Ontario doctors fear ‘really hot’ two or three weeks
Ontario has a record number of people in intensive care, with ICU admissions still rising and hundreds more facing weeks or months of rehabilitation after defeating COVID.
Despite hopeful glimmers Ontario may be nearing a COVID-19 plateau, the situation remains very much critical and unpredictable, health experts cautioned Monday.
“Any change in our collective behaviour can result in cases continuing to increase — it would be way too early to conclude that wave three has peaked and that we have turned the corner,” said Dr. Irfan Dhalla, an internal medicine doctor at Toronto’s St. Michael’s Hospital and a vice-president at Unity Health Toronto.
Ontario logged 3,510 new cases Monday, while the number of people in intensive care hit 877, with 605 of them connected to mechanical ventilators. A second children’s hospital — CHEO in Ottawa — has begun admitting adult COVID patients to its ICUS, community transmission in many areas remains rampant, the critically sick are being transported between hospitals in delicate “load-sharing” transfers, the military is sending in nurses and other medical personnel to help and the test positivity rate — the number of people tested who are testing positive — is at an “unbelievably high” 10.9 per cent, Dhalla said.
The sparks of hope? New cases appear to be starting to crest, the seven-day moving average appears to be trending down and Ontario’s reproduction number — the number of people each infected person goes on to infect — was just below one, suggesting spread is slowing.
However hospitalizations lag infections by one to two weeks, meaning many more admissions in the weeks ahead, said Dr. Chris Simpson, a Kingston cardiologist and executive vice-president of Ontario Health.
“We’ve had two or three days where it was down in the teens, in terms of a net increase of new COVID patients in the ICU, but today (Monday) it was a little higher again,” Simpson said.
“Bottom line is, my biggest worry is that people are going to say we’ve got some hopeful signs, we can take our foot off the accelerator of all the stuff we’re doing in terms of ICU capacity-building and the (patient) transfers, and nothing could be further than the truth.
“This doesn’t change our plans for the next few weeks at all,” Simpson said, adding that the Greater Toronto Area is facing “what I think is going to be a really hot next two or three weeks, with lots and lots of people needing ICU care.”
And ICU numbers don’t tell the whole story. The threshold for transferring people to intensive care has increased in many GTA hospitals. Many people now being treated on a regular hospital ward are sick enough to warrant intensive care. “And in any other year, that’s where they would be,” Dr. David Juurlink, of Toronto’s Sunnybrook Health Sciences Centre, said on the weekend.
And once people leave ICU, they don’t miraculously return home. Many will require weeks or months of hospital or rehabilitation care. That includes people with a tracheostomy — a small, surgically created hole in the front of the neck, a standard procedure that’s done when people need to be on a ventilator for more than a few weeks. With an open connection between the trachea, and the outside world, it’s easier for bacteria to get in and out, Dhalla said, increasing the risk of pneumonia and other complications. “It can take many weeks or months to recover,” he said.
“I think there are people out there that have the view that COVID is an acute illness and that either you die or you recover,” he said. “More and more we know that those aren’t the only two options. There will be a substantial proportion of people whose lives are forever changed by COVID.”
The heart-breaking case of 13-year-old Emily Victoria Viegas, the daughter of an essential worker who died at her home in Brampton, Ont., last Thursday while her mother lay in hospital with the same disease is a “devastating reminder” of what the pandemic virus can do, Ontario Premier Doug Ford, who has faced scathing criticism for his earlier refusal to institute paid seek leave for essential workers, said Monday.
Severe COVID in children is uncommon. “Even if it is rare, if you have thousands of cases (of COVID) you will see the rare events come to your emergency department,” Dr. Andrew Healey, chief of emergency services at the William Osler Health System, told reporters.
While Ontario’s official case counts are falling, the numbers are hard to interpret because testing volume is low, Dhalla said. The province has no sustained, public campaign to keep reminding people to get a test if they have any symptoms at all or have been exposed to COVID-19. Testing centres also need people to collect the specimens, “and we need those same people vaccinating and staffing” clinics and hospital wards, Dhalla said.
By contrast, Nova Scotia, which reported a single-day record 66 cases Monday, is testing at a rate never seen in Ontario, he said.
Ontario’s chief medical officer of health, Dr. David Williams, confirmed a third case in Ontario of a blood clot following the Astrazeneca shot. He said if there was “any undue concern” the public would be notified.
Death rates are coming down, Williams said. Confirmed case numbers are coming down. In some regions, “we are starting to see the bending of the curve, in some areas we’re seeing it actually coming down,” Williams said.
“Overall in the province it looks like we are making progress. But this is just a few days and I don’t want to be overly optimist, because you can get down and go back up again,” he said.