SOME OPTIMISM, CAUTION IN WORST-CASE SCENARIO

B.C. is preparing a “worst possible scenario” for the novel coronavirus outbreak, where the big hospitals would become overloaded with critically ill patients and others would be moved to alternative facilities outside the system.

“What we’re presenting here is not what we expect to happen,” said Health Minister Adrian Dix in releasing the scenario Friday. “We are preparing for the most, the worst possible scenario ... regardless of whether it’s the most likely scenario or not.”

The scenario, modelled on the outbreak still raging in northern Italy, is one of four prepared under the direction of provincial health officer Dr. Bonnie Henry.

“This is modelling so it is not a prediction,” said Henry, who presided alongside Dix at the release. “It’s a set of parameters that allow us to make some rational decisions about planning.”

Even with that caveat, the four scenarios provided a window into the backroom planning by Dr. Henry and her team.

She has this far balked at the kind of speculation that has been commonplace elsewhere in Canada and around the world.

Asked as far back as March 9 how many cases the system could handle before it was overwhelmed, she said “there’s a good question” but didn’t answer.

“One of the reasons why we haven’t presented these data before now is because we haven’t had enough cases to be confident that this is actually meaningful,” she explained Friday. “But we are confident that this gives us a good sense of where we are in our trajectory right now in B.C., compared to these other jurisdictions.”

Besides Italy (which was the basis for two of the scenarios) the other jurisdictions were Hubei province in China, where the outbreak has plateaued, and South Korea, successful in bending the curve of the outbreak downward.

B.C. appears positioned to manage through an outbreak mirroring either the Chinese or Korean scenarios.

“Using the likely scenario of below or at a Hubei-epidemic level, capacity looks good,” said Dix.

“This has been enabled in large part by the decision made by health authorities and by the government to defer scheduled surgeries, which has opened up significant surge capacity across hospitals.”

But it would take greater effort to accommodate the projected number of hospitalizations under the worst of the scenarios derived from the Italian experience.

Based on trends here and elsewhere, B.C. officials have assumed that about 14 per cent of novel coronavirus patients (one in seven) would need to be hospitalized for 12 days or so.

A further five per cent (one in 20) would need to spend 10 days in critical care. Most of the latter group (80 per cent) would require the assistance of a mechanical ventilator to breathe.

The model based on the experience in northern Italy projects that coronavirus hospitalizations would max out at 2,746 patients in the 17 major B.C. hospitals designated to handle the outbreak. There would be a further 374 patients in critical care, 300 of them on ventilators.

But that’s just coronavirus patents. Based on the average hospitalization rate for patients with other conditions, the 17 major hospitals could be short 1,800 regular acute care beds, plus a further 340 critical care beds. Based on current supplies, it would have barely enough ventilators.

“You can see what happened in Italy, in particular, where the system was at 100 per cent capacity at the time when the surge of COVID-19 patients came,” Dix explained.

“It’s why we cancelled elective surgeries, based on the advice, based on what we were seeing, based on projections like this.”

Those cancellations have freed up almost 4,000 acute care beds. Other measures mean that almost half of the critical care beds in the system are available for use.

Plus the health regions have already identified overflow space in smaller hospitals and other care facilities. Plus if the squeeze were to increase, some patients could be moved into converted lodgings in convention centres, hotels and other spaces.

“Not because we expect it to happen, but we have an obligation and determination to be prepared for that to happen,” emphasized Dix.

As a measure of the unlikeliness of his worst-case scenario, I would note that based on a 14 per cent hospitalization rate, the 2,742 patients in his model would equate to 20,000 coronavirus cases overall.

Based on the current rate of increase, Dr. Henry suggested Friday that the more plausible peak for B.C. is 2,000 to 3,000 cases.

She sees “a slight chance of optimism” based on a recent slackening of the rate of increase in cases. “We are, maybe, starting to bend it (the curve) a little here.”

Not for a moment was she suggesting that people could reduce their due diligence in obeying her directives on physical distancing and the rest.

“I hope this will be a motivation for people to double down,” said Dr. Henry.

“We have looked at other places where they have eased off on the measures, and we have started to see increases again.

“But what I don’t want to see, and what I lie awake at night worrying about, is that line is going to start to dramatically increase again. And that is what’s going to happen if we let things off too quickly.”

She’s surely not alone in lying awake at night worrying.

But anxieties notwithstanding, Friday’s scenarios were more reassuring than other speculation on where the outbreak might be headed in B.C.

B.C. appears positioned to manage through an outbreak mirroring either the Chinese or Korean scenarios.