As COVID-19 cases reach a critical tipping point, Alberta hospitals are in danger of being pushed beyond capacity, with the virus running through wards crowded by patients in isolation, frontline doctors warn.
“Infection control can destroy a hospital,” says Dr. Darren Markland, an intensive care physician at the Royal Alexandra Hospital in Edmonton, one of nine hospitals in the province contending with outbreaks.
“We need to have concrete guidance and that involves possibly rotating lockdowns or just kind of flipping the breakers for two weeks to stem the tide of this.”
Alberta must enforce more stringent public health measures immediately to protect hospitals from community spread, Markland said in an interview Friday.
If government health officials fail to clamp down, case numbers will escalate to where they will overwhelm health-care facilities, he said.
“We need clear direction from our government, from our chief medical officer, and that can not be voluntary at this point,” he said. “But right now, we’re getting some very vague leadership from our health authority.”
Alberta reported about 800 new infections on Thursday, breaking the daily case record.
The province did not have an exact number because of technical problems, but the range given was well over its previous one-day record of 622 new cases.
In her briefing Thursday, Dr. Deena Hinshaw, Alberta’s chief medical officer of health, warned that numbers will rise further and hospital care for Albertans with other issues besides COVID-19 will be affected.
As more patients are quarantined and wards are placed in isolation, operations will become more strained, Hinshaw cautioned. Additional measures will be considered unless the numbers drop dramatically in the next few days, she said.
“I am very concerned about the levels of hospitalizations for COVID-19 in Edmonton and Calgary,” Hinshaw said.
“We must protect our health system by reducing community transmission. The fact that we are now reporting 800 new cases is extremely concerning.”
A hospital fails well before it is over capacity.– Dr Darren Markland
While Markland worries about the growth in the caseload, the real issue in Alberta hospitals is the strain of controlling infection and isolating patients.
“A hospital fails well before it is over capacity,” Markland said.
“When you have a pandemic, your most important mechanism is prevention of spread. And you can imagine, hospitals concentrate the sickest people in small areas.
“As you pack sicker and sicker people in smaller areas, you are going to see spread.”
Markland said Alberta’s hospitals are not designed to handle pandemic protocols.
Placing even a single patient in lockdown can have a ripple effect through the entire hospital, he said.
Outbreaks make it impossible to move patients through the system, while understaffing from illness and exhaustion leads to further outbreaks, Markland said.
“You can’t get out of the emergency department. You can’t get into the cath lab. You can’t get into the operating room and you can’t get into the ICU because you can’t put uninfected people together with infected people.”
Already the pressure on front line staff is immense, he said.
“There is a feeling of ongoing dread,” Markland said. “We can’t be complacent about this.”
Some hospitals are already operating at threshold.
Nine Alberta hospitals — the Royal Alexandra Hospital, the University of Alberta Hospital, Leduc Community Hospital, Misericordia Community Hospital, Grey Nuns Community Hospital, Foothills Medical Centre, Peter Lougheed Centre, Rockyview General Hospital, Chinook Regional Hospital — have declared outbreaks. All continue to operate but with restrictions.
Some wards have been locked down or non-emergency surgeries have been postponed. In some facilities, visitation has been restricted.
In Edmonton, 30 percent of non-urgent and elective surgeries have been postponed for the foreseeable future to ensure hospitals have the capacity to withstand any outbreaks among their patients.
Health officials say hospital capacity has been limited too by the need to quarantine staff who have fallen ill or have potentially been exposed to the virus.
We’re going to see the death rate of the virus go up.– Dr Raj Bhardwaj
Dr. Raj Bhardwaj, a family physician and urgent care doctor working in downtown Calgary, said health officials should have seen this coming.
The government’s response to the virus thus far has been weak, Bhardwaj said.
Despite repeated warnings, little was done to avoid the anticipated second wave, he said.
The province no longer has the luxury of targeted controls, he said. More drastic measures such as rotating lockdowns will be required to turn things around.
“If we don’t impose some sort of restrictions to turn these numbers around, we are going to the hospital overwhelmed with numbers,” he said.
“We’re going to see the death rate of the virus go up because the death rate is not intrinsic to the virus alone. It is also partly changeable, depending on our ability to treat people who are very sick from the virus.”
Bhardwaj said he wants to see the province adopt new mandatory restrictions but a lack of transparency has stymied efforts to contain the virus.
Government health officials should be releasing more data on current hospital capacity thresholds and ensure their modelling for the trajectory of the virus is up to date, he said.
Any investigations done on the spread of the virus within hospital wards should be made public and shared widely among the medical community, he said.
Without these critical details, the public and front-line healthcare workers are often operating in the dark, Bhardwaj said.
“There’s a lack of transparency on a lot of levels,” he said.
“People just aren’t informed. And the people who are tasked with informing them, sadly, are not sharing the information that I’m sure that they are operating with.”
Without better protocols, he fears for the winter ahead, Bhardwaj said.
“I fear for the public for sure, for my patients for sure. But I also really fear for my colleagues.
“I’m really worried about how they’re going to cope with the moral injury of having to deny people care or having to ration care in terms of beds and ventilators and visitors and things like that
“It’s going to be the type of damage that lasts a lifetime.”
Bracing for a spike
Dr. David Zygun, Edmonton zone medical director with Alberta Health Services, said front-line staff are bracing for an increase in hospitalization rates.
There is no doubt that a spike in infection rates will be felt in health-care centres in a matter of days, Zygun said in an interview Friday.
Staffing is the largest challenge in Alberta hospitals right now, he said. Many workers have been sent home due to illness or possible exposure. Workers are also exhausted from the strain of months spent contending with the added anxieties of working through a pandemic.
Demand for isolation space is at an “all-time high” and it’s eating up critical space in hospitals, Zygun said.
“I am very concerned about the numbers I see in the community,” he said.
“Ultimately, that’s what’s driving a lot of the isolation and demand. Until we get control over those, we will see increasing strain.
“I absolutely have seen the stress on our frontline health-care providers and the leaders that are also trying to manage this. This now a very prolonged pandemic.”
If hospitals do approach the tipping point, Zygun said detailed contingency plans are in place for staffing and facilities.
For instance, “unconventional” strategies could see doctors from the ER called in to assist with patients in intensive care units. If intensive care units fill up with COVID patients, cardiac units or post-op rooms could be equipped with ventilators.
Hundreds of surgeries have already been postponed. If the trend continues, more procedures will be called off, Zygun said. Any extra measures that could help curb the spread of the virus would be welcome, he added.
“We know, as the numbers go up, the end of this is further and further away.
“We’re trying to do as much as possible. But as things escalate, we will have to focus more and more on the inpatient response. And that means delayed care for others, which is extremely troubling.”