Surge strategy enacted as COVID-19 shows little sign of slowing in Saskatchewan

Saskatchewan healthcare workers are preparing to mobilize in order to meet an anticipated surge in COVID-19 hospitalizations over the coming days and weeks.

With the number of COVID-19 related hospitalizations growing by 400 per cent in the last 30 days and additional strain being put on Intensive Care Units, the Saskatchewan Health Authority is ready to redeploy close to 600 full time equivalent positions to handle a jump in COVID-19 hospitalizations which could occur in the upcoming week.

“In consideration of this potential lab-confirmed cases in our immediate timeline, we could see over 500 lab-confirmed cases a day, and that’s up from the 325 that we experienced on the 30th of November. And likewise we’ll continue to see our hospital census and our ICU census rise as well over the next two weeks. And we are planning for numbers up to 250 COVID positive patients in our hospitals within that two week period. And in the ICU up to 65 COVID patients,” SHA Emergency Operations Chief Derek Miller said during a press conference last Thursday.

In a presentation outlining the severity of the pandemic totals across the province as of December 3, Miller noted there has been a 400 per cent increase in the number of hospitalizations over a 30 day period, and ICU capacity for COVID patients has grown from five per cent a month ago to 31 per cent of available space. And trends point to the healthcare system using significantly higher totals by mid December.

During the period of December 1 to 6, Saskatchewan recorded 1,578 new positive COVID-19 cases, with 14 additional hospitalizations and eight new deaths. The provincial seven day average jumped from 264 to 272 during the same six day period.

To meet these projections, the Saskatchewan Health Authority will be enacting a strategy which calls for 175 Registered Nurses, 74 Licensed Practical Nurses, 15 Continuing Care Assistants, a dozen Environmental Services Workers, 11 Recreation Workers, in addition to 301 additional positions being redeployed as part of a shuffling of resources.

The largest number of RNS and LPNS will be accessed through rural facilities, with 67 of 175 redeployed RNS coming from the rural system, and 27 of the 74 LPNS also from rural spots.

Already healthcare teams are under intense pressure to manage the surge in COVID demand while also providing everyday health services. However, Saskatchewan’s major centres no longer have the capacity to deal with new cases, as case surges have been too high and the projected case growth over the next two weeks is even higher.

Miller said to meet the forecasted two seek surge targets in the area of contact tracing alone, staff will be put into place to meet the demand for contact tracing the approximate 562 positive case average per day which could occur within two weeks, which would generated over 6,000 hours of work per day. That increase would require the redeployment of 500 licensed healthcare workers, unlicensed workers and data entry staff.

Additionally, to meet the forecast ICU Surge Target, the SHA is preparing for the potential of 64 COVID patients being admitted to ICU within two weeks. Those additional ICU admissions would exceed the ICU capacity in Saskatoon and Regina by 28 per cent.

The province is also gearing up for an acute care surge where an additional 250 COVID patients requiring hospitalization could occur within two weeks.

“This represents, for an easy reference, the capacity of the Cypress Regional Hospital in Swift Current and the Prince Albert Victoria Hospital combined. So it is a significant number of patients requiring hospitalization,” Miller said during his presentation.

The SHA has already identified spaces in facilities where they can move into to create capacity, plus they will be enacting a slow down of some services in order to achieve increased space. They are also pursuing other ways of creating spaces where can cohort COVID patients, which includes transferring patients to other locations where they can receive care.

These strategies are being enacted to allow the healthcare system to keep a step ahead of the demand curve.

“We don’t want to be in a position where we’re riding the demand curve and where we’re at risk of becoming overwhelmed by COVID demand. These surge targets will allow us to take those steps to get in front of the demand curve and ensure that we’re able to respond.”

The strategy will also see the creation of a pool of approximately 55 to 60 healthcare workers who could respond to COVID outbreaks in long term care facilities as well as acute hospitals.

Plus, there could be service disruptions when

COVID impacts healthcare workers, so they need to be ready to respond to that in order to avoid any critical service disruptions. They have identified resources that would be put in place to support acute and long term care, so they could redeploy 25 nurses for acute care and redeploy 57 to 67 healthcare workers into long term care facilities.

They are also taking a targeted approach to identify areas which can undergo partial service slowdowns to create system capacity by redeploying staff.

“This is not a broad reduction in services like what was undertaken in the spring slowdown. This is rather a much more finely tuned adjustment in multiple areas that will allow us to achieve the capacity and resources we need,” Miller stated.

Admittedly, there were difficult decisions to identify and prioritize these slowdown areas.

“It is very difficult to chose as we know that every time you reduce a service you have a direct impact on a patient and on the care they they need.”

The exact timing of these strategies will occur as the SHA watches modelling information and case trajectory to assess the need for further slowdowns.

“If we plan on taking a ‘dimmer switch’ approach to services in the weeks ahead in order to scale up and scale down so that we an stay ahead of the COVID demand curve, while also maintaining all of the non COVID services that Saskatchewan residents need on a day to day basis. Changes in service delivery will vary by area of the province just based on the local needs and how they need to be able to adapt to meet these COVID demands. So there will be some variation at different sites.”