Intensive care physicians and nurses share their concerns as they brace for an influx of patients that threatens to overwhelm hospitals due to the resurgence of the coronavirus and the flu.
When Canadians successfully flattened epidemic curves during the summer, the goal was to prevent hospitals and intensive care units from facing a crush of too many patients with COVID-19 all at once. Health officials wanted to avoid what happened in hospitals in New York City, where refrigerated trailers were used as temporary morgues.
But the recent surge of new coronavirus cases in all provinces beyond Atlantic Canada has already thwarted surgery plans and led to the cancellation of surgeries such as hip replacements at one hospital in Toronto and postponements in Edmonton.
Dr. Bram Rochwerg, an associate professor at McMaster University and critical care lead at the Juravinski Hospital in Hamilton, anticipates a surge of patients with COVID-19, and he worries they won’t be able to accommodate them all as more surgeries resume.
Unlike in the spring, beds and crucial staffing need to be reserved for medical and surgery patients, too. Traditionally, autumn in hospitals means scrambling for health-care workers such as nurses and respiratory therapists to backfill those sick with the cold and flu or who need to stay home to care for sick children.
“We’re all worried about it,” Rochwerg said. “You see the provincial [COVID-19] numbers creep up day by day. We see that critical care numbers [of ICU patients] creep up.”
The challenge, Rochwerg said, is to find a balance between adding restrictions to protect vulnerable populations such as residents in long-term care homes while preserving crucial aspects of society.
Rochwerg also pointed to several lessons physicians worldwide have learned to help take better care of patients critically ill with COVID-19 during the resurgence.
“We should treat them like we would any other patient,” he said. “Sometimes, you just need [to insert] a breathing tube.”
When patients are on a ventilator, it takes the skilled hands of four to six hospital staff, including a respiratory therapist who regularly checks the breathing set up and tubing to ensure the airway is protected, as well as nurses to safely turn or “prone” them onto the stomach to improve ventilation.
WATCH | COVID-19 resurgence raises hospital capacity concerns:
The importance of getting patients up and out of bed, including those on ventilators when possible, as well as excellent nursing care and other day-to-day supportive care can’t be minimized.
“Supportive care is not the sexy part of it, but it’s so crucial,” Rochwerg said.
It gives patients’ bodies time to heal themselves, he said.
Fear of flood of sick patients
Patty Tamlin, registered nurse working in critical care at a hospital in Toronto’s east end, said she’s also concerned about the coming cold-and-flu season.
“One of the biggest concerns is you may be overrun by patients,” Tamlin said.
Her message to Canadians? “Tell everyone to get their flu shot.”
In the spring, the Ontario government created more beds for patients needing long-term ventilated care at a rehabilitation hospital. Even if administrators find more space for more beds, adding temp agency nurses can only go so far, she said.
“It’s going to be a long time,” Tamlin said. “It’s fatiguing … to have this constantly on our head all the time about COVID on top of our regular work.”
Experience, though, has helped ICU staff to prepare for a resurgence of COVID-19 patients.
“The more you do something, the more comfortable you are with going in and out of a room,” for example, to perform CPR during a “protected code blue” for cardiac arrest when wearing full personal protective equipment, which can be exhausting. The masks, gowns and gloves need to be donned and removed carefully to avoid health-care workers contaminating themselves.
Dr. Eddy Fan, medical director of the Extracorporeal Life Support (ECLS) program at Toronto’s University Health Network, said the increase in COVID-19 cases so far is “manageable.”
Extracorporeal membrane oxygenation (ECMO) is like an artificial heart and lung machine to support the sickest patients. People with COVID-19 who were intubated at hospitals across Ontario and didn’t improve with conventional therapy were transported to Toronto General for ECMO.
Still, Fan said, “We’re going to need to brace ourselves for another potential flood of very sick patients.”
During the spring, patients were transferred to Toronto General, but family members could not visit. Fan said cutting off patients from their relatives harmed morale not only among loved ones, but it pained people working in the hospital, too.
But influenza season also typically brings patients with lung failure who may need ECMO.
“Their families ask questions like ‘they’re dying of the flu?'” Fan said. “COVID is no different as a viral infection. We see even young patients come with very severe lung failure requiring ECMO.”
During Toronto’s first wave of COVID-19, the team successfully treated a 22-year-old with ECMO.
