Patients with COVID-19 have been showing up in increasing numbers at Alberta hospitals and things remain manageable for the time being, but doctors are bracing for a potential influx that could push the system close to its limits.
“We are preparing for an increase that will certainly test our capacity,” said Dr. Neil Collins, who is handling the pandemic response for emergency departments in the Calgary health zone.
People with COVID-19 symptoms have been showing up at ERs for roughly two weeks now, he said, and a growing number are expected in the coming weeks.
“Some of them have serious respiratory illness and others have mild illness — the whole spectrum,” Collins said of the cases he’s seen to date.
Alberta Health said Wednesday that 29 patients are in hospital with COVID-19, including 13 in intensive care.
Those numbers have been gradually rising since mid-March but are relatively lower than other provinces.
In British Columbia, for example, provincial health officer Dr. Bonnie Henry said Wednesday there are now 142 patients in hospital, including 67 in critical care.
In Quebec, there were 307 people in hospital, including 82 in intensive care, at last count.
Collins said there are provincial models forecasting possible scenarios for the extent of the outbreak in Alberta and some of them include patient volumes that would stretch hospital resources close to capacity.
Reporters have been asking the provincial government for days for the details of those models but it has so far refused to make the information public. Chief Medical Officer of Health Dr. Deena Hinshaw has said there are plans to release the information eventually.
Premier Jason Kenney reiterated that on Wednesday.
“It is our intention to come forward and present Albertans with a fairly detailed briefing on our modelling for the pandemic in Alberta and our capacity to cope with it,” he said. “We think it’s important to be as transparent as we can.”
Other jurisdictions have already shared their modelling data publicly.
B.C., for example, has published some forecasts of peak use of acute-care beds and ventilators. Those models also suggest physical distancing measures have reduced the spread of the COVID-19 in that province, compared to what would have happened without such measures.
On Tuesday, the White House said its models forecast 100,000 to 240,000 people in the United States could die from the disease, even if people follow measures such as physical distancing, and possibly more if they don’t.
Collins said “there’s a lot of smarter people than me working on projections for the volume of patients” in Alberta.
Based on those projections, he said the province has been taking “some extraordinary measures, the likes of which I have not seen in my career,” to free up resources.
Reorganizing health-care resources
All elective surgeries have been cancelled, which Collins said is a “big sacrifice” for both the patients who had been waiting on them and the surgeons whose careers rely on the work.
Hospital wards are also being expanded and some community sites are being prepared to help shoulder the expected health-care needs.
The footprints of emergency departments have also been increased and Collins said “we’re looking at our manpower and our processes to handle the large influx of patients.”
Alberta has also been expanding its inventory of ventilators for the most critically ill patients.
But are there enough?
“It depends on how many people are going to require them,” Collins said. “And that, right now, is a big unknown.”
As for the health of health-care workers, themselves, Collins said there are “really rigorous practices for preventing staff from becoming infected.”
“The province and AHS have given us the tools to protect ourselves during this pandemic,” he said.
Alberta Health Services medical director Dr. Mark Joffe said the province had amassed a significant stockpile of supplies as part of its pandemic planning prior to the COVID-19 outbreak.
“We actually have a three-to-four-month supply of most of the items of personal protective equipment that will be required by our front-line health care workers,” he said.
“The supply is slightly less for the N95 respirators that are used under specific circumstances and, of course, we are in the process of sourcing additional supplies.”
Emergency-room physicians are also preparing schedules that have them working extra shifts, Collins said, and a roster of ER doctors throughout the Bow Valley is being prepared. If needed, he said doctors from outside Calgary will be redeployed to fill gaps in the city, or vice-versa if there are needs at smaller hospitals elsewhere.
Overall, Collins said he is confident that staffing will be maintained.
“We have a very dedicated group of 220 career emerg docs in Calgary,” he said. “We staff four large emergency departments. We take great pride in being able to staff those 24 hours a day, seven days a week on every single day. We’ve done that for the past many years and I don’t see a reason why we won’t be able to do that in the future.”
Discharges and deaths
The hospitalization numbers cited above are the latest, current counts in Alberta and don’t include patients who have been discharged from hospital — or died.
In total, the province says 62 people have ever been hospitalized for COVID-19, including 20 who required intensive care.
Eleven people have died from the disease, according to the latest count from Alberta Health.
A 12th person has also died who is not yet included in that count. Late Wednesday, Revera Living, which operates the McKenzie Towne Long Term Care Home, confirmed that another resident of the facility had succumbed to the disease.
Alberta Health confirmed that person’s death was not yet included in the numbers released Wednesday afternoon.
Collins said the coming days and weeks will be crucial in determining how many people ultimately end up in hospital with COVID-19.
“We need to listen to the leaders in public health and our provincial guidance around social distancing and staying at home right now,” he said.
“We in the health-care business really need the curve to flatten here, and the number of cases to stop increasing exponentially in Alberta.”