The Hamilton Spectator
Hamilton’s overwhelmed ICUs on a ‘knife edge’
Doctors describe facing a threat like never before as COVID-19 fills wards
Mental health supports have had to be brought in to help Hamilton intensive-care unit staff cope with caring for a surge of severely ill adults with COVID.
“These younger folks ... get really, really sick in a very short period of time,” said Dr. Alistair Ingram, chief of medicine at St. Joseph’s Healthcare. “Younger folks with children and some of them are dying ... Most healthcare workers do not see that on a regular basis. It’s very difficult.”
ICU physician Dr. Sunjay Sharma has worked 50 days straight as Hamilton hospitals cope with what he calls “unprecedented” numbers of the sickest patients in Ontario.
“It’s the busiest it has ever been,” said Sharma, who works at Hamilton General Hospital. “It’s like a once-in-a-century situation where things that we never thought would ever occur are happening in terms of the volumes.”
He described the terrible toll on staff of “seeing people who are your age and younger than you” in an ICU.
“When you look at someone and say, ‘That person could be me,’ to see them lying in a bed on life support,” he said. “It’s really troubling and upsetting. You go home at night and you ... can’t help transposing it onto your own family, friends and colleagues. It’s really hard.”
For the first time ever, Hamilton’s hospitals have drastically increased their ICUs temporarily — doubling up patients in single rooms and taking over parts of the hospital that are usually step-down units and surgery recovery areas.
Hamilton Health Sciences (HHS) has increased its ICU beds to 115 from 88 and plans to expand further to 126 by the end of the week. More than one-quarter of the patients in its ICU — 33 of 115 — have COVID.
St. Joseph’s has more than doubled its ICU capacity to 54 beds with 22 of them — more than 40 per cent — being used for COVID patients. It plans to open seven more beds this week if possible.
“We’re really on the knife edge here,” said Ingram. “Really on the precipice.”
Area hospitals have had 73 COVID patients transferred from the Greater Toronto Area in the last eight days alone. It shows the incredible and increasing strain on the healthcare system considering a total of 91 patients were transferred from Jan. 11 to April 13.
Of those 73 patients, 43 came to Hamilton — 19 went to St. Joseph’s, 13 went to Hamilton General and 11 went to Juravinski Hospital. Of the rest, nine went to Burlington’s Joseph Brant, 11 went to Niagara Health and 10 to Brantford General.
“If we don’t help these heavily affected hospitals in Toronto, they will collapse,” said Dr. David Russell, interim vice-president, academic and medical affairs and chief of staff at St. Joseph’s. “None of us have seen anything like what is going on in Toronto right now. We heard last night that William Osler (which has hospitals in Etobicoke and Brampton) admitted 20 patients in 12 hours, all with COVID.”
For these transferred patients, it means families split far apart while lives are on the line.
“The wife is here relaying things to the kids at home — teenagers and younger even,” said Ingram. “It really is awful.”
ICU doctors are watching with trepidation Hamilton’s surging COVID numbers — the city set a new pandemic record with 301 new infections Wednesday. Hospitalizations are usually about two weeks behind.
“We’re worried,” said Ingram. Sharma called it “depressing.” “If these are the numbers now, we need to expect that things are going to get worse,” he said. “How are we going to prepare for that ... Ultimately, we have to take care of those people who are going to result from those numbers and that’s the immediate priority.”
Russell predicts that “if Hamilton gets worse, this would lead to a huge capacity problem in the hospital.”
Getting the resources in place to care for a coming surge is not as simple as opening up new beds. ICUs require large numbers of highly trained staff.
HHS has redeployed 200 staff so far while St. Joseph’s is at 80 — many have come from areas that have been significantly cut back to free up ICU beds such as elective surgery.
“The whole system is stretched to the limit,” said Sharma. “That doesn’t just affect the care of COVID patients. As the system is more and more taxed, it has the potential to affect everyone ... If we continue down the path we’re going down, it puts a lot of things at risk.”
He stresses the “the public has the ability to mitigate some of this.”
“It’s frustrating when you leave a shift here and you see all the people who are sick and at your own personal cost you’ve put your blood, sweat and tears into trying to keep people alive, and then you go out and see people not really taking the situation as seriously as they should,” said Sharma.
Every person needs to do their part by following public health measures and staying at home except for essentials, pleads Russell.
“We can’t vaccinate ourselves out of this current surge,” he said. “This is an extraordinarily dangerous situation and we have never been anywhere near this kind of threat ever.”
“Younger folks with children and some of them are dying ... Most health-care workers do not see that on a regular basis.
It’s very difficult.”
DR. ALISTAIR INGRAM
CHIEF OF MEDICINE AT
ST. JOSEPH’S HEALTHCARE