Montreal ICU using COVID-19 lessons learned for second wave

MONTREAL - During the first wave in the COVID-19 pandemic, the mortality rate in the intensive-care unit of Montreal’s Jewish General Hospital averaged 20 per cent, about half the rate of other ICUs around the world, researchers have found.

Doctors in the ICU communicated early in the pandemic with their counterparts in China to learn more about the novel coronavirus. The ICU team was quick to drop things that didn’t work on COVID19 patients and was one of the first centres to use steroids to treat patients.

And as the Jewish General grapples with a second wave, admitting far more patients than it has during the summer, its ICU chief says the medical staff are applying the lessons learned from the first wave.

“I think the patients who come into the ICU now will have an even lower mortality,” said Dr. Paul Warshawsky, chief of the 27-bed unit in Côte-des-Neiges.

Prior to the pandemic, the ICU had a 24-bed capacity and was expanding gradually to 30 over the coming months. During the peak of the first wave, the medical team was swamped with 31 COVID-19 patients and five with other conditions.

During that wave, 120 patients were admitted to the ICU and about one in five died, compared with nearly 80 per cent who perished in some New York City hospitals. A separate study by the American College of Cardiology found ICU mortality rates declined from above 50 per cent in March to almost 40 per cent at the end of May in hospitals in Asia, Europe and North America.

During Quebec’s first wave, the government purposely ramped down elective surgeries and other medical procedures to protect its acute-care hospitals — a decision that has since come under criticism after the coronavirus rampaged instead through long-term care centres.

But Warshawsky defended that decision, saying it allowed the Jewish General to reduce its normal ICU volume from about 20 non-COVID patients at any given time to about five, freeing up resources to treat those with the pandemic illness. What’s more, suddenly available anesthetists and surgeons assisted in the ICU.

“We were at 150 per cent of our baseline capacity during the first wave,” Warshawsky noted. “If we hadn’t been able to get our baseline number of non-COVID patients down to five, we would have been completely overwhelmed.

“So for people to say we didn’t get overwhelmed so we shouldn’t have cancelled surgeries is a bit of circular logic,” he added.

Early into the current second wave, the ICU is back to treating COVID-19 patients, with about half placed on ventilators. On Monday, eight were in the ICU, a fraction of the number during the first wave’s peak. Still, Warshawsky expressed concern about Quebec’s new plans to let hospitals continue with elective surgeries as usual, warning this could hurt ICUs should the number of hospitalizations spike.

“That’s where I get worried, because right now I have both patient populations in my ICU, a significant number of patients with COVID and a very significant number without it,” he said. “We’re doing that successfully. But if there are a hundred patients who come into the ICU in a short period of time, it still won’t matter because we won’t be able to handle them all.

“So our message to the population is to please listen to what the government is telling you, to respect the public-health guidelines and try not to get sick,” added Warshasky, who has managed the ICU for the past decade.