Health System Readiness Update shares planning in place for sobering possibilities
While Saskatchewan’s healthcare system is preparing for a continued significant rise in COVID19 cases and hospitalizations, health officials are hoping the public strictly adheres to public health orders to keep pandemic numbers somewhat contained.
The Saskatchewan Health Authority provided a Health System Readiness Update on November 26, highlighting the multifaceted plans which will take effect in response to exponentially growing COVID-19 numbers.
Dr. Susan Shaw, Chief Medical Officer Saskatchewan Health Authority, said COVID-19 has already placed strain and stress on front line workers, but the public can play a big role by taking steps to keep themselves and others safe during the pandemic.
“This is a sustained increase in very sick people for the longest period of time that I think we’ve ever seen, and we know it’s going to continue for the weeks to come. And we really need the public to stay home, keep your bubble small, and stay as safe as you can by following every single public health measure,” Dr. Shaw stressed during last Thursday’s update.
Saskatchewan’s contact tracing network is under strain during the current surge in positive COVID cases. A single positive case provides hours of work for contact tracers over the two week time period post-positive result.
“Our rolling average of cases has been around 214 per day. If we take that over a two week period of time and apply the average number of contacts per case, it creates more than 32,000 of work for contract tracers in a two week period of time. Unfortunately some of our investigations have revealed that some individuals have as many as 150 contacts for a single positive case,” explained Saskatchewan Health Authority CEO Scott Livingstone.
Last week the average contact per positive case was 70.7 people, so with just 200 cases a day that would generate over 32,000 hours of work over two weeks, an average of just under 2,300 hours a day on just contact tracing.
When positive cases grow, that workload further increases. Saskatchewan’s seven-day average of daily new cases was 250 for the period of November 22 to 29.
“If people don’t limit their contacts then the numbers will continue to increase and place significant strains on our capacity,” Livingstone noted.
Even negative callbacks have required 60,000 hours of work during the pandemic. With a goal of reaching 4,500 tests per day, that level of testing would create about 200 hours of work just on negative call backs each and every day.
“The small good news is that we are seeing the average number of contacts slightly lower than it has been in recent weeks, but we certainly need to both decrease the number of positive cases and contacts if we are going to get ahead of this virus,” Livingstone said on November 26.
SHA Emergency Operations
Chief Derek Miller shared a presentation on how the healthcare system will be adapting and expanding services in specific areas to match the forecasted growth of COVID-19. Plans became necessary after Saskatchewan recorded exponential growth in active cases, with positive cases jumping 363 per cent in the last month.
“Just the last week we’ve seen an increase of 1,000 active cases. This has a direct impact on our health system. We see it in our acute facilities with an increase in the number of hospitalizations - up 383 per cent in the last month. And that’s continuing to grow,” Miller explained.
At the time of the presentation there were 35 COVID patients in regular hospital beds in Saskatoon, and only two available ICU beds if their conditions deteriorate and they require admission to an ICU bed.
The current percentage of ICU capacity being used for COVID patients has grown from five per cent to 27 per cent over the past month, marking a fivefold increase in ICU COVID cases.
And with modelling data informing their forecasts, adjustments would be required to meet the continued growth in COVID cases.
“If our current trajectory is left unchecked, we would see COVID and future demand essentially accounting for half of all of our available acute care beds across the entire system over the next four to six months,” Miller said, adding COVID ICU demands would be five times higher.
The SHA is gearing up to move to an Alternate Level of Care in order to redeploy staff to priority areas as well as create capacity in other parts of the system.
They are currently almost near capacity in ICU beds across the province, with the system currently operating at 97.3 per cent of ICU capacity. Additionally there are ongoing capacity challenges in Saskatoon, with the current daily inpatient demand at 105 per cent of capacity and the current daily ICU demand at 126 per cent of capacity.
Saskatchewan is planning for a potential surge forecast of 1,324 COVID19 acute care patients. To meet this demand the SHA would implement a strategy to draw down elective services, non essential surgery, and other services to create capacity in 15 hospital facilities, along with redeploying patients to field hospitals in Regina and Saskatoon.
The province would utilize northern and rural hospital strategies though the implementation of developing a series of mixed hospitals for COVID and non COVID cases, while others would be identified as NONCOVID hospitals.
Rural COVID hospitals in Southwest Saskatchewan would be in Swift Current, Maple Creek, Gravelbourg, Assiniboia and Shaunavon. The full rural strategy would result in 20 facilities designated as COVID hospitals, six as non COVID hospitals, while 11 community hospitals would be converted to alternate level of care facilities. There are 11 alternate level of care facilities across the province, including Leader and Herbert in the Southwest.
“They would only be activated as required in response to the actual demand that we would be experiencing. This is not necessarily in effect at the moment right now, although we are certainly starting to move in this direction in some areas. But it would be applied in response to the actual demand,” Miller said.