A6 | NEWS O THE GLOBE AND MAIL| FRIDAY, APRIL 3, 2020
Health ministries across Canada
are unearthing unused ventila-
tors from government stockpiles
and rushing to buy some of the
few still for sale as they work to
put to rest doubts about whether
Canada has enough intensive
care beds and ventilators to cope
with the coronavirus pandemic.
Even in British Columbia,
where detailed modelling re-
leased last week showed the
province would likely manage
comfortably, Provincial Health
Officer Bonnie Henry said she
will remain confident as long as
people stick with the restrictive
social-distancing measures that
she credited with keeping the
case numbers from exploding.
“We feel that the planning that
is being done should allow us to
adequately care for everybody
who needs it,” she said at a brief-
ing where the province released
the models, which compared the
growth of cases in B.C. with those
of Hubei province in China and
northern Italy.
Other modelling has raised
questions about whether Canada
has enough intensive-care capac-
ity and ventilators. A report from
Toronto’s University Health Net-
work says if cases in Canada in-
crease at the rate seen in Italy,
Ontario’s critical-care wards
could be overwhelmed.
If the numbers progress more
slowly, with 25-per-cent daily in-
crease in cases, capacity would
also soon be exhausted, said one
of the report’s co-authors, Beate
Sander, a UHN scientist.
But under the second scena-
rio, capacity would return be-
cause the peak of the pandemic
would be spread over a longer
period. If physical distancing
keeps the rate of growth at 15 per
cent a day, resources will be suffi-
cient.
The effectiveness of closing
schools and distancing measures
will determine which path we
end up on, Dr. Sander said. Her
calculations are based on as-
sumptions such as the number of
beds and ventilators, which can
change as health-care systems
adjust capacity.
“I feel like I’m holding my
breath for what will happen in
the next seven to 10 days,” Dr.
Sander said.
Provinces are doing what they
can to find more ventilators. Al-
berta, which has 477 adult critical
care ventilators, expects to re-
ceive another 50 from suppliers
by April 8. Ontario recently or-
dered 800 ventilators, and has an
unallocated surplus of 210 that
will be deployed where needed.
Canadian companies are being
enlisted to help build ventilators
quickly.
Kevin Smith, chief executive
officer of the UHN, estimates that
Ontario could have more than3,000 ventilators once additional
sources are tapped.
“I think it will be enough,” Dr.
Smith said.
As of last Friday, British Co-
lumbia had 914 ventilator-capa-
ble critical care beds. But the
number available for COVID-
patients in the province’s main
hospitals is 348 – the others are
in use, are designed for children
or transport services, or are in
smaller regions. That would be
enough to meet the peak de-
mand of 271 adults that would re-
quire ventilation under the Hu-
bei model.
B.C. is also preparing for the
numbers to surge as they have in
Italy, a scenario that would re-
quire other patients to be moved
from hospitals to alternate facil-
ities. The province ordered 120
new ventilators on March 5, but
so far has secured just 15. In the
meantime, it has refurbished old
machines.
Dr. Henry said the most likely
scenario in B.C. would look more
like that of Hubei than the surge
of cases that has overwhelmed
hospitals in northern Italy.
That’s because the province
emptied more than one-third of
its acute-care beds over the past
two weeks, and because of social
distancing.
“I’m starting to see some glim-
mers of hope that we’ve flattened
out our increase, our trajectory
has leveled off a bit,” she said.
Robert Fowler, a physician and
senior scientist at Toronto’s Sun-
nybrook Health Sciences Centre,
co-wrote a research paper on
Canadian ventilator capacity in- He said supply has im-
proved since 2015, “but not as
much as we might need in the
weeks ahead.”
Dr. Fowler said critical-care
ventilation can probably be in-
creased by 50 per cent to 100 per
cent by cancelling elective sur-
gery, ensuring all ventilators are
used, repurposing machines that
are capable of performing venti-
lation and drawing on emergen-
cy supplies.
The government of Canada
maintains an emergency stock-
pile of ventilators in warehouses
around the country, but the
number is considered a security
secret.
