Nova Scotia ICUs, already taxed, are bracing for more COVID-19 patients

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Dr. Brendan Carr is the president and CEO of Nova Scotia's health authority. (Robert Short/CBC - image credit)
Dr. Brendan Carr is the president and CEO of Nova Scotia's health authority. (Robert Short/CBC - image credit)

Nova Scotia's intensive care units are treating more COVID-19 patients now than at any other point since the pandemic started, and the head of the provincial health authority says hospitals are preparing to get busier yet.

"As of today, they're taxed, although we do have capacity in the ICU," Dr. Brendan Carr said in an interview with CBC News at 6.

As of Monday afternoon, there were 42 people in hospital with COVID-19, eight of them in intensive care. Most of the cases are in the central zone, at Halifax's QEII hospital, but Carr said there are hospitalizations in each of the other three zones.

The province currently has 119 ICU beds, and an expansion plan is in place that would add another 44 beds.

Expanding capacity within existing critical-care settings is the first part of the COVID-19 response plan, Carr said. Those plans are based on modelling, and the expectation that about 10 per cent of people who test positive for COVID-19 might require hospitalization, with about three per cent possibly requiring intensive care.

One precursor to expansion is the slowing or delay of other health-care services to free up beds and staff. That's already begun in Nova Scotia. Carr said about 500 non-essential surgeries have been postponed in the central zone. It's a step that was taken in the first wave of the pandemic, too, and required many months to catch up.

Military health-care personnel prepare for patients at a Toronto field hospital in April.
Military health-care personnel prepare for patients at a Toronto field hospital in April.(Nathan Denette/The Canadian Press)

Carr said it's too early to tell what the catch-up process will look like this time.

"It really depends how long we have to keep surgeries down to keep capacity for COVID. If it's a few weeks that's one thing, if this goes on for six weeks, eight weeks, that's an entirely different story," he said.

Field hospitals

In case internal expansion is insufficient, the health authority is preparing for the possibility of building field hospitals, as some other Canadian provