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Canada’s hospitals deploy artificial lungs, scramble for staff as COVID-19 hits younger patients

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By Anna Mehler Paperny and Allison Martell

TORONTO (Reuters) -Younger Canadians are bearing the brunt of the nation’s latest COVID-19 surge, creating growing demand for artificial lungs and a struggle to maintain staffing in critical care units as hospitals make last-ditch efforts to save patients.

Treatment with artificial lungs, known as extracorporeal membrane oxygenation, or ECMO, is much more likely to be deployed for patients under age 65, explained Marcelo Cypel, surgical director for the extracorporeal life support program at Toronto’s University Health Network (UHN).

Last week, there were a record 19 ECMO patients at UHN, 17 of them with severe COVID-19. When the sickest COVID-19 patients’ lungs fill with fluid and mechanical ventilators can no longer do the job, artificial lungs can save lives.

By Monday, doctors had weaned some off the machines and were down to 14 ECMO patients, 12 of them with COVID-19.

The need for these artificial lungs reflects a change in Canada‘s epidemic, which has taken a turn for the worse, with new cases surging and outbreaks hitting workplaces and schools.

With many seniors vaccinated and new, far more contagious coronavirus variants circulating widely, younger patients are increasingly arriving in intensive care.

“It’s very different now than the first wave, when we saw older people with comorbidities,” Cypel said. “We’re seeing more … young essential workers.”

The ECMO situation is under control for now, but things can change very quickly, Cypel cautioned.

When hospital systems in other countries were overwhelmed, they had to stop using ECMO because it requires a lot of staff – seven or more people to start the treatment.

About 55% of people who receive the therapy survive, Cypel said. However, they are often left with “severe physical limitations” from their extended hospital stay, he added.

Many of Canada‘s provinces are in the grip of a worsening third COVID-19 wave, as they struggle to hasten vaccine rollouts. The country reported more than 6,200 new cases on Monday, with the percentage of people testing positive for the virus up to 3.8%.

‘SEEING BURNOUT’

In British Columbia, where hospitals are bracing for a surge in demand for intensive care unit (ICU) beds caused by the highly concerning P.1 virus variant first discovered in, and now ravaging, Brazil, critical care doctor Del Dorscheid from Vancouver’s St. Paul’s Hospital is more worried about staffing than artificial lung use.

On a given shift, he said, a third of the staff are working overtime.

“They’re working so hard to find bodies to fill those empty spots,” he said. “I wouldn’t say we’re seeing more mistakes. Not yet, anyways. But we are certainly seeing burnout.”

For ICUs, there is no end in sight. As of Tuesday, there were 497 COVID-19 patients in Ontario’s ICUs, a new high. Last week, experts advising the provincial government said that could rise to 800 by the end of April even with a new stay-at-home order – or approach 1,000 without it. The province stopped short of a new stay-at-home order.

New restrictions implemented in Ontario last week change little for hardest-hit areas. In Toronto, patios for outdoor bars and restaurants closed, and a plan to reopen salons was shelved. On Monday, hard-hit Peel, west of Toronto, moved on its own to suspend in-person classes at schools for two weeks.

Canada‘s vaccination rate has picked up after a slow start, with 15% of the population getting at least one shot. But data from the Institute for Clinical Evaluative Sciences shows that the Ontario communities at highest risk of COVID-19 transmission also have the lowest rates of vaccination.

These communities tend to have a high proportion of residents unable to work from home, many of them non-white immigrants holding down jobs at high risk of virus exposure.

Some lack cars to drive to vaccination sites or paid time off to get the vaccine, said Brampton doctor Amanpreet Brar. Some of the hardest-hit neighborhoods lack pharmacies that dispense COVID-19 vaccines.

“It really reflects systemic inequities we see in our society,” said Brar. “They’re considered non-essential, while their work is considered essential.”

(Editing by Denny Thomas and Bill Berkrot)

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COVID cases in Ontario could spike to 30,000 per day by June

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TORONTO (Reuters) – New cases of COVID-19 in Canada‘s most populous province could rise more than six fold, topping 30,000 per day by early June if public health measures are weak and vaccination rates remain flat, a panel of experts advising the province of Ontario said on Friday.

Even if measures to control the virus are “moderate,” the number of patients in Ontario ICUs could reach 2,000 in May, up from 695 on Friday.

The College of Physicians and Surgeons of Ontario told doctors last week they may soon have to decide who can and cannot receive intensive care.

 

(Reporting by Allison Martell; Editing by Chris Reese)

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Moderna sees shortfall in Britain COVID vaccine shipments, EU deliveries on track

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ZURICH (Reuters) – U.S. drugmaker Moderna expects a shortfall in COVID-19 vaccine doses from its European supply chain hitting second-quarter delivery quantities for Britain and Canada, though European Union– and Swiss-bound shipments are on track, a spokesperson said.

The delays, first announced on Friday when Canada said Moderna would be delivering only about half the planned 1.2 million doses by the end of April, come as Switzerland’s Lonza ramps up three new production lines to make active ingredients for Moderna vaccine supplies outside of the United States.

“The trajectory of vaccine manufacturing ramp-up is not linear, and despite best efforts, there is a shortfall in previously estimated doses from the European supply chain,” Moderna said in a statement.

Lonza didn’t immediately return a phone call and email seeking comment on any issues in its production.

 

(Reporting by John Miller; editing by David Evans)

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Moderna says vaccines to Canada to be delayed due to Europe shortfall

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(Reuters) -Moderna Inc said on Friday a shortfall in COVID-19 vaccine doses from its European supply chain will lead to a delay in deliveries to some countries including Canada.

The drugmaker would be delivering only 650,000 doses by April end as opposed to 1.2 million, Canada‘s Procurement Minister Anita Anand said in a statement.

She said one to two million doses of the 12.3 million doses scheduled for delivery by Moderna in the second quarter would be delayed until the third.

Moderna officials in Europe did not immediately comment on the reason for the delays or give the total number of countries that would be impacted.

“Vaccine manufacturing is a highly complex process and a number of elements, including human and material resources have factored into this volatility,” said Patricia Gauthier, an executive at Moderna Canada.

Canada has distributed a total of 2.82 million doses of the Moderna vaccine as of April 14 and 12.7 million doses of COVID-19 vaccines in total.

Moderna has been aiming to deliver 700 million to 1 billion doses of the COVID-19 globally this year, including from plants in Europe and the United States.

Swiss contract drug manufacturer Lonza makes active ingredients for Moderna’s vaccine in Visp, but it was still ramping up three new production lines that once operational would be able to produce 300 million shots annually.

The current supply, demand and distribution landscape has led the drugmaker to make adjustments in the expected second-quarter deliveries, Gauthier said.

(Reporting by Manas Mishra in Bengaluru, Allison Martell in Toronto and John Miller in Zurich; Editing by Arun Koyyur)

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