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Top N.S. ICU doctor says if public acts now, COVID-19 patients could avoid transfers

Top N.S. ICU doctor says if public acts now, COVID-19 patients could avoid transfers
Canada
HALIFAX - Nova Scotia’s top COVID-19 critical care doctor says Halifax patients in intensive care may face transfers around the province in coming weeks, depending on whether the population manages to “flatten the curve” of the disease’s spread.

Dr. Tony O’Leary, the medical director of critical care for Nova Scotia Health, says models suggest critical care units in the city could approach capacity by mid-May.

He says at that point, it’s possible patients will have to be shifted to hospitals outside Halifax with spare critical care beds.

“If the public follows public health measures now and in the coming weeks, it is going to make the difference between people having to be transferred around the province because we’ve reached our capacity in central zone,” O’Leary said in an interview on Tuesday.

As of Monday, Nova Scotia had 943 active COVID-19 cases — with most in the Halifax area — and models predict up to 10 per cent of those infected will require hospitalization, with about three per cent of the total needing intensive care.

O’Leary says if the modelling bears out, this will put pressure on the city’s critical care units, but he predicts they can handle the surge if people strictly adhere to public health guidelines in the coming weeks.

The physician says the city’s system has capacity for about 28 critical care beds, and it can extend that capacity up to 44 beds.

However, he says his teams are bracing for a possible tripling of the city’s current level of seven COVID-19 patients currently in intensive care to between 20 to 25 patients in seven to 10 days.

The doctor says the ability of the intensive care staff to handle the pandemic surge will depend on how many other extremely sick patients need intensive care, as well as the rate at which COVID-19 patients are being referred and recovering.

O’Leary says once Halifax’s system hits about 85 per cent capacity and if there is steady flow of COVID-19 referrals, that would be a trigger for transfers of patients to some of the other hospitals around the province.

The critical care physician said Nova Scotia’s system is well prepared for that possibility.

“The idea is that if a patient needs a bed, they’ll get it. It may not be at their closest hospital if we get very full but the plan is in place to use all critical beds as a provincial resource,“ he said.

Overall, Nova Scotia Health estimates that it has 245 beds intended for COVID-19 patients in the province, many of whom won’t require critical care but will need to be in hospital.

There are a total of 93 intensive care beds around the province for both COVID-19 and other patients, with a plan to increase that to 133 if necessary.

O’Leary noted that treatments in intensive care have evolved considerably since the first wave of cases a year ago.

Critical care teams will now delay putting patients on ventilators, instead using methods to keep a high flow of oxygen to them and – in some instances – the patients are encouraged to roll over onto their stomach to assist in breathing, a method known as “proning,” the physician explained.

Combinations of the steroid drug dexamethasone and the antiviral drug remdesivir, are being used to reduce the need for mechanical ventilation and to shorten recovery times.
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