Toronto area hospitals are redeploying hundreds of doctors, nurses and other health workers to care for critically ill COVID-19 patients — with one bringing in physicians from northern Ontario — to keep pace with the ongoing flood of patients with the virus.
Weeks into the third wave, doctors say the number of patients coming to hospital is accelerating, many arriving sicker, needing care faster, putting an increasing burden on emergency departments already struggling to cope.
Some GTA hospitals are treating severely ill COVID-19 patients in hallways, with others reporting entire families coming to emergency departments needing urgent care.
The mounting challenge of finding intensive care beds comes even as paramedics are transferring a record number of patients from overburdened hospitals. Between April 1 and 13, paramedics transported 327 patients to create ICU capacity, more than any other month in the pandemic.
“This is beyond what we’ve ever anticipated,” said Dr. Steven Jackson, chief of staff at Mackenzie Health, which includes the Richmond Hill Hospital and the new Vaughan Cortellucci Hospital, currently serving as a COVID-19 overflow site. Intensive care units at both hospitals are at capacity and staff, including anesthesiologists and surgeons, are being redeployed to care for COVID-19 patients.
“The projections show us something beyond our comprehension: That we will run out of capacity. We don’t want to institute the critical care triage protocols, where we actually have to ration care and decide what patient gets the life saving support, and which patient does not.
“We’re going to do everything we possibly can to be as creative as possible to avoid that dire scenario.”
Provincial modelling released earlier this month predicts as many as 800 or 900 COVID-ICU patients in the coming weeks, though current daily case counts will push those numbers even higher. As of Wednesday, there were 635 adults with COVID-19 in Ontario ICUs.
On Monday, Health Minister Christine Elliott said recent moves by the province, including the ramp down of scheduled surgeries and an emergency order allowing patients to be transferred without consent, would create an additional 350 critical care beds.
But hospital leaders and front-line health workers say it’s increasingly difficult to find enough specialized staff, including critical care nurses and respiratory therapists, for the influx of severely ill COVID-19 patients.
“The challenge is there isn’t really an adequate human resource pool to be able to staff those beds, particularly given the fact that the care needs for critically ill COVID-patients are so significant,” said Dr. Kyle Vojdani, chief and medical director of emergency medicine at Toronto’s Michael Garron Hospital.
“When we hit that top number of ICU beds, because we don’t have the nurses or critical care physicians or PSWs to support them, patients don’t stop coming. They bottleneck in the emergency department. And when they bottleneck, the only thing that starts to happen is our ability to deliver care will drop.”
In the last two weeks, the number of patients coming to Michael Garron’s emergency department has “increased significantly,” with numbers so high some days that COVID-19 patients are being treated in hallways and in waiting rooms while waiting for beds elsewhere in the hospital, Vojdani said.
This year, the hospital doubled its emergency capacity, increasing its physical space, number of beds and staffing, but still can’t keep up with demand in the third wave, he said.
The department also has two or three emergency physicians on call every day for backup, he said, noting there are plans to add surge ICU capacity to the ER, including caring for intubated COVID-19 patients.
“When we look ahead it’s a very dark picture, but it is the reality of what is happening,” he said.
Peel’s William Osler Health System — among the hardest-hit hospitals in the province — on Wednesday was caring for 170 acutely ill COVID-19 patients across its two sites, a record number in the pandemic.
In a recent 24-hour period, Osler admitted 25 COVID-19 patients and is recently seeing whole families admitted, said Dr. Andrew Healey, Osler’s chief of emergency services.
“We are seeing that more and more with the variants of concern,” he said, adding many patients are coming to hospital with “a high level of acuity,” meaning they are very sick.
“We recently had one family where we admitted the mother and sent the father home with an oximeter (a device to monitor blood-oxygen levels) — both were in their 70s — and their son, who is in his 30s, is at Sick Kids on a ventilator.”
Earlier this month, Toronto’s Hospital for Sick Children opened an eight-bed ICU for younger adults with COVID-19 that was full within days. On April 12, Sick Kids started to accept pediatric in-patients from GTA hospitals that needed to clear beds for COVID-19 patients; so far, it has received 25 patients, a spokesperson confirmed to the Star.
In the last two weeks, Osler, which includes Brampton Civic Hospital and Etobicoke General Hospital, has transferred 60 per cent of its admitted COVID-ICU patients and 40 per cent of patients on COVID wards to free up beds for those coming into the emergency departments, said Healey, also a critical care physician.
“We’re dangerously close to not being able to manage the patients that present to our hospital’s front door,” he said.
The mass transfer of critically ill patients out of overwhelmed hospitals — both within the GTA and outside the region — has intensified in recent weeks. On Monday, The Ottawa Hospital confirmed hospitals in the region had started accepting patients from the GTA.
Between April 1 and 13, paramedics transferred 327 patients to create ICU capacity, according to a spokesperson for Ornge, the province’s air ambulance service. In March, 242 patients were transported in total, the spokesperson said.
On April 12, Osler asked for physician volunteers to work alongside ICU nurses as a way to immediately add more staff to stressed units, Healey said. Among those volunteering to take on nursing duties include anesthesiologists, cardiologists, gastroenterologists, family physicians and emergency physicians, he said.
“Two nights ago, a radiologist did a shift on the COVID ward looking after (COVID) patients,” Healey said. “Up until now they’ve been looking at the X-rays and CT scans of COVID patients and now they are seeing them up close.”
Physician colleagues from across the province and Canada have offered help to Osler and two critical care doctors from northern Ontario will soon be working in the hospital for two weeks, Healey said.
A field hospital at Sunnybrook Health Sciences Centre with capacity for up to 84 beds is expected to open at the end of this month. Right now, the plan for the mobile unit, built in a parking lot, is to have beds for 20 patients recovering from COVID-19, according to a news release from the hospital.
Ru Taggar, executive vice-president and chief nursing and health professions executive at Sunnybrook, said the hospital is in its second tier of staff redeployment to help manage the increase in COVID-19 patients, with more steps likely to come.
On April 5, Sunnybrook reduced surgical activity at its Holland Centre site to redeploy its staff to other parts of the hospital, and so it could take in patients from its main site who are awaiting transfer to a long-term-care home, Taggar said.
The move will free up more beds for COVID-19 patients; so far Holland Centre has accepted 12 patients with capacity for up to 16 more, she said. As well, she added, about 26 of its operating room staff are in the process of being moved into other units to help with staffing pressures.
“I’m concerned about our ability to continue to adapt to the rising volumes of patients, which are happening rapidly,” Taggar said. “Our teams are tired. Every redeployment of a team or a staff member is a significant change; their resilience is being challenged right now.”
As of Wednesday, Mackenzie Richmond Hill is caring for 66 COVID-19 patients, including 15 in the ICU. At Vaughan Cortellucci Hospital, there are 85 patients with the virus, all of whom have been transferred in as the new hospital has yet to open its emergency department.
Jackson, also vice-president of medical planning, said there are plans to add more ICU beds to the Vaughan site, but staffing remains a challenge, which is why Mackenzie Health is asking for physician volunteers from the hospital and community.
“We would have one ICU doctor overseeing three or four surgeons or anesthesiologists or internal medicine doctors,” he said, noting the hospital has already adopted a similar team-based model for nursing, with a critical care nurse supervising four or five other nurses who typically don’t work in the ICU. “This allows us to look after a larger number of patients.”