A new study from the University Health Network projects that in a conservative scenario Ontario will exceed its intensive care unit bed capacity within 37 days, creating downstream health system effects that will make the crisis even more difficult to manage.
In the conservative scenario that experts modelled, Ontario would run out of ICU beds within 37 days and out of ventilators within seven weeks. But that's based on things going well in Ontario and seeing the coronavirus' rate of growth slow down to 7.5 per cent. In a situation that follows Italy's path, which one report co-author called "crazy-scary," Ontario would exceed its ICU capacity within 16 days, based on a 33-per-cent daily growth rate in positive tests, which is similar to numbers that have been seen recently in Europe and North America.
Over the past week Ontario has averaged a 25.14-per-cent daily growth rate in positive tests, bringing its number closer to the Italy scenario than the conservative scenario. But Dr. Beate Sander, a co-author of the study and the director of health modelling and health economics at the Toronto Health Economics and Technology Assessment (THETA), stressed that it is early days to extrapolate that daily growth rate going forward, as there is still plenty of uncertainty around the availability of testing and the extensive social distancing implemented won't be reflected in the rate of new cases until early next week.
The report also warns that it is based on a preliminary model and includes evolving data, and thus its results should be interpreted with caution. The report was released late Wednesday night and was put together by health experts from the University Health Network, Sunnybrook Hospital and the Dalla Lana School of Public Health, among other institutions.
Instead, the projections are not meant to offer precise outcomes but to give context and guidelines that highlight the issues for policymakers and citizens, Sander told QP Briefing. "It's not about creating panic; it's also not about false reassurance. It's about helping people make good decisions." Sander added that it's plausible that Ontario could do even better than the conservative 7.5-per-cent case given its response so far, and the team will model that outcome in the coming days.
Among those major issues is the capacity of Ontario's health-care system to address the coronavirus pandemic. After analyzing the coronavirus trajectories in other countries, researchers applied that information to Ontario. A host of assumptions went into the analysis, including the length of infection, the percentage of people who would require ICU care and ventilators and the length of stay per patient.
Given that there are only 2,053 ICU beds in the province and only 1,311 ventilators, Ontario would hit capacity in either scenario modelled by researchers. Once that happens, Sander warned that a risk is that not all patients get the care they need. Not modelled are the knock-on effects of the health-care system being overwhelmed, and what that would mean for patients who have medical needs other than coronavirus, Sander added. Another risk that she outlined that has not yet been studied is that the model assumes that medical staffing is at full capacity, but in the event that staffers also get infected that may not be the case, which would further reduce the province's ability to respond.
In a conservative scenario where the province adds 600 ventilators and ICU bed capacity is doubled, the capacity limits won't be reached until about two months from mid-March, according to the modelling.
Health Minister Christine Elliott was asked about the pressures on ICU bed capacity in a press availability Thursday morning with a message that the government is working on the issue. "We don't know exactly what's going to happen but we do know that the pressures on our health-care system are going to increase," she acknowledged.
"We will be able to increase the number of beds in the areas where we most need them. We're also looking at other alternative measures where we can perhaps place some people who are alternate level of care, that are currently in our hospitals, to a setting that is going to be safe for them and appropriate for them," she added, noting that the government has moved to add 300 ventilators to the system.
Chief Medical Officer of Health Dr. David Williams downplayed the modelling, saying while it "is a really good tool to look at scenario design," the assumptions that go into the data don't match the reality on the ground — there would be more fatalities if it did. "One should not be too overconfident," he said of Ontario's ability to respond and referring to Italy as a cautionary tale. "But I'm confident."
He added that in the event that coronavirus patients exceed the number of ICU beds some may have to be doubled up in rooms, given that they would not be able to infect one another. He noted that he wouldn't recommend it as a practice.
Williams also added that he would not be surprised if the number of daily positive cases continues to go up in the coming days.
Ontario saw its second known coronavirus-related fatality today after a Halton man in his 50s passed away. The individual had other health complications and was being treated at Oakville Trafalgar Memorial Hospital and Milton District Hospital.
In late-breaking news on Thursday, the Toronto Star also reported that four residents at a nursing home in Oshawa, aged 68 to 92, tested positive for the novel coronavirus.
BREAKING: Four residents test positive for #COVID19 in outbreak at Hillsdale Terraces nursing home in Oshawa, Durham Public Health reveals. Ages 68 to 92. Staying in isolation there. Nursing home outbreaks are dangerous, as we have seen in Seattle and B.C. #onpoli
— Rob Ferguson (@robferguson1) March 19, 2020
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