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Ontario’s strained intensive care units

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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)

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Germany’s confirmed coronavirus cases rise by 12,656

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Germany

BERLIN (Reuters) – The number of confirmed coronavirus cases in Germany increased by 12,656 to 3,520,329, data from the Robert Koch Institute (RKI) for infectious diseases showed on Sunday.

The reported death toll rose by 127 to 84,775, the tally showed.

 

(Reporting by Berlin Newsroom; Editing by Himani Sarkar)

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Canada ready to discuss COVID-19 vaccine IP waiver, ‘not interfering or blocking’ -Trudeau

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By David Ljunggren and Steve Scherer

OTTAWA (Reuters) – Canada is ready to discuss an intellectual property rights (IP) waiver for COVID-19 vaccines and will not block one even though it stresses the importance of protecting patents, officials said on Friday.

U.S. President Joe Biden on Wednesday threw his support behind waiving IP rights for COVID-19 vaccines. Any such waiver would have to be negotiated through the World Trade Organization (WTO).

“We’ve been working with partners at the WTO to find a consensus-based solution and are ready to discuss proposals, in particular for COVID-19 vaccines,” Prime Minister Justin Trudeau told reporters.

Biden’s proposal angered pharmaceutical companies. Firms working on vaccines have reported sharp revenue and profit gains during the crisis.

Canadian International Trade Minister Mary Ng earlier said that Ottawa firmly believed in the importance of protecting IP.

“I can assure you Canada is not interfering or blocking. Canada is very much working to find a solution,” said Trudeau, who did not give details of the Canadian negotiating stance.

Ng said Ottawa recognized how much the pharmaceutical industry had done to innovate COVID-19 vaccines, adding that many barriers to access were unrelated to IP, such as supply-chain constraints.

Canada is trying to quell a third wave of the coronavirus pandemic that is pushing some healthcare systems to breaking points, particularly in the western provinces of Alberta and Manitoba.

Manitoba officials said they were postponing some non-urgent surgeries to open space for COVID-19 patients and planned to announce tougher public health restrictions as daily cases soared to a near-record high.

The U.S. state of Montana will offer vaccines to around 2,000 Alberta truckers who regularly cross the border, Alberta Premier Jason Kenney said.

Truckers will get vaccinated at a post being set up just south of the border, using Montana’s surplus Johnson & Johnson vaccines.

The scheme mirrors an agreement that Saskatchewan and Manitoba reached with North Dakota.

 

(Additional reporting by Nia Williams in Calgary and Rod Nickel in Winnipeg; Editing by David Goodman/Mark Heinrich, Grant McCool and Marguerita Choy)

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Moderna says waiving IP rights won’t help increase vaccine supply

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Moderna Inc said on Thursday that waiving intellectual property rights on COVID-19 vaccines will not help boost supply in 2021 or 2022, a day after U.S. President Joe Biden backed a proposed waiver that is aimed at giving poorer companies access.

 

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