Intensive-care doctors are also
contemplating the possibility of
placing more than one patient
on a single ventilator, which
would be unusual for a Canadian
hospital.
“We’ve all seen in the media
some cases where they split the
ventilator and put four people on
a ventilator,” Dr. Smith said. “We
just have to make sure that we
don’t run the risk of harming pa-
tients by doing so. But that work
is under way to analyze it.”
Canadian intensive-care units
are designed to function at or
near capacity with little excess.
And the kind of patients who re-
quire ventilation in normal times
will still be there when the CO-
VID-19 surge arrives.
So how much of an increase
can the system handle?
“You can’t beat a pandemic
fight in the ICU, but you can cer-
tainly know when you are losing
one,” Dr. Fowler said. “It’s not
just the [ventilator]. You need
people to operate it.”Canadian ICUs typically have a
ratio of one nurse to one or two
patients, and an adequate supply
of respiratory therapists to help
run the machines and ensure pa-
tients can breathe. There’s usu-
ally one physician for 10 to 15 pa-
tients. A surge would severely
test those ratios.
Dr. Fowler said the disease
may peak in different regions at
different times, so people and re-
sources could be moved as need-
ed.
“We have to figure out how
we’re going to share capacity,” Dr.
Fowler said.
Kathleen Ross, president of
Doctors of BC, the provincial
physicians’ association, said she
is more concerned about staffing
and physical space for hospital
patients right now than the num-
ber of ventilators.
“Will we have enough nurses
and physicians, trained to both
use the machines to support pa-
tients, but also to have the
knowledge and experience to re-
spond to the reading on those
machines? What we’re trying to
do is understand what is our po-
tential workforce, should we
need to call upon physicians who
are recently retired.”
In B.C., the first Canadian
province where the pandemic
was felt, Health Minister Adrian
Dix said health-care workers
need Canadians to do their part
to keep the virus from spreading.
“One hundred per cent all-in.
That’s how we change the projec-
tion to the better, 100 per cent all
in. That’s how we deal together
with COVID-19 in the coming
days, weeks, and months.”Provincesrushtolocateunusedventilators
Officialssaysuccess
ofdistancingmeasures
îillbethekeyfactor
inkeepingCOVID-
caseloadîithincapacity
ofhealth-caresystems
JOE FRIESEN
JUSTINE HUNTER
gary’s City-Wide Medicine
Emergency-Pandemic Oper-
ations Command (MEOC) and is-
sued their call based on projec-
tion models that suggest the city
does not have enough acute-care
physicians to look after the many
patients expected in the weeks
ahead.
Alberta health officials are ex-
pected to soon release their own
modelling that will show what
they expect in terms of the po-
tential surge of COVID-19 pa-
tients. Premier Jason Kenney told
the legislature on Wednesday
that 2,250 acute-care beds will be
set aside for COVID-19 patients
and that the province expects to
need 250 intensive-care beds. The
Calgary models predict that, in
the worst-case scenario, as many
as 587 COVID-19 patients a day
could arrive at the city’s four hos-
pitals during the pandemic’s
peak. The best-case scenario,
which assumes social distancing
is effective, still projects about
185 patients with COVID-19 will
arrive in a single day. The peak is
expected to hit in about five or
six weeks, organizers said.
They caution that their mod-
els lack empiric data, and are
based on assumptions that make
the projections unstable and un-
certain. But even in the best-case
scenario, they say they expect
the number of patients who
come daily to the city’s hospitalsPhysicians in Calgary are plan-
ning for between 200 to 600 CO-
VID-19 patients a day to show up
at local hospitals at the height of
the pandemic, depending on the
success of physical-distancing
measures.
Doctors who are leading the
effort to prepare hospitals in Cal-
gary, which has by far the most
cases in Alberta, are calling on
colleagues to help with an ex-
pected surge of patients, even if it
means taking on clinical duties
outside their usual practices or
coming out of retirement.
