Pandemic response plan receives update with new modelling data
The Saskatchewan Health Authority (SHA) has updated the provincial pandemic response plan after using province specific COVID-19 modelling data to guide planning activities. SHA officials provided a COVID-19 modelling and health system readiness update during a teleconference media briefing, April 28.
SHA CEO Scott Livingstone emphasized the update provides encouraging information, but it does not distract from how seriously the health authority is taking cases of COVID-19 in the province. The key factor in this update is the use of Saskatchewan specific data for the modelling.
“It is an important development,” he noted. “It allows us to more accurately plan for different scenarios in the healthcare system while our efforts to contain, delay, mitigate the virus continue.”
Saskatchewan specific data were not previously available when the health region released details of its COVID-19 response plan in early April. At that time, it had to rely on modelling date from other jurisdictions in Canada and elsewhere in the world.
The modelling helps the SHA to create a COVID-19 response, which have two components. The offensive strategy includes measures to offer expanded testing, to implement aggressive contract tracing, and to have other measures in place to reduce the risk of infection. The defensive strategy provides a staged response plan to deploy resources for the treatment of COVID-19 patients.
“We have to continue to plan for the worst while hoping for the best,” he said. “As we’ve seen from other jurisdictions, the situation can fluctuate very quickly.”
Several speakers emphasized that modelling is not a crystal ball and the model does not predict what will happen, but it is something the SHA will use to plan.
The SHA’s previous modelling presentation on April 8 was based on the basic reproductive number, or R0 (pronounced R-naught). This refers to the average number of people that one person with the virus could infect in a situation where the entire population is susceptible and no interventions took place. This number is used for planning purposes to ensure health system readiness. Saskatchewan data was used to calculate the R0 for the province at 3.12.
The SHA is using another number, the effective reproductive number or Rt, to determine if the curve of infection is flattening, and this will guide their decisions about public health measures.
The Rt is the average number of people that one person with the virus will infect after the effects of intervention measures.
The Rt value needs to remain below one to flatten the curve. Saskatchewan’s Rt value was 0.7 on April 25, but this indicator has a lag time of 7-14 days.
The SHA’s original COVID-19 planning scenario, based on the R0 value, identified an upper, mid, and low range scenario for the number of COVID-19 patients in the province. The revised planning scenario, based on Saskatchewan modelling data, indicates there will be fewer patients than in the original scenario.
The SHA used the original planning scenario to prepare for a total of 335,000 COVID-19 patients, resulting in 458 hospital admissions per day, 800 patients requiring ventilation, and 6,815 cumulative total deaths.
The revised planning scenario will require fewer resources, because the SHA will prepare for 254,756 COVID-19 patients, there will be 190 hospital admissions per day, 403 patients will require ventilation, and there will be 3,050 cumulative deaths.
“With the new modelling information, we have the opportunity to adjust the planning scenario based on the Saskatchewan information,” SHA Emergency Operations Centre Lead Derek Miller said. “By doing so, we still sustain a conservative capacity estimate and the contingency to ensure that we are prepared for a worst-case potential surge.”
The revised planning scenario means the maximum COVID-19 response capacity can be reduced by 1,000 hospital beds, 400 ICU beds, and 400 ventilators.
The local surge plans will be adjusted and over the next few weeks the SHA will work with the Ministry of Health to develop a health system service resumption plan. This plan will outline the process to resume health services that were affected due to the implementation of the original COVID-19 planning scenario.
“It will be a cautious and methodical approach to reintroduction of services,” he said. “Many factors are being considered as part of the development of this plan, including prioritization of highest patient need, looking at the risk of transmission of the virus, looking at the impact that resumption of services would have on COVID-19 surge capacity, and also the impact on personal protective equipment inventory as well as other factors.”
Miller emphasized the resumption of health services must take place in a way that will not hamper the SHA’s ability to respond to a potential COVID-19 surge in the future.
“Our offensive strategy continues to support the sustainment of low rates of transmission, but I want to emphasize that the public has the biggest impact on our offensive strategy and its success, and certainly on the success that we’ve seen to date,” he said. “Our defensive strategy continues to adapt, based on the new modelling information, and we will be adjusting that and we will ensure that we have our defence ready should we need it in the future.”
SHA officials made repeated reference during the presentation to the role of Saskatchewan residents to keep the curve of COVID-19 infection flat.
“You’re ongoing role in this pandemic is so important,” Chief Medical Officer Dr. Susan Shaw said. “No health system in the world can flatten the curve of COVID-19 without the help of the public, and in Saskatchewan we’ve done so well to flatten the curve, and now, as plans are put in place to re-open our province, we need your help even more.”
Restrictions will be relaxed in certain areas, but Saskatchewan residents still need to comply with many other public health measures and restrictions that remain in place.
“You may even see increased measures to protect some of our more vulnerable populations,” she noted. “The virus is still here. We will have clusters and even outbreaks within the province in certain areas. So we need to remind ourselves that we are all in this together and that these flare-ups or outbreaks can happen anywhere.”
Livingstone cautioned that any lapse in effort to adhere to public health measures can cause a review of the situation.
“If we don’t stay flat, then we know we’re going to have to back off in what we’re doing with respect to providing more services, we will redirect those resources to COVID, and we may have to start instilling more restrictions in the province again,” he said.