DOCTORS HAVE BEEN BRACING FOR A DELUGE OF DESPERATELY SICK COVID-19 PATIENTS WHO WILL OVERWHELM RESOURCES, BUT SOME PHYSICIANS IN THE HARDEST-HIT PROVINCES SAY THEY HAVE YET TO FACE THAT FEARED SURGE.

No surge yet, but slow rise could still fill care units

They have been bracing for the worst, a deluge of desperately sick COVID-19 patients who overwhelm resources and lead to chilling decisions over who gets life-saving care.

Doctors, nurses and other staff who run the nation’s intensive-care units have feared for their own safety, too, amid shortages of protective equipment.

But, perhaps surprisingly, some critical-care physicians in the hardest-hit provinces say they have yet to face that feared surge. So far, at least, there is no flood, and plenty of available ICU beds.

In Ontario, almost 78 per cent of the province’s expanded ventilator capacity remained free. The patient volume was well under the “best case” scenario depicted in Ontario-government epidemic modelling released this month.

Quebec has seen a modest eight to 10 COVID-19 admissions a day to the ICU recently, and none at all from April 7 to April 8, said Dr. Frédérick D’aragon of the University of Sherbrooke, his province’s spokesman for the Canadian Critical Care Society.

“In my centre, we have still a lot of empty beds in the ICU,” said D’Aragon late last week. “That is a surprise. We changed all our schedules, our ICU schedules three weeks ago, to be on call. We cancelled all the teaching classes, all other administrative activities … So far, today, I’m at home. It’s not what we expected.”

At Toronto’s Sunnybrook Health Sciences Centre, which treated Canada’s firstknown COVID-19 patient, no one is taking anything for granted, but the intensive-care unit is definitely not overrun, said Dr. Gordon Rubenfeld, a critical-care physician there.

“Is Sunnybrook right now being stressed by the number of COVID patients? … “I would say ‘No,’ ” he said. “I’m cautiously optimistic we’re not going to see the giant surge and nightmare that we’ve seen in Italy and New York.”

Critical-care doctors are quick to add caveats — that the worst may still be to come, and that even the slow daily accumulation of COVID-19 patients, who often spend weeks on a ventilator, could gradually fill up ICUs.

And the fact every new critical-care patient is treated as a PUI — person under investigation for COVID-19 — means staff must constantly don protective equipment, a stressful and time-consuming process, he said.

Physicians also note it is crucial for people to abide by stay-at-home directives, which they suspect have suppressed the number of patients. But even so, the dearth of apocalyptic scenes in Canada’s ICUs seems to offer at least a glimmer of hope, especially after the release of federal government modelling last week that predicted 11,000 COVID-19 deaths in a best-case scenario.

And while statistics on the total number of people testing positive for the disease vary with the amount of testing a province does, data on seriously ill people admitted to hospital and ICU would seem to offer a more reliable barometer of the epidemic’s severity and path.

“I’m cautiously optimistic that we are going to see a sort of slow trickle with this concept of flattening the curve,” said Dr. Michael Detsky of Toronto’s Mount Sinai Hospital. “We’ll still see patients getting admitted to our ICU, but not that surge like we saw first in Wuhan, then in Italy, Iran, Spain, New York City — and now some other U.S. cities.”

Doctors say they’re unsure exactly why they have not seen more cases, but point

to both the mass, at-home social-distancing measures still in place, and a cancellation of thousands of elective surgeries that freed up space.

A detailed report on ICU admissions in Ontario obtained by the National Post hints at a positive trend. It includes both confirmed and suspected cases and shows a peak on April 2 of 538 possible COVID-19 sufferers in critical care. The number has remained at between about 500 and 535 since then — out of a total number of ICU patients that stood at 1,321 last Thursday.

The “best case” scenario in Ontario’s modelling had put the number of COVID-19 sufferers in intensive care at between 800 and 1,000 by last Friday.

And almost 78 per cent of the province’s ventilator capacity — expanded to try to meet the pandemic demand — was still available, according to the Critical Care Services Ontario document.

Quebec was reporting just under 200 COVID-19 patients in the ICU as of Friday, out of an expanded capacity of 1,000 available critical care beds, said D’Aragon. That said, the total number of patients admitted to hospitals does seem to be rising faster in Quebec than the figures for ICUs specifically, he noted.

It has in Ontario, too. An average of about 50 laboratory-confirmed COVID-19 patients a day have been admitted in the last week and a half, according to government figures.

And it’s possible the number of people dying from COVID-19 in hospital is outstripping the new admissions, keeping the occupancy rate down — and making the situation look brighter than it actually is, said Dr. Michael Warner, ICU director at Toronto’s Michael Garron Hospital.

After Quebec and Ontario, British Columbia and Alberta have the largest number of confirmed coronavirus cases. One Alberta physician suggested ICUs there have yet to face a surge.