More than 400 beds have been made available for the sickest COVID-19 patients who are expected to soon flood Ontario hospitals, provincial health officials say.
Even more critical care beds, equipped with ventilators to assist with breathing, are being created in anticipation that the pandemic is about to hit the province hard, a news teleconference was told Friday.
Leaders of the province’s “COVID-19 Command Table” said plans are also being made for a worst-case scenario, such as those experienced in jurisdictions such as Italy where the number of required ventilators exceeded the number available.
“We are creating as much critical-care capacity as possible,” said deputy health minister, Helen Angus, who is co-chairing the command table.
As international research on the coronavirus accumulates, more is being learned about the outcomes of patients treated on ventilators, explained Kevin Smith, president of the University Health Network. He is co-chairing what is known as the “Critical Care COVID-19 Table.”
There is a small proportion of patients who don’t survive even with the breathing assistance from ventilators, he noted.
“If we find ourselves in a worst-case situation like Italy and other jurisdictions have found themselves in, it will be important to (determine) whether or not a patient should even go on a ventilator or on other advanced forms of life support,” he said.
Accumulating evidence is showing that patients who are ill even before contracting the virus, particularly those over 80 who have co-morbidities or multiple illnesses, do not fare well, even with the assistance of a ventilator, Smith said.
This includes people with advanced heart and lung disease, including chronic obstructive pulmonary disease.
Healthcare planners are now studying if care should be withheld under an ethical framework, Smith said.
The thorny issue needs to be addressed so that front-line clinicians are not left to make decisions on rationing care.
Such decisions would be dictated by guidelines established in advance “before we start what might be considered futile care,” Smith said.
“If we ran out of ventilators that would be a process we would have to consider,” he told reporters.
He hastened to add that there will be no age cut off for ventilators. Some parts of Italy have restricted use of ventilators to those under age 80, or even under age 60.
Health-care leaders hope it never comes to pass that any treatment options would be withheld from anyone, Smith said.
But that’s up to Canadians and their willingness to abide by public health recommendations on physical distancing and self isolation, he said.
The 400 critical care beds for COVIID-19 patients were made available through such means as cancelling elective surgeries.
In total, the province currently has upward of 2,900 ventilators, including those already in use in intensive care units, those from an emergency stockpile created after the 2003 SARS epidemic, and those used in schools that teach health-care workers. This also includes about 400 anesthesia machines, which are equipped with both ventilators and monitors.
The province expects to get access to 200 ventilators from the federal government’s stockpile.
So far, only 40 of about 800 ventilators ordered from “industrial partners” have been delivered. “It will take months” to get the remaining, said Matt Anderson, president of Ontario Health and co-chair of the COVID-19 Command Table, explaining that some are coming from manufacturers in different parts of Canada and around the world.
Hospitals are continuing to increase capacity by “decanting” alternative-level-of-care, or ALC patients, Anderson said.
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They are being moved to long-term-care homes, retirement homes and in some cases are going back home to live with relatives.
Discussions are underway with hotels to move some there.
Consideration is also being given to the creation of “field hospitals” should demands on the hosptial sector continue to mount, Anderson said. These could take the form of tents located beside hospitals. They would not be for COVID-19 patients, but could, for example, help out emergency departments.
Smith said that “heated garages” or large open manufacturing spaces could also be used.
“All of those (options) are on the table if the curve isn’t flattened,” he said.