OVERWHELMING THE SYSTEM

SHA pandemic models forecast ‘pronounced loss of life and health’

The Saskatchewan Health Authority (SHA) expects COVID-19 will “almost certainly overwhelm the health system,” as a recent model suggests serious cases will exceed current capacity for ICU beds and ventilators.

The model was cited in an internal SHA Powerpoint presentation obtained by the Leader-post on Tuesday. Dated March 19-20, it estimates COVID-19 could affect 30 per cent of Saskatchewan people, potentially leading to thousands of deaths.

The SHA on Tuesday called it “a draft document based on early modelling and worst case scenarios.”

But the presentation noted that the system will be almost certainly be overwhelmed “even under conservative assumptions.”

“Demand for acute services will exceed existing capacity for hospital beds, ICU beds, ventilators as well as creating a major burden on other acute services, supports, HR, supplies, and equipment,” said the document.

“There will likely be pronounced loss of life and health,” it added.

Dr. Susan Shaw, the SHA’S chief medical officer, could not guarantee that every severely ill patient in need of a life-saving ventilator or ICU bed will have access to one if that scenario comes to pass.

“Our commitment is to prepare and do everything possible at our end to be ready,” said Shaw when asked for such a guarantee. “And our ask is that everybody out in the public keeps themselves safe.”

She urged Saskatchewan people to help limit contact with others to win time as the health system ramps up for the expected surge.

SHA CEA Scott Livingstone said minimizing the surge requires the help of everyone in the province.

“We need to ensure that everyone in our lives is following the measures as best we can,” he said. “We are supporting each other and we will contain this virus. Only together can we protect each other and minimize the severity of illness wherever possible and avoid the loss of life.”

The SHA is planning “exceptional measures” to treat those who contract the virus. On Tuesday, it announced plans to cohort COVID -19 patients to designated health facilities and potentially open field hospitals in Regina and Saskatoon.

The presentation, entitled “COVID-19 planning, strategy for continuity of health services and surge capacity,” said COVID-19 will have “a significant impact” on acute care services. It estimates that 300,000 Saskatchewan people could contract the virus over the course of the pandemic.

Of those, 240,000 would be well enough to stay home. But 45,000 would require hospitalization, and 15,000 would require admission to a bed in an intensive care unit (ICU).

It foresees fatality rates between three and five per cent, or somewhere between 9,000 and 15,000 people.

There are only 109 ICU beds and 198 ventilators in Saskatchewan, according to the presentation. Shaw said that includes 91 intended for ICU care for adults and 80 for subacute care.

But the presentation noted that demand for ventilators could reach 500 to 600 in Saskatoon alone at the peak of the pandemic. It predicted “exponential growth” in cases there. And Livingstone said there’s no reason to believe Saskatoon is unique.

“Saskatoon is not going to be any different than any other community in this province, unless the data shows us that it is,” he said.

Shaw noted that there are a “significant number” of ventilators on order, but officials weren’t able to give a timeline for when delivery is expected.

“Every jurisdiction on the planet right now is trying to get ventilators,” Health Minister Jim Reiter said. “We’re dealing with our normal suppliers, we’re dealing with the federal government because they’re trying to co-ordinate and do bulk purchasing.

“I’m optimistic that we’re going to get some. I don’t know if it will be full orders, and again, it’s virtually impossible. I don’t want to diminish the situation. Ventilators are a very big concern right now.”

It is hoped that current measures meant to slow transmission of the disease will mean infections will arrive over a longer time. Livingstone noted that the model was prepared before restrictions were tightened on March 20, when public health orders were made mandatory under the penalty of fine.

“It didn’t factor in all the impacts of things that have been put in place in this province to lower and flatten the curve,” said Livingstone.

But the model also uses a lower-end estimate total cases. Saskatchewan’s chief medical health officer has said cases could be as low as 30 per cent, or as high as 70 per cent.

Livingstone noted that, so far, there isn’t a single jurisdiction on earth that has seen 70 per cent of its population infected.

He said further updates to the model will come next week. That will include specific information about Saskatoon, Regina, the north and rural areas. Livingstone said he has no concerns with releasing the models publicly.

He said the SHA already has significantly more capacity than it did just a month ago, or even last week. He called those efforts “the tip of the sword,” and acknowledged they won’t be enough.

“Even if it’s not the worst-case scenario, and the data is wrong by a large percentage, we are still going to have to continue to build capacity,” said Livingstone.

The Powerpoint document makes a similar point, saying strong measures would still be needed even if the numbers are off by 50 per cent.

“Time is of the essence,” it says. “Preparations must begin immediately.”

Those preparations will involve efforts to repurpose space and cohort patients. That means moving functions between different hospitals so some can specialize in COVID-19 care.

Field hospitals could be located in school gymnasiums, community centres, arenas or leased community space. They will open “where warranted,” beginning in Regina and Saskatoon.

The document also foresees “strict” limitations on blood product usage, efforts to expand intubation and oxygen capacity as well as strategies to protect health care workers.

It details plans to screen and test health workers, establish PPE protocols, reduce shift length and rotate staff between high and low acuity areas.

The plan is most specific for Saskatoon. It foresees concentrating COVID-19 patients at Saskatoon City Hospital, Royal University Hospital and field hospitals as necessary. Young COVID-19 patients would be treated at the Jim Pattison Children’s Hospital.

Other health services, including cardiac, neurological and trauma care, would be provided at St. Paul’s Hospital, as would intensive care for patients without COVID -19.

Through those measures, the presentation estimates that a total of 2,900 beds could be made available for COVID-19 patients in Saskatoon.

NDP Leader Ryan Meili was encouraged by the “leadership” the SHA is showing internally in planning for the worst, but he doesn’t believe the government is moving quickly enough to avoid the horrible scenario set out by the model.

“When you see there in black and white the level of potential damage to the province, and the potential number of people who could be sick, or the number of lives lost, it’s really scary,” said Meili.

But Livingstone argued that the measures from the province are the most “extreme” he has seen in his 30-year career.

Meili said the numbers should be a wake-up call. The government, in his view, has to tighten restrictions further still to prevent thousands of deaths.

“Right now, we are not on the path to avoid that outcome,” he said. “I believe we can get there.”

He called for tighter restrictions on gatherings, closing all daycares and expanded testing. He also demanded more honesty about what the future looks like. In Meili’s view, the province should have proactively disclosed the modelling data, which the Leader-post has been asking for since last week.

Dr. Anne Huang, a former deputy medical health officer with the Saskatchewan Health Authority and Health Canada, agreed that proactively sharing modelling information could motivate people to take action.

But she said much remains uncertain, since the Powerpoint presentation does not include the parameters used to build the model. She said public health efforts like contact tracing could make a big difference on how high the numbers go.

Huang encouraged the SHA to share its assumptions in more detail.

“There’s actually a lot of unknowns,” she said.

Further, she said the three-tofive-per-cent estimate for fatalities is in keeping with highly overburdened countries like Italy, but is much higher than countries like South Korea that have been more successful in containing COVID -19.

That leads her to believe that SHA officials are correct in calling the estimate a “worst-case scenario.”

But she said she can’t be sure whether the restrictions announced so far will be enough to keep the province from approaching it.

“I cannot say,” said Huang. “The devil is in the details, so implementation of these policies is going to be crucial.”

Livingstone said that will depend on every Saskatchewan person.