While respiratory failure from COVID-19 can resemble that of the flu, doctors say the scale is much larger.
Dr. Gregory Haljan, head of Surrey Memorial Hospital’s critical care department in British Columbia, said influenza has vaccines and medical treatments to shorten symptoms and improve death rates. COVID-19 doesn’t, aside from corticosteroids for severe cases.
When Haljan and his co-authors across the Lower Mainland looked at 117 people with COVID-19 who were admitted to ICU between Feb. 20 and April 17, they found the mortality rateranged from one in six to one in 10.
In comparison, the first studies from China and Italy showed mortality rates as high as one in two or one in three.
Safety ‘our primary focus’
Haljan credited having time to prepare, Dr. Bonnie Henry’s “outstanding” leadership as the provincial health officer, the support of British Columbians, hard work and luck.
“We never got overwhelmed,” he said.
To prevent being overwhelmed, Haljan said the hospital and its health region focused on basics, including:
- Engaging patients in the community and long-term care homes through a virtual hospital to keep patients safe at home.
- Improving communication with centralized repositories of information to avoid mixed messages.
- Adapting as the science changes.
“It can be a challenge in that things change very, very slowly because safety is our primary focus,” said Haljan, who works at one of the hospitals caring for among the highest volume of patients in the emergency department, according to the Canadian Institute for Health Information.
“Research is how we keep change safe.”
Haljan said that includes research not only on vaccines and drugs but also measuring patterns and assessing them in areas such as delivering health services.
COVID-19 testing site set up as supplement in Red River College parking lot
Dr. Gerald Brennan wants to help.
That’s why he, along with medical colleagues from The Minor Illness & Injury Clinic on Corydon Avenue in Winnipeg, dons and doffs personal protective equipment to work at a new COVID-19 testing site set up adjacent to Red River College’s campus on Notre Dame Avenue.
Novel coronavirus cases — and deaths, a record 19 Saturday — are still surging in Manitoba.
It’s the second-hardest hit province after Alberta.
As of Saturday, 349 people were hospitalized with COVID-19 in Manitoba, 51 of whom are in intensive care.
Meanwhile, 2,981 tests were completed Friday, which brings the total number completed since the start of the pandemic’s reach into Manitoba to 369,154.
The appointment-only, drive-in site is a collaboration between Shared Health, the clinic and the college which began in October as a supplement to the province’s existing testing infrastructure, Brennan said.
“It’s been fantastic to see these folks come together and put together something that’s pretty efficient and seamless in a short period of time,” Brennan said.
“We’ve got a group of IT people, a group of doctors and nurses, we’ve got Red River College who’s been a fantastic partner, Shared Health, (the Winnipeg Regional Health Authority), everyone’s kind of pulled together so we were actually able to get this site up and running within a very short period of time to try and help out with the demand for testing.”
“We can make it so getting a test done can be done fairly quickly and with as little inconvenience to people as possible, that was our motivation,” he said, noting the average wait is about five minutes.
Source:- Global News
Coronavirus: 19 deaths, 354 new cases in Manitoba Saturday | CTV News – CTV News
In Manitoba’s deadliest day, health officials are reporting 19 new COVID-19 deaths and 354 new cases of the disease.
Announced in the province’s daily COVID-19 bulletin on Saturday, all of the deaths except one are from Winnipeg.
The deaths from Winnipeg not linked to senior facilities include a woman in her 20s, a man in his 60s, two women in their 70s, a man in his 70s, a man in his 80s and a woman in her 90s.
Three deaths, a man in his 70s, a man in his 80s and a woman in her 90s are linked to the outbreak at St. Norbert Personal Care Home.
Another three deaths, a man in his 70s, a woman in her 90s and a man in his 90s, are linked to the outbreak at Park Manor Care Home.
Health officials also said a woman in her 90s and a woman in her 100s, both linked to the outbreak at Holy Family Home, died of COVID-19.
A woman in her 70s inked to the outbreak at Oakview Place personal care home and a man in his 90s linked to the outbreak at Bethania Mennonite Personal Care Home also died of the virus.
The only death outside of the Winnipeg region was a woman in her 60s from the Northern health region linked to the outbreak at The Pas Hospital Acute Care.
