Peel hospitals coped well during virus peak, officials say

Measures taken by region, province helped mitigate impact on health care Dr. Michael Miletin said he’s learned to provide “great supportive care.”

Working during the COVID-19 pandemic is what Dr. Michael Miletin, head of intensive care with William Osler Health System, said he imagines what being a doctor in a pre-antibiotic era would be like.

“It is unlike anything I’ve ever treated because there is … no cure,” he explained. “As a physician, it’s very hard not having that sense of control. There are a lot of unknowns.”

Treating patients with COVID-19 has taught the intensive care specialist patience.

He said he can usually tell pretty quickly how a patient is responding under normal conditions. “With COVID-19, I have learned to give it time. You can’t always tell after two weeks if someone is going to pull through. I’ve learned to sit on my hands and provide great supportive care.”

Despite concerns in early March that hospitals could become overwhelmed with COVID-19 patients and considering Peel had higher than average case counts, local hospitals fared well, according to Peel Public Health.

The health unit looked at trends in Peel hospitals and intensive care admissions for COVID-19 in its July 17 epidemiology report.

In Peel Region between Feb. 24 and July 16, 631 people were treated in hospital for COVID-19 — 113 or almost 18 per cent in an intensive care unit.

On average during that period, 77 per cent of those in the ICU were on a ventilator.

Average ICU occupancy between April 4 and May 31 was well below capacity, according to the Ministry of Health.

Mississauga Hospital was at 66.8 per cent, Credit Valley Hospital 48.36 per cent, Brampton Civic 62 per cent and Etobicoke General 47.15 per cent.

Health officials said, given what could have happened in terms of hospitalizations and deaths based on earlier modelling data as well as what they had seen in places such as New York City with overcapacity at hospitals, the measures taken in Ontario and Peel helped to mitigate the impact on the health-care system.

But it took a lot of work to get there.

William Osler Health System, which comprises Brampton Civic Hospital, Peel Memorial Hospital and Etobicoke General, focused on space, staff and stuff, said Miletin.

They used staff in roles different from their normal assignments in order to manage when it got busy.

For example, with severely ill COVID-19 patients, one supportive treatment that’s used is putting the person into a face-down or prone position to help with oxygen flow to their lungs.

But, it takes about five staff members to move a patient into that position, as they need to make sure they do it safely and keep all the necessary equipment attached.

“It’s a pretty labour intensive thing to do,” Miletin explained.

Brampton Civic Hospital and Etobicoke General used physiotherapists from other departments to help reposition the patients several times a day.

In April, Trillium Health Partners, which includes Credit Valley Hospital, Mississauga Hospital and Queensway Health Centre, constructed a temporary pandemic response unit on the grounds of Mississauga Hospital to be able to care for more COVID-19 patients if needed.

“This global health crisis has been an unprecedented time in our history as an organization and as a community,” said Michelle DiEmanuele, president and CEO of Trillium. “It meant continuing to innovate and reimagine how to provide care in this new reality.”

The hospitals also added about 100 in-patient care spaces by temporarily closing Queensway Health Centre’s Urgent Care Centre and also added 36 new critical care beds across Credit Valley Hospital and Mississauga Hospital. COVID-19 did pose some challenges for local hospitals.

There have been 13 hospital outbreaks of COVID-19 since the beginning of the pandemic, according to Peel Public Health. These were cases spreading outside of specialized COVID-19 units.

The peak in hospitalizations came early in April — coinciding with the peak in the community’s overall epidemic curve for the first wave.

Peel Public Health said the April peak was driven largely by cases in long-term-care and retirement homes — people who for the most part had underlying medical conditions, which added to hospital numbers.

“Hospitals in Peel have done a great job in adapting and implementing their surge plans to ensure they have sufficient capacity to manage,” the health unit said.

While local hospitals have continued to have cases since the peak, the average age of cases has dropped and there’s been a parallel drop in those hospitalized and ICU patients, the health unit said.

But public health officials and hospital staff are bracing for a potential second wave of cases.

Miletin is hopeful for how the ICUs will be able to handle the next expected spike.

Public health said they will be debriefing with hospital partners in the coming weeks about a potential second wave.

Miletin said he’s hopeful that public health initiatives — such as contact tracing — will prevent case counts from getting too high all at once.

“If we do have a second wave, let’s hope it is more like small wavelets,” he said.