Yael Moussadji, an emergency
physician and chair of the physi-
cian work-force pandemic plan,
said Calgary’s hospitals are likely
to need extra physicians with all
kinds of backgrounds, including
community doctors and pediatri-
cians. Up to one-third of admit-
ted COVID-19 patients may re-
quire a ventilator, and others will
still require high levels of care,
she said. At the same time, physi-
cians must be available to treat
patients without COVID-19, too.
“We’re casting our net wide to
appeal to physicians throughout
the zone, regardless of what their
background is,” she said in an
interview.
Dr. Moussadji and her col-
leagues are working with Cal-
will be higher than anything in
Calgary’s history, said Gabriel Fa-
breau, a specialist in internal
medicine and assistant professor
of medicine at the University of
Calgary. He made the prediction
to 750 physicians during a
recruitment webinar on the
weekend.“We cannot become Italy. I
don’t say that in a disparaging
way to Italy. But we have seen
these pictures,” he said. “We can-
not say to ourselves that we don’t
have any evidence of what it
looks like when a health-care sys-
tem becomes completely over-
whelmed by this virus.”
The Calgary physician pan-
demic planning group expects to
lose a significant portion of the
health-care work force becauseof illness and self-isolation after
an exposure. They worry, too,
about the possibility of deaths.
Reports from China, Italy and
Spain show health-care workers
are at a higher risk of infection
than the rest of the population
because of frequent exposures.
Physicians and other health-care
workers outside Canada have
died from COVID-19 acquired in
hospital.
As of Thursday, the Calgary
zone had 589 confirmed cases of
COVID-19, representing 61 per
cent of the province’s 968 con-
firmed cases. There were 247 in
the Edmonton zone.
Calgary’s physician pandemic
plan was developed based on
principles of disaster medicine
andfieldmedicine, and can be
rapidly scaled up as needed, Dr.
Fabreau said.
Physicians who enlist will un-
dergo specialized training in
proper donning and doffing of
personal protective equipment,
called PPE. The planning group is
collaborating on COVID-specific
guidelines for different aspects of
clinical care, including palliation,
infection control and intensive
care. These will be available to
help guide physicians.
Physicians will work in eight-
hour shifts, and are organized in-
to teams led by physicians with
expertise in managing patients
who are acutely ill. As the num-ber of patients increases, more
enlisted physicians will be called
into service in hospitals and
community clinics. The plan in-
cludes strategies to send patients
home as soon as possible, or to
long-term care facilities or med-
ical centres that provide less
acute care. Alberta Health Servic-
es is also looking at non-hospital
spaces that can be turned into
temporary units for COVID pa-
tients.
Around 150 physicians in Cal-
gary have enrolled so far, Dr. Fa-
breau said. He added that physi-
cians are being asked to take on
additional risks by signing up.
“We acknowledge that we col-
lectively have fears and anxieties
for ourselves and for our families.
I myself have three young chil-
dren. We all have people that we
love.”
The College of Physicians and
Surgeons of Alberta has contact-
ed 225 physicians who retired in
the past two years, offering to po-
tentially reinstate them and con-
nect them to Alberta Health Ser-
vices to be redeployed where
they are best suited.
The Canadian Medical Protec-
tive Association, which provides
medical-legal support to Cana-
da’s physicians, sped up its mem-
bership process to cover physi-
cians who are re-entering the
work force or changing roles in
response to COVID-19.Yael Moussadji, who is leading the pandemic plan, is recruiting physicians with various backgrounds, including community doctors and pediatricians.TODDKOROL/THEGLOBEANDMAIL
Doctorsenlistforcritical-careserviceinCalgary
CHRISTINA FRANGOU
Wecannotsayto
ourselvesthatwedon’t
haveanyevidenceof
whatitlookslikewhen
ahealth-caresystem
becomescompletely
overwhelmedbythis
virus.GABRIEL FABREAU
SPECIALISTININTERNALMEDICINEAND
ASSISTANTPROFESSOROFMEDICINE
ATTHEUNIVERSITYOFCALGARY