By Anna Mehler Paperny
TORONTO (Reuters) – Over the course of a single shift last week, critical care physician Laveena Munshi saw her intensive care unit (ICU) at Toronto’s Mount Sinai Hospital fill with pregnant and post-partum COVID-19 patients.
During that week, the ICU doubled the total number of pregnant COVID-19 patients it had previously seen throughout the entire pandemic. Swamped with patients with complex medical needs, one day Munshi ended up pulling a 36-hour shift.
“You do what you have to do,” she said.
Ontario’s hospitals and ICUs have been crushed by a punishing third coronavirus wave, as depleted resources and overworked staff push Canada‘s healthcare system – often held up as a model for the rest of the world – to the brink.
Last week, Munshi and her colleagues spent agonizing hours discussing what to do if a pregnant woman needed an artificial lung to help her get enough oxygen.
“Having delivery equipment outside an ICU room is never a thing you want to be walking into at the beginning of your shift,” she said. “It just adds an added layer of unnecessary sadness to this whole pandemic.”
By Thursday, ICUs in Ontario, Canada‘s most populous province, had 800 COVID-19 patients, with such admissions at the highest point since the pandemic began.
Patients are coming in younger and sicker, driven by more highly transmissible virus variants. Hospital staff say they are seeing whole families infected due to transmission at front-line workplaces that have remained open through lockdowns and stay-at-home orders.
Mount Sinai Hospital just added a third ICU. It has seconded non-ICU nurses to help deliver critical care to the most seriously ill patients as it braces for the worst.
“The next couple of weeks are going to be extremely busy, there’s no question,” Munshi said, adding that people most affected by the current wave do not come from privileged backgrounds that would allow them to protect themselves, for example by working from home.
The provincial government has promised more ICU beds and requested medical staff from other provinces.
‘HOW MUCH MORE CAN WE STRETCH?’
Ramping up vaccinations targeting high-risk communities will help bring the third wave under control, experts said. But that will not relieve the immediate pressure on hospitals.
Exhausted staff are pulling overtime shifts and doctors are bracing for the tipping point no one wants to talk about: The activation of a “triage protocol” that will dictate who gets critical care when there isn’t enough for everyone who needs it.
Ontario’s Ministry of Health did not respond when Reuters asked what criteria would activate that protocol.
The protocol provides a standardized way to predict who is more likely to survive the subsequent 12 months, “trying to prioritize so that the most lives could be saved,” explained Dr. James Downar, one of its authors.
It does not include a provision for withdrawing life-sustaining measures, he said.
Raman Rai, manager of the ICU at Toronto’s Humber River Hospital, said she has never seen such a volume of critical care patients.
The hospital has redeployed staff, is treating people in “unconventional spaces,” and is stretching resources so a nurse who might have been responsible for one or two patients now has three, Rai said.
“We have already gone over capacity,” she said. “How much more can we stretch?”
Hospitals have been conducting drills and exercises in preparation for the triage scenario, said Ontario Hospital Association Chief Executive Anthony Dale.
“If it is used, it means we’ve failed as a province,” he said. “This did not have to happen. But are we preparing with everything we’ve got? Yes.”
In Toronto’s Sunnybrook Hospital on Wednesday morning, the ICU was buzzing with health workers having bedside discussions, punctuated by alarms from pumps and various equipment monitoring patients’ vital signs.
“It’s particularly distressing when we see someone who is 30 years old and healthy who comes in unable to breathe,” said intensivist doctor Hannah Wunsch. She is also seeing younger patients, pregnant patients and whole families with COVID-19.
From a medical perspective much of the work is the same, Wunsch said – save for ubiquitous masks.
“I haven’t seen anyone smile in a long time.”
(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Bill Berkrot)
Factbox: Countries respond to heart inflammation risk from mRNA shots
Some countries have halted altogether or are giving only one dose of COVID shots based on so-called mRNA technology to teens following reports of possible rare cardiovascular side effects.
Europe’s drug regulator said in July it had found a possible link between a very rare inflammatory heart condition and COVID-19 vaccines from Pfizer/BioNTech and Moderna.
However, the benefits of mRNA shots in preventing COVID-19 continue to outweigh the risks, European and U.S. regulators and the World Health Organization have said.
Here are some of the steps some countries are taking:
The Public Health Agency of Canada said data suggested that reported cases of rare heart inflammation were higher after Moderna’s COVID-19 vaccine compared with the Pfizer/BioNTech shots.
The Danish Health Agency said on Friday that it was continuing to offer Moderna’s COVID-19 vaccine to under-18s, and that a statement on Wednesday suggesting a suspension had in fact been a miscommunication.
Finland paused the use of Moderna’s vaccines for younger people and instead would give Pfizer’s vaccine to men born in 1991 and later. It offers shots to those aged 12 and over.