The number of deaths in the province related to COVID-19 rises to 381.
Along with the 19 deaths, 354 cases of the virus were announced.
Of the new cases, 235 are in Winnipeg, which has a five-day test positivity rate of 14.1 per cent.
The total number of cases in Manitoba since early March is 18,423.
The province currently has 9,115 active cases, and 8,927 people have recovered from the virus.
The current provincial five-day test positivity rate now sits at 13.1 per cent.
There are 349 people in hospital with COVID-19, down slightly from Friday, with 51 patients in intensive care.
On Friday, 2,981 tests were performed, bringing the total to 369,154 since early February.
Six new cases of COVID-19, province reports – HalifaxToday.ca
As of today, Dec. 5, Nova Scotia has 95 active cases of COVID-19. Six new cases are being reported today.
Four of the new cases are in Central Zone and two cases are in Eastern Zone. All are under investigation.
“As we get into the holiday season, weekends are usually filled with friends, family and shopping, but this year must be different,” said Premier Stephen McNeil. “We need to limit our social contacts and non-essential travel, and follow all the other public health protocols. That is how we protect each other and slow the spread of COVID-19.”
Nova Scotia Health Authority’s labs completed 1,410 Nova Scotia tests on Dec. 4.
Yesterday there were 276 tests administered at the rapid-testing pop-up site in Halifax. There were no positive test results identified at the site.
Since Oct. 1, Nova Scotia has completed 74,664 tests. There have been 275 positive COVID-19 cases and no deaths. No one is currently in hospital. Cases range in age from under 10 to over 70. One hundred and eighty cases are now resolved. Cumulative cases may change as data is updated in Panorama.
“It is encouraging to see new case numbers go below the double-digits we have been seeing but it is too soon to relax now,” said Dr. Robert Strang, Nova Scotia’s chief medical officer of health. “We must remain diligent and continue to follow public health orders and advice so we can keep our citizens safe.”
Visit https://covid-self-assessment.novascotia.ca/ to do a self-assessment if in the past 48 hours you have had or you are currently experiencing:
— fever (i.e. chills/sweats) or cough (new or worsening)
Two or more of the following symptoms (new or worsening):
— sore throat
— runny nose/nasal congestion
— shortness of breath/difficulty breathing
Call 811 if you cannot access the online self-assessment or wish to speak with a nurse about your symptoms.
When a new case of COVID-19 is confirmed, public health works to identify and test people who may have come in close contact with that person. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days.
Anyone who has travelled outside of Atlantic Canada must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.
It remains important for Nova Scotians to strictly adhere to the public health order and directives – practise good hand washing and other hygiene steps, maintain a physical distance when and where required. Wearing a non-medical mask is mandatory in most indoor public places.
Rules concerning interprovincial travel within Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland and Labrador have changed. The premiers of all four Atlantic provinces are cautioning against non-essential travel into neighbouring provinces. Currently, all non-essential travel into Prince Edward Island, New Brunswick and Newfoundland and Labrador requires a 14-day self-isolation. All public health directives of each province must be followed. Under Nova Scotia’s Health Protection Act order, visitors from outside Atlantic Canada must self-isolate for 14 days unless they completed their self-isolation in another Atlantic province.
Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus .
Businesses and other organizations can find information to help them safely reopen at https://novascotia.ca/reopening-nova-scotia .
— testing numbers are updated daily at https://novascotia.ca/coronavirus
— a state of emergency was declared under the Emergency Management Act on March 22 and extended to Dec. 13
— online booking for COVID-19 testing appointments is available for Nova Scotians getting a test at all primary assessment centres or at the IWK Health Centre in Halifax
Government of Canada: https://canada.ca/coronavirus
Government of Canada information line 1-833-784-4397 (toll-free)
The Mental Health Provincial Crisis Line is available 24/7 to anyone experiencing a mental health or addictions crisis, or someone concerned about them, by calling 1-888-429-8167 (toll-free)
Kids Help Phone is available 24/7 by calling 1-800-668-6868 (toll-free)
For help or information about domestic violence 24/7, call 1-855-225-0220 (toll-free)
For more information about COVID-19 testing and online booking, visit https://novascotia.ca/coronavirus/symptoms-and-testing/
The COVID-19 self-assessment is at https://covid-self-assessment.novascotia.ca/
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