater Toronto Area, said Dionne Aleman, a University of Toronto professor and expert in pandemic modelling.
“Once we start running out of ventilators, then doctors have to make choices about who gets a ventilator among the next, say, two people who show up at the hospital who need one, and our doctors should never be put in a position where they have to make that judgment,” Aleman said.
Dr. Barbara Yaffe, Ontario’s associated chief medical officer of health, told reporters Thursday that 405 confirmed COVID-19 patients have been hospitalized in the province, with 167 in intensive care, 112 of whom are on ventilators. Another 165 patients on ventilators had suspected cases of COVID-19, according to provincial data from April 1.
This data monitoring the province’s available critical care beds and ventilators is distributed to hospitals daily by Critical Care Services Ontario, an agency that emerged from the SARS crisis to help the health-care system better manage these limited, intensive-care resources. The data has not been publicly released, but some doctors with access are sharing it online.
A ministry of health spokesperson said Thursday the province currently has 1,384 intensive-care beds equipped with ventilation for adults and pediatric patients. In addition, there are 210 ventilators currently stockpiled and ready for distribution to hospitals, while an additional 300 have been procured, the spokesperson said.
Meanwhile, the province recently placed an order with medical equipment company O-Two Medical Technologies for 10,000 ventilator units, he added.
Hospitals across the province have been freeing up capacity by cancelling elective surgeries, ordering more supplies and clearing space for potential use by a surge of sick patients. Some are taking advantage of new permissions given by the government to use space in other buildings, such as retirement homes and hotels, provided certain conditions are met. At Joseph Brant Hospital in Burlington, for example, COVID-19 surge patients will be allocated to a 93-bed, $ 2-million modular structure currently under construction on the hospital grounds.
Speaking to reporters Thursday, Dr. David Williams, Ontario’s chief medical officer of health, noted that there is always demand for ventilators in the health-care system, even without the added burden of COVID-19. And even though the province has cancelled elective surgeries, he said that doesn’t stop other health conditions requiring ventilation from continually presenting at hospitals.
“Even before we came to this phase, ventilators, for the most part, were very highly used,” he said.
As for how additional ventilators are distributed, Williams said one way would be to ensure they are sent to areas that have capacity — not just for the machines, but also rooms to put them in and staff to run them.
“So you want to go and give them to the organizations that have the greatest surge capacity,” he said, adding that if “all of a sudden you’re going to double your ventilator capacity, you have to have more than just the ventilators, you need other things in place.”
A New England Journal of Medicine study of Seattle-area hospitals found 75 per cent of the COVID-19 patients admitted to intensive care needed “invasive mechanical ventilation” — a tube stuck down their windpipe so they could breathe. The median number of days the patients spent on ventilators was 10.
The coronavirus attacks the lower respiratory tracts of these patients, damaging the lung walls’s tiny air sacs, through which oxygen enters the bloodstream. The damage leads to fluid building up, making it harder to transfer oxygen to organs that need it. The ventilators make sure the patient gets enough oxygen.
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Across the province, 47 per cent of the patients undergoing invasive ventilation have confirmed or suspected cases of COVID-19, according to the April 1 data. That is roughly the same ratio in the Central West region, where hospitals saw a jump from five confirmed or suspected cases needing ventilation to 15 in three days.
Modest influxes of critically ill patients can cause havoc for Ontario hospitals, many of which are operating at 90 per cent capacity on a normal day, said U of T’s Aleman.
“Our system doesn’t have the capacity to handle a modest increase because they’re already running so close to the edge. We’ve been asking our hospitals to run leaner and leaner on smaller budgets, something like this is really only inevitable,” she said.
Todd Coleman, an epidemiologist and assistant professor in health sciences at Wilfrid Laurier University, told the Star the ever-decreasing baseline critical care capacity worries him.
“We still don’t see any of the plateauing that we would expect to see within an epidemic curve. It really is anyone’s guess as to how many more people are going to get (COVID-19),” he said, adding that as more people contract the virus, a percentage of those will be critical cases, “which means that the number of required ventilators is also going to creep up.”
“The urgency on this is really key right now.”