A panel of health experts advising the Hong Kong government has recommended in September children aged 12-17 should get only one dose of BioNTech’s COVID-19 vaccine after reports of heart inflammation as a side effect.
Norway will hold off giving children aged 12-15 a second dose of a vaccine against COVID-19 until it has gathered more research. On Oct. 22 the health ministry said there was no urgency given that children have a low risk of falling seriously ill from COVID-19.
On Sep. 2 Norway decided on giving one dose of Pfizer/BioNTech vaccine to children aged 12-15.
Sweden has extended the pause of Moderna COVID-19 vaccine beyond the original Dec. 1 deadline for people aged 30 and younger due to rare heart-related side-effects, the public health agency said on Oct. 21.
The agency said earlier in October that data pointed to an increase of myocarditis and pericarditis among youths and young adults vaccinated with Moderna vaccine Spikevax, and paused the use for all born 1991 or later.
South Africa will start vaccinating children between 12 and 17 using the Pfizer vaccine, the health minister said, as the country looks to ratchet up inoculations ahead of final year examinations.
On the advice of its vaccine advisory committee the government would only give teenagers a single shot of Pfizer’s normal two-shot regime due to concerns that it may affect the heart.
Britain has been offering all 12-15-year-olds a first a shot of the Pfizer/BioNTech vaccine. Second doses would not be offered to the age group until at least spring when there may be more data from around the world.
(Compiled by Antonis Triantafyllou; Editing by Joanna Jonczyk-Gwizdala and Tomasz Janowski)
Hong Kong’s zero-COVID policy undermining financial hub status – industry group
A financial industry group warned on Monday that Hong Kong‘s zero-COVID policy and strict quarantine requirements for international travellers threatens to undermine the city’s status as a financial hub.
The Asia Securities Industry and Financial Markets Association (ASIFMA) said a survey of members, including some of the world’s largest banks and asset managers, showed 48% were contemplating moving staff or functions away from Hong Kong due to operational challenges, which included uncertainty regarding when and how travel and quarantine restrictions will be lifted.
Hong Kong has some of the most stringent travel restrictions in the world and is virtually COVID-19 free, however unlike regional rival Singapore, which is slowly re-opening its borders, the Chinese-ruled city has no public plan for opening up to international travellers.
Local leaders say their focus is removing restrictions on travel from Hong Kong to mainland China, which also has strict entry restrictions. At present travellers from Hong Kong to the mainland must still undergo quarantine.
“Hong Kong’s status as an (international financial centre) is increasingly at risk along with its long-term economic recovery and competitiveness as a premier place to do business,” Mark Austen chief executive of Asifma wrote in open letter to Hong Kong’s financial secretary Paul Chan.
The letter made a series of recommendations including publishing “a roadmap for exiting Hong Kong’s ‘zero-case’ based COVID-19 strategy beyond solely the immediate goal of opening borders with China”, as well as prioritising vaccinations.
Hong Kong has reported just over 12,300 cases since the start of the pandemic, mostly imported, and 213 deaths.
Regional rival Singapore is expanding quarantine-free travel to nearly a dozen countries, but authorities are grappling with how to do so while averting a surge of Covid-19 cases among older people and those with weak immune systems.
(Reporting by Alun John; Editing by Michael Perry)
Red Cross urges action for Papua New Guinea as COVID-19 overwhelms health system
Concerted international action is needed to support Papua New Guinea as a surge in COVID-19 cases overwhelms the Pacific country’s health system, the International Federation of Red Cross and Red Crescent Societies said on Monday.
Coronavirus cases in the island nation of 9 million have been surging in recent weeks, with 385 new cases recorded on Thursday, according to latest available government data.
There have been 26,731 officially confirmed cases and 329 deaths in the country 150 km (90 miles) north of Australia.
Less than 1% of the population has been fully vaccinated, according to Our World in Data figures, although the government anticipated months ago that it would have enough shots by now for everyone who wanted to be vaccinated.
Misinformation, public apprehension, and logistical challenges with the rollout have slowed down vaccinations, the Red Cross said.
“Urgent efforts and further support are needed in healthcare to prevent a massive loss of life in the coming days and weeks,” Uvenama Rova, PNG Red Cross secretary general, said in a statement.
According to the PNG National Control Centre for COVID-19, all major hospitals have been hit with rising cases.
“We’re at the moment barely managing with the existing load,” Gary Nou, team leader for Emergency Medical Team at the National Centre, was quoted as saying last week in a statement on the centre’s website.
A medical team from Australia arrived in Port Moresby this month, and Britain was also to send a team.
While some other nations in the Pacific region, such as the Solomon Islands and Kiribati, have also had sluggish vaccine rollouts, the tiny nation of Palau had 99% of its population over 12 vaccinated by mid-October, while Fiji had 96% of eligible people with one dose, the Red Cross said this month.
(Reporting by Lidia Kelly in Melbourne; Editing by William Mallard)
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