For Manitoba's intensive care wards, the 3rd wave crest is yet to come
ICUs struggle with record COVID patient numbers and the burden's expected to increase
In the middle of April, when COVID-19 case counts were rising exponentially in Manitoba, the deputy public health officer promised this province wouldn't allow the third wave of the pandemic to get out of control.
Dr. Jazz Atwal pledged Manitoba would not suffer the same fate as Ontario, which failed to enact measures early enough to prevent its own case counts from rising to the point where Toronto intensive care wards struggled to treat record numbers of COVID-19 patients.
"Ontario, you know, when you look at how the case numbers went up, they likely waited much too long," Atwal said at a news briefing on April 16.
"We're not going to go down that road, I could assure you that."
One month later, Winnipeg intensive care wards are struggling to treat record numbers of COVID-19 patients. A record 71 COVID-19 patients are being treated in Manitoba ICUs.
Hospitals are now doing everything they can to divert patients of all sorts from intensive care.
Some of the more stable COVID patients have been sent home, where they're given oxygen and monitored remotely. Others have been sent to long-term care homes, most of which are no longer death traps, thanks to vaccinations.
Hospitals are placing acute-care beds anywhere they can, knowing the number of COVID-19 patients that require intensive care is expected to keep rising until sometime in June.
"Right now, it's fair to say that from a physical capacity, we've expanded dramatically to all kinds of corners of the hospital and we're almost working one bed at a time. Where's the next patient going to go? Where can we move?" said Eric Jacobsohn, a Winnipeg ICU physician and anesthesiologist.
"We are sort of just running day by day, expanding where we can. And from what I'm told is … we're going to make physical space, we have the equipment, but the issue is human resources. Where do you find the people, particularly nurses, other front-line staff, physicians, to look after these patients?"
There is no easy answer to this question, and not just because the number of ICU patients continues to grow.
Sending serious patients home requires the deployment of outreach staff. Pushing COVID patients out of intensive care earlier than physicians may prefer comes with a risk those patients will have to return to the ICU.
All this turnover creates even more work for health-care workers who are already exhausted at this stage of the pandemic.
Over the past week, Manitoba Shared Health declined daily requests to address the growing burden on hospitals.
It was left to Atwal to insist health-care workers are up to the task ahead of them.
"The system will be pushed, but they are prepared," he said on Friday, during the same news briefing where he revealed Manitoba's COVID-19 case counts and ICU patient numbers have risen at a rate that exceeded the worst-case scenario envisioned by provincial pandemic modelling.
"If we continue to follow the model, we could be seeing high case counts throughout the summer, and the current trends lead to the health system becoming closer to being overwhelmed," Atwal said.
Atwal surmised ICU numbers are bound to rise 18 to 20 per cent a week for the next few weeks. That creates the prospect of 95 COVID patients in Manitoba ICUs before the end of May.
That would push the total number of ICU patients — both COVID and non-COVID — well above the second-wave peak of 129.
It is unclear how hospitals will manage.
On May 7, Chief Nursing Officer Lanette Siragusa said a second-wave plan to staff as many as 173 ICU beds is no longer on the table.
This raises the prospect of acute-care COVID triage, where doctors decide which patients warrant placement on ventilators on the basis of who is most likely to survive.
That was a grim prospect during the second wave, when some of the most severely ill COVID patients were elderly Manitobans with do-not-resuscitate orders.
It is more unpalatable now, given that the average age of COVID patients in ICU is lower. Shared Health said nine of the 71 COVID patients in ICU are under the age of 40.
So far, ICU doctors have not been forced to decide which COVID patients live and die, Jacobsohn said.
"I think anybody that has needed a ventilator has got a ventilator. Everybody that has needed critical care has has got critical care," he said.
"Are we looking after sicker and sicker patients on the wards before they come to the ICU? No doubt about it. They've had to expand the ward capacity of the non-ICU wards in the city to accommodate the flood of patients. And you know, it's a balancing act every day."
There is some cause for optimism in Manitoba. Vaccinations are increasing. The COVID-19 death rate is down. Case counts may soon level off.
Unfortunately, none of these factors are going to improve the hospital situation in the short term.
Manitoba went down the same road Ontario did. It will take weeks to come back.
With files from Erin Brohman