With an increasing number of COVID-19 patients expected over the next few months, some Canadian hospitals could face significant shortfalls of ICU beds, according to projections from a team of researchers.
The model, developed by a team of health system researchers at the Dalla Lana School of Public Health at the University of Toronto, the Harvard Global Health Institute and the Harvard T.H. Chan School of Public Health, anticipates that many hospitals would need to boost their ICU bed capacity to meet the projected demands.
“What it’s really showing is that certain areas of the country are better equipped to deal with an acute stress like COVID-19 than others,” said Dr. Andrew Boozary, an assistant professor at the University of Toronto’s Dalla Lana School of Public Heath and co-lead on the project.
The model anticipates the need for ICU beds under three scenarios: whether 2.5 per cent, five per cent and 10 per cent of the population gets infected over the next four months.
In the best-case scenario, many hospitals across Canada would have more than enough capacity to handle COVID-19 patients, the projections show. Indeed, looking at the provinces as a whole, all except Ontario would have enough ICU beds.
Some hospital regions across the country would have to boost their ICU beds by at least 1½ times their capacity. Ten hospital regions in Ontario, eight in Quebec, three in Saskatchewan and two in Alberta and Manitoba would all face ICU bed capacity challenges, according to the data.
Boozary said the projections should alert health-care policymakers about some of the “significant challenges” faced by certain regions, “where there are potential risks given current capacity.”
And, not surprisingly, the situation becomes more dire if the infection rates multiply.
Broken down provincially, Ontario would face the greatest shortfall in capacity per capita in the five per cent infection model scenario, with projections that the province would need twice as many ICU beds.
And some hospitals across the country would have to triple their capacity for ICU beds in such a scenario.
But those issues could be mitigated by actions already being undertaken by health officials across the country, provincial health officials say. Those measures include, transferring patients to other regions or converting spaces within hospitals. And some provinces have created additional ICU capacity.
The model builds on the Public Health Agency of Canada’s latest projections of how the COVID-19 crisis could unfold in the country, which included “green-zone” scenarios involving strong controls resulting in one to 10 per cent of the population infected.
‘There needs to be planning’
Boozary said it was promising to see hospital bed and ICU capacity surge planning taking place in different regions.
“This is not to say that there hasn’t been these efforts across the country and in various spots,” said Boozary. “But really for us to see success, it has to be concerted, there needs to be planning. We can’t afford panic or complacency.
“The hope is that this effort might spur more transparency about the needs and action on the capacity front.”
In some of those regions, ICU shortages could be alleviated by transferring patients from vulnerable hospital regions to city hospitals that have a larger capacity.
However, Boozary pointed out there are areas in the country where it’s more difficult to shift that capacity.
“Richmond Hill to downtown Toronto is totally possible,” he said. “The challenge I think is when you look at some of the more remote communities.”
To come up with their projections, researchers first determined the number of available ICU beds in each hospital region for people with COVID-19.
That number was then adjusted by taking into consideration measures taken by hospitals to decrease the burden on ICUs — cancelling certain surgeries that could put someone in the ICU, for example.
Like any prediction model, it makes certain assumptions. For example, it assumes every hospital stay by a critical COVID-19 patient is 10 days. It also doesn’t take into account the possibility of moving patients around a province to relieve overcapacity.
Provincial health officials do have plans and have implemented measures to deal with potential ICU bed shortages.
Hayley Chazan, a spokeswoman for the Ontario Ministry of Health, said to meet ongoing capacity issues, the ministry has granted general approval to all public hospitals to operate and use another institution, building or other premises provided that certain conditions are met.
“For example, this change could give hospitals the ability to increase their capacity by entering into contractual agreements with retirement homes, hotels and other buildings or facilities to house COVID-19 or general patients,” she said.
Health authorities in B.C. say they are planning to add more bed capacity off-site from hospitals for less acute medical and surgical inpatients to open up additional capacity for COVID-19 patients in hospitals.
Alberta plans to increase its ICU capacity by adding ICU beds to existing ICU rooms and converting operating rooms and recovery rooms, along with procedure and treatment rooms, to ICU capacity.
Meanwhile, a health spokesperson for Manitoba said no single region is expected to be the sole provider of ICU care to its population and that any modelling done by external sources will not include all resources available to the government.
Hannah Wunsch, a doctor in the department of critical care medicine at Toronto’s Sunnybrook Health Sciences Centre who researches the organization and management of critical care services, said in Ontario they have already started shifting resources and have rebalanced the number of patients across hospitals.
She said there are many spaces in the hospital that can be turned temporarily into an ICU, including the recovery rooms.
“There’s actually a fair number of spaces that are not ideal by any sense for care of ICU patients,” she said.
“But when you get desperate … [you can] actually increase capacity pretty substantially.
“If we reach the point where it’s five times as many patients as ICU beds, no amount of capacity expansion can handle that. But when you’re talking 50 per cent to 100 per cent increase … we can potentially do that.”
About the ICU forecast model
Members of the ICU bed capacity model project included research assistant Robert Redelmeier and Jose Figueroa, an assistant professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health. The ICU bed model builds on the Public Health Agency of Canada’s latest projections, as well as the most recent publicly available data from the Canadian Institute for Health Information with respect to regional hospital bed capacity.
The hospitalization and ICU utilization rates are based on data from Imperial College across seven different age groups. The model takes into account the recent efforts by hospitals to lower occupancy rates. The potential infection rates used are also scenarios provided by Public Health Agency of Canada under strong epidemic controls.
The model does not account for a unexpected spikes in infections that will likely impact regions differently over time. This might mean that to accommodate any peaks in demand, the true resource needs could be even greater sooner than expected.