Health officials are coordinating hundreds of COVID-19 patient transfers across the province to make space for massive intensive care unit (ICU) needs in the coming weeks, Ontario Health says.
The race to move patients and open beds within reach of Ontario’s most taxed ICUs has become a complicated web and a snapshot of a province’s health-care system on the verge of breaking amid the third wave of the pandemic.
“I think we pretty much know that the next two weeks are going to be just horrific,” said Dr. Chris Simpson, executive vice president of Ontario Health.
“Every discussion we have, everything is about how are we going to get those health human resources in there? How are we going to get more ICU capacity? How can we accelerate these transfers even more? How can health-care workers work in different ways without pushing them too far out of their comfort zones,” he said.
There are about 2,200 critical care beds in Ontario right now, with a couple hundred more to be added shortly, Simpson said. Wednesday, the province reported an all-time high of 790 patients in ICUs and 566 patients on ventilators.
But, the problem is that not all ICU patients have COVID-19 — accidents, heart attacks and other critical-care issues still need to be addressed in hospitals. Last week, the province cancelled elective and non-urgent surgeries to release pressure from Ontario hospitals, allowing them to reroute resources to critical care. Simpson said this was a dire example of the state of Ontario in its third wave.
“I see the system has been in crisis since the day that we decided we had to ramp down surgeries and procedures. I mean, that is a not normal situation,” Simpsons said.
Transfers are being overseen by the Ontario Health, Ontario’s Incidence Management System and the Ontario Critical Care COVID Command Centre, which together coordinate flying or driving critical-care or hospitalized COVID-19 patients from hot spots like the Greater Toronto Area (GTA) to lesser affected areas or nearby hospitals who simply have open beds to fill.
“Ornge, which is our medical transportation agency, is now working literally around the clock — 24/7. A lot of the municipal ambulance services are engaged,” Simpson said.
Ornge’s chief medical officer, Dr. Bruce Sawadsky, said lately, its ambulances have been transferring up to 25 patients a day.
“The majority of patients we’re transporting, especially for the decanting of the ICUs, are all COVID-ventilated patients. So they’re quite complex and it can be difficult to ventilate. So it’s unusual for us to do that many persistently back to back,” he said.
Because the pandemic is not hitting all parts of the province in the same way, places like Kingston, which as of Wednesday has 88 active COVID-19 cases and only one local person in its ICUs, have become major overflow catches from overtaxed Ontario ICUs, specifically Scarborough.
“We’re sort of the biggest academic center on this side of Scarborough,” said vice-president of patient care at Kingston Health Sciences Centre Dr. Renate Ilse.
Ilse said London Health Sciences are receiving transferred GTA patients from the west.
Kingston Health Sciences Centre said as of Wednesday it was caring for 46 COVID-19 patients from out-of-region, 32 of which are in ICUs. Kingston too has had to add ICU beds during the pandemic, and now has 96 critical care beds and 78 ventilators.
Simpson said since November, something like 2,000 ICU patients have been transferred from their home hospitals to elsewhere in the province. He expects up to 300 transfers this week alone.
According to Ornge, more than 1,200 COVID-19 patients have been transferred by local paramedics and Ornge ambulatory services since Jan. 1, 2021. Ornge says 570 of those patient transfers have taken place in the last 21 days.
It’s come to a point where even offload points like Kingston have to transfer to even smaller locations like Brockville — a hospital about an hour away that has only 10 to 12 ICU beds and 13 ventilators.
Sawadsky said places like London and Kingston have been used for initial Ornge transfers because they’re easiest to drive to.
“We’re filling Kingston up with COVID patients. They have other patients in their ICU. They can move to Ottawa. So by separating it out, we’re managing to get patients in to Ottawa and try to fill their critical care beds as well,” Sawadsky said.
Ilse said the provincial bodies make decisions on the number of patients that need to be transferred in a day, but collaborate with the local hospitals to see who should go where.
“Clinical appropriateness always comes into that, stability for transfer. We try really hard not to transfer the same person twice because that’s difficult for them and for their family,” she said.
The logistics of these transfers is nothing but complex, and takes a lot of planning on all levels of the health-care system.
“If you’re sending a patient from, say, Lakeridge (in Ajax) to Ottawa, that requires a fixed-wing aircraft to make that transport safely, whereas you can get somebody from Oshawa to Kingston by ground transport, but a little harder to Brockville. So it’s a very complicated thing to calculate,” Simpson said.
Just on Wednesday, Frontenac Paramedics tweeted about its first-ever round-trip drive to collect a patient from the GTA back to Kingston.
“It’s all about diffusing the strain on the health-care system during the third wave,” the local paramedics said.
Another 27 #COVID ICU patients on the move.
However, we are now seeing "Critical Care hopscotch."
GTA #COVID patients are going to Kingston, but Kingston must offload patients to Brockville & Ottawa (OH East) to make space.
This is very concerning.
Options are running out. pic.twitter.com/RlKo49P5HQ
— Michael Warner (@drmwarner) April 20, 2021
The most pressing issue this week, Simpson says, is to make space for the avalanche of cases and hospitalizations expected to hit the GTA in the coming days.
“It’s partly kind of proactive, trying to anticipate what we know is going to get a whole lot worse in Toronto in the next couple of weeks by really filling every nook and cranny in the health-care system that we can,” he said.
To make sure there’s space to treat a mass amount of new critical care patients, Ontario health officials are creating what Simpson called “concentric circles” of open beds, with the GTA at the centre. This means filling up smaller ICUs like Brockville first, to allow hospitals like Kingston to have space to accept patients from Scarborough and so on.
“We’re trying to protect the GTA hospitals so that if they suddenly have 20 patients in, say, a hospital in Etobicoke some morning and everything is full, they need to be able to rapidly do rescue transfers in large numbers,” he said.
Tuesday, Ontario’s Science Table said the province’s hospital system is “buckling” under the weight of patient admittance. Simpson said Ontario is not quite at its breaking point yet, but could be soon if numbers continue at the same rate.
“We’ve never seen anything like this before, and if the wave three numbers don’t start to come down, then then we are going to be over capacity. We will run out of options,” he said.
He said health officials are considering all options right now, including sending patients out of province or even out of country in the worst-case scenario.
“Border towns to Michigan and New York have historic relationships with hospitals just across the border. They’ve always been our partners and could continue to be our partners in this setting as well,” he said.
Simpson said Ontario is not at that point yet, that there’s still capacity for shuffling within the province, but “everything is on the table,” he said.
“It’s all going to be determined by how quickly we can turn this wave three around,” he said.
— With files from Global News’ Abigail Bimman
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