All hospitals in Saskatchewan are entering the second phase of readiness in anticipation of an even higher number of COVID-19 patients in the next six weeks.

The SHA made the announcement on Sept. 17, with the changes effective immediately.

“All teams are required to identify and activate, without delay, slowdowns that will enable staff to assess the high priority COVID services and ICU and acute care services within our hospitals and across our system,” said Scott Livingstone, CEO of the Saskatchewan Health Authority.

In order to meet the demand for COVID treatment, there will be a reduction in elective procedures – among others – so that staff can be re-tasked to COVID patient care.

The staff that will be re-tasked right now are SHA staff, but some doctors that have private practices along with the training needed to work with COVID patients could also be used.

“It is targeted to those that work within the SHA and with us, whether they are family physicians, primary care providers in rural Saskatchewan that provide services today in hospital or long term-care facilities,” Livingstone said.

Hospitals in smaller communities are more likely to see alternate level patients moved from larger centres to free up beds in those communities for critical care and ICU patients.

The province will increase its ICU bed capacity from the normal 79 to 175, a large bump from the 130 it is at now. Of the 175 ICU beds, 125 are estimated to be COVID patients while the remaining 50 would be likely to be non-COVID.

Hospitals will have flex capacity for a total 350 non-ICU patients, an increase of 95 from the previous 255.

Projections on any case numbers and the likelihood all beds will be needed are based on no other intervening measures, but yesterday the province re-instated the mandatory indoor masking rule for public places and will limit access to services such as restaurants, concerts and bars for unvaccinated people starting October 1.

Delta is 200 per cent more contagious than original variations of COVID-19, and that has impacted the speed at which cases have been seen in the health care system.

“The rate of increase in our ICU census right now, is increasing at six times faster than we saw in wave three,“ said Derek Miller, Site Commander of the provincial Emergency Operations Centre overseeing the pandemic.

Miller said the peak has not been reached yet as there is a two-week lag between being infected and hospitalization, if it occurs. The system is at a critical juncture and the highest pressure point is not far in the future.

“The danger we face is that this will escalate to the point where many Saskatchewan residents won’t be able to reliably access critical care or emergency services,” Livingstone said. “That point is not far off. We already know that our ICUs and emergency rooms are operating at over capacity.”

Victoria Hospital bypass

In Prince Albert, Victoria Hospital has been on bypass off and on for some of the last several days as the beds are filled with COVID patients, primarily from the North East and North West regions.

“Bypass means a planned approach to make sure that all patients that need ICU services are managed in a way that balances services across the province,” SHA chief medical health officer Dr. Susan Shaw said. “For patients needing ICU, they will not go first to their nearest hospital if it is on bypass, they will be taken to another hospital in the province first.”

Last Friday, seven patients had been diverted from Victoria Hospital to other locations in Saskatchewan in the previous week.

“The pressure on our hospitals is a direct result of the ongoing pandemic of the unvaccinated,” Livingstone said. “The result is that many Saskatchewan residents will now go without the health services they need to preserve their quality of life.”

Age of patients

As Delta has surged across Saskatchewan, and other parts of Canada, health care staff have noticed a change in the demographics of those admitted to hospital.

“The Delta variant just does not care about your age, it just cares that you are not vaccinated in terms of putting you at risk,” said Shaw. “Most patients in ICU due to COVID last week were not elderly and they certainly were not chronically unwell. They were unvaccinated.”

She attributed the age change to the high uptake of the vaccine from people in the higher age groups.

Potential for triage

In the spring of 2021, the province update its triage protocol in the event the demand for beds exceeded capacity of staff to treat patients, a move Shaw said was necessary.

“It would be irresponsible to not have a framework and it would be irresponsible to not talk about and prepare people to think about it,” Shaw said.

The plan involved input from a variety of perspectives beyond a pure medical decision and essentially allows medical staff to allocate care based on the likelihood of the survival of the patient.

“It’s evidence informed. It’s been reviewed by the Human Rights Commission,” said Shaw. “It uses criteria that are based on medical evidence. It looks at who is most likely to survive an intensive care admission and if we ever get to the point we have to use it, referrals will be made”

A doctor and an ethics team have an initial discussion on treatment available and then refer the information to physician and ethicist in another facility before a decision is made, she explained.

“At this stage of pandemic, we have not formally activated triage but as I said before, that does not mean that decision are not being made today that have a direct impact on patient care,” Livingstone explained. “We are seeing procedures postponed almost each and every day because we do not have an available ICU bed if that patient requires post-surgical intervention.”

Mental health and addictions services will be maintained as will cancer treatments.

Staff will be redeployed to areas that are facing increasing increased demand and patients will start noticing the impact next week, said Livingstone.