Inside Ontario’s hospital patient load
Data offers snapshot of those in intensive care, availability of critical care
People hospitalized in Ontario with confirmed or suspected cases of COVID-19 make up 31 per cent of all critical care patients across the province, according to provincial data the government has not made publicly available.
At the same time, hospitals are ramping up capacity by cancelling elective surgeries, clearing out operating rooms and securing extra equipment in anticipation of increasing numbers of sick people coming through their doors.
The data provides a snapshot of the number of patients in intensive care units across the province, including those with confirmed and suspected cases of COVID-19, as well as the prepandemic inventory of available critical care beds and ventilators.
The information is collected by Critical Care Services Ontario, a provincial agency set up to help the health system better manage a sudden spike in critical care resources, and distributed daily to hospitals. The most recent data is from Monday.
Some doctors with access to the data have posted it online. A spokesperson for Critical Care Services Ontario directed questions about why the data is not publicly available to the Ontario Ministry of Health, which did not provide a response by deadline.
In the seven days leading up to this past Monday, the number of patients in critical care with confirmed and suspected COVID-19 cases grew at an average rate of nine per cent per day.
As of Monday, there were 125 critical care patients in Ontario with confirmed positive COVID-19 cases, of which 82 were on ventilators. There were also 353 critical care patients with suspected cases of COVID-19, and of those, 159 were ventilated, for a combined total of 478 patients with confirmed and suspected cases.
On Wednesday, Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, said the number of patients confirmed to have COVID-19 in ICUs had risen to 145 and the number on ventilators had risen to 98.
The data shows that as a whole, the health-care system is not at capacity. Roughly 77 per cent of pre-pandemic critical care beds are in use, meaning there are at least 450 sitting unused.
These numbers do not take into account “surge capacity” — extra beds and ventilators — being ramped up by hospitals in anticipation of rising demand.
Dr. Anna Banerji, who teaches at the Dalla Lana School of Public Health at the University of Toronto, says preparing for possible surges of patients is “critical to saving lives.”
“Getting the ventilators ready, that’s very important because we may not go the same way as New York or Italy or China, but we might. Who knows?” Banerji said. “Right now we’re not seeing that huge surge that they’re seeing in other places because we’re doing the physical distancing.”
According to the data, one of the 14 Local Health Integration Units tracked — Central West, which oversees regions of Brampton, Caledon, Dufferin, Malton, north Etobicoke and west Woodridge — is already at nearly 90 per cent of its prepandemic ventilator capacity. The LHIN referred the Star’s questions to the health ministry, which did not respond by deadline.
“The strategy that we’ve taken is we need to be prepared to provide maximal capacity of critical care beds regardless of what comes our way. We will get as many beds and ventilators ready as we need to, to try to meet demand,” said Dr. Randy Wax, critical care physician lead for the Central East district with Critical Care Services Ontario.
That Central East region stretches from Scarborough west to Cobourg and as far north as Haliburton, and includes Bobcaygeon, where an outbreak at the Pinecrest Nursing Home has killed 14 residents.
As of Monday, 24 staff members of the nursing home had been confirmed positive for COVID-19, according to the local public health unit.
A spike in local cases can risk overwhelming hospitals, particularly ones with few — or even no — critical care units.
“If a region is running into trouble, then we would reach out to our partners in adjacent regions to help fill vacant beds,” Wax said.
“The ability for us to work well as a system is going to help deal with potential local areas where there might be a flare in a short period of time with a large number of patients.”
The March 30 data shows that nearly 45 per cent of the Central East region’s137 patients in critical care have or are suspected of having COVID-19. Fortythree of those patients were on ventilators, according to the data.
The data shows the hospitals in that region are at 84 per cent of their baseline ICU capacity.
Dr. Jeff Kwong, a family doctor and a professor at U of T’s Dalla Lana School of Public Health, said he believes there is not a lot of flex built into the health system.
“So that’s something that every single person in the health-care system has been worried about,” he said. “Are we going to have enough capacity in our healthcare system to manage it or not is something we won’t know until the wave has hit us already. I think everyone is watching the numbers nervously.”