Doctors warned Saskatchewan headed towards health care crisis

Hospital ICUs at risk of becoming overwhelmed if current trajectory continues, physicians told at weekly town hall

Prince Albert's Victoria Hospital. (Herald file photo)

Doctors across Saskatchewan have been presented data about the province’s COVID-19 outbreak that is drastically worse than what has been presented to the general public, and doctors are calling for urgent action to prevent the health care system from being overwhelmed.

Each Thursday the province’s doctors meet for a virtual town hall. This week’s town hall, which was posted online publicly following the event, warns of a worsening situation in the province’s intensive care units that are projected to get worse before it gets better.

“We’re at the heart of the pandemic now,” Saskatchewan Health Authority Chief Medical Health Officer Dr. Susan Shaw told her colleagues. “I would call this a new pandemic inside the previous pandemic.”

The doctors were told that so-called leading indicators are showing concerning numbers. Those indicators include the average daily new case rate as well as test positive rates. Both are still at concerning levels.

Then there are what’s known as trailing indicators. Those statistics, which include, for instance, the number of hospitalizations or ICU admissions, tend to lag a few weeks behind spread.

Much of the increase in COVID-19 spread right now can be attributed to gatherings held during Easter, as it can take up to two weeks for an infection to show up in someone in the form of symptoms. From there, it takes more time for a case to become severe enough for hospitalization. Still, the physicians were warned, with the variants of concern, those time periods are growing shorter and shorter.

The province saw a record 54 COVID patients in ICUs Friday.  Still, Thursday’s presentation warned, “we have not yet seen the peak of this surge.”

The severity of the situation in the province’s intensive care units was laid out by John Ash, the executive director of acute care in Regina and by Dr. John Froh.

The number of new cases per day on April 10 was the same as on Nov. 25. The difference, attributed to the variants, is an 88 per cent increase in the number of COVID-19 patients in the hospital and a 109 per cent increase in the number of COVID-19 positive patients in the ICU.

Overall, the variant-driven spread has lead to a 64 per cent increase in hospitalization, a 100 per cent increase in the risk of requiring ICU care and a 61 per cent increase in death.

In the first wave, he said, there were four inpatients for every one ICU case. Now, more are requiring ICU treatment. The current ratio is 1.5 inpatients for every one person requiring treatment in the ICU.

 “It’s a very disproportionate number of younger, very healthy individuals who are becoming infected and deteriorating quite rapidly,” Ash said.

“We’ve got mothers and fathers of young children with a whole life ahead of them in the ICU. Some very critically, and some have not done well.”

The presentation said that ICU admissions are happening earlier and lasting longer, that people are deteriorating faster and the burden is being placed on the most highly-trained, least available and hardest to recruit staff.

While much of the national media coverage has focused on Ontario and Toronto, proportionately, Regina and Saskatchewan are doing much worse. The rate of COVID-positive patients in the ICU in Ontario is 23.8 intubated per million population. In Regina, the rate is 153 ICU patients per million population, and in Saskatchewan as a whole, it’s 43.4.

For now, it’s manageable provincially, as only Regina has seen the worse impacts. But Saskatoon is starting to show a similar trajectory, with more variants showing up in their ICUs and in acute care.

The doctors were warned that if the same rates of variants of concern seen in Regina expand across the province, there could be as many of 180 people in the ICU. Saskatchewan’s base ICU capacity, where everything is properly staffed and no services are affected, is 79.

It’s already heading in a bad direction. Saskatchewan’s seven-day average of the number of people in ICU is higher than at any other time in the pandemic and is trending up.

If the province sees between 79 and 110 ICU patients, the system would be challenged, Froh said.

At that point — something Saskatchewan is already starting to see — “your ICU ratio of nurses to patients is starting to be altered. You are starting to use more non-traditional IUCU staff. You’re going to need service slowdowns to staff your ICU.”

The province is also starting to see some triage decisions required to manage capacity.

One the province exceeds 116 patients in the ICU, it enters the red zone. At that point, a lot of non-traditional ICU staff are needed.

“We have to slow down many, many things to staff this ICU,” Dr. Froh said of the red zone.

“We will have to triage patients who are going to receive ICU care.”

Froh called the red zone “system crisis.”

There are no projections about where Saskatchewan might be headed, Froh said, “but the trend is up. This is not where we want to be.”

The issue, SHA executive director Scott Livingstone said Thursday, is that the province will run out of appropriate intensive care staff. It has the space, the beds and the equipment, but only a finite number of staff members with the training and experience to work in intensive and critical care situations.

Saskatchewan’s situation was likened to the parable of the frog in boiling water. If you add a frog to tepid water and slowly increase it to boiling, the frog won’t jump out, it will die, the parable says.

Froh compared the health care system capacity to a bathtub. The drain is only so big. Water can only exit the bathtub if people get better or if they lose their fight. The water — new COVID cases — is flowing out of the tap.

“We’re in the tub, but we can’t turn off the tap,” he said. “Somebody needs to turn off the tap.”

There are worries among the doctors that people see the maximum capacity the province has and think that’s what it should be doing. But that added surge capacity, comes at the cost of safety, of quality of care and of health outcomes.

Shaw said her big concern is if trends continue, doctors will be forced to triage — to choose who gets ICU care and who doesn’t. It’s a concern she expressed earlier this week in an interview with Global News. The province isn’t there, but it’s preparing for the possibility.

Already, Regina is triaging operations, including postponing or choosing not to conduct life-threatening or life-altering surgery because there are no beds for the patients to use to recover.

“These are people we’re caring for,” she said. “These are people who work with us to care for people. We’ve gotten used to the numbers rising and think we are the frog.”

She emphasized to doctors, though, that it’s not too late. That all actions to slow the spread, such as social distancing, working from home when possible, wearing masks in public, are vital to keeping things from getting worse. That, she said, is the message everyone needs to hear.

“Everything we do now matters. It’s not too late. There is an opportunity ahead of us to make changes. Everything we do right now … matters.”

In the provincial legislature, NDP Opposition Leader Ryan Meili questioned why the presentation’s “cry for help” was not being echoed by the government, which he called a “jarring discord.”

Health Minister Paul Merriman rejected that premise and said case counts in Regina were stabilizing. He said the bulk of transmission is inside households, which is why the province restricted private indoor gatherings earlier this month.

“We haven’t seen the exponential numbers that were predicted a few weeks ago,” he said.

The presentation urges a continuation of stronger provincewide health measures as well as the “targeted immunization approach to at-risk populations.”

With files from the Saskatoon StarPhoenix