The impact of COVID-19 on intensive care units remains “alarming” despite a recent steadying of the number of patients treated there, says a group representing Ontario’s hospitals.
Anthony Dale, president of the Ontario Hospital Association, said there are, on average, 25 new COVID-19 patients being admitted to ICUs every day.
“This apparent stabilization masks the fact that capacity is actually being freed up as patients either leave ICU as they get better, or pass away from COVID-19 or another very serious condition,” Dale said.
Over the last week, up to 416 patients with COVID-19 have been treated in ICUs, according to data provided by the Ontario Hospital Association.
On Jan. 15, Ontario recorded an all-time high of 420 patients with COVID-19 in ICUs – about a quarter of all intensive care patients.
“The rate of transmission appears to be decelerating, but we cannot declare victory,” Dale said. “We must remain extremely cautious and keep up the fight against community spread to keep up our progress and prevent a third wave, especially when we see the new variant’s impacts in the United Kingdom.”
The province warned at the outset of the most recent lockdown that ICUs were on the verge of being overrun with COVID-19 patients, at which point physicians would be in the difficult position to choose who received critical care and who did not.
There were 595 patients transferred out of the worst-hit regions from November 2020 to January 2021, the association said. There were nearly 200 transfers planned for last week.
Many Toronto-area hospital ICUs are at or above capacity and have been transferring patients for months.
Ornge, the not-for-profit organization providing air ambulance and critical care transport services in Ontario, has taken the lead on transfers along with help from local paramedic services.
There have been 188 patients transferred by Ornge from ICUs to create capacity between Dec. 1, and Jan. 24. They are also transferring ICU patients between regions for the first time, sending some patients from Toronto as far as Kingston, Ont.
“It’s busy, it’s non-stop,” said Dr. Bruce Sawadsky, chief medical officer of health for Ornge.
“Ornge has performed a significant increase in ICU-to-ICU transports over the last two weeks to support hospital ICUs at capacity.”
But Sawadsky said the volume of patient transports has decreased over the last five days as ICU admission rates have decreased
The province has said a new hospital in Vaughan, Ont., set to open in February, will be able to help ease the burden by adding 35 ICU beds, with the ability to add 24 more.
Much has changed for Ornge during the pandemic.
Andrew Burns, a critical care paramedic for the organization, said he is doing a lot of things for the first time because of COVID-19.
Just last week, for example, Burns said he transported his first intubated COVID-19 patient face down in his land ambulance. It’s a relatively new approach to treat the most severely affected COVID-19 patients, to allow for better oxygenation.
But it also makes for trickier patient transfers.
“That’s a very new thing for us, we would have never done that before,” Burns says.
“Everything in medicine has always been designed for the patient to be on their back. Our stretcher is designed to be on your back, the ventilators are designed to be on your back, all the monitoring equipment … so when we flip people onto their stomach, it brings a whole risk of challenges.”
Burns said over five shifts last week, he and his partner transferred nine critical care patients, largely from the Toronto area, to more outlying areas. Eight of those patients had COVID and the other was moved to make room for a patient with the disease, he said.
“Back in April, it seemed like all the regular calls that we were doing kind of disappeared,” Burns says.
“COVID really became, not the only thing we were seeing, but very close to the only thing that we were seeing.”
Back then, most of the transports of COVID-19 patients came from outlying areas to the big hospitals in Toronto, he said. Now, it’s going the opposite way.
The pace is frantic.
“It’s not uncommon for us to be in an ICU now and as we’re taking a patient out of there to make room, they’re wheeling the next patient in,” Burns said.
Despite working with hundreds of patients with the disease, only one Ornge employee has had COVID-19, Sawadsky said.
They’ve implemented strict personal protective equipment protocols and the paramedics clean the trucks and helicopters down after each transfer, he said.
Burns is waiting for the pandemic to ease.
“I’d like for one day to go into an ICU and take a patient out and the nurses say there is nobody coming to fill this bed right away,” he said.
“Unfortunately that’s not the case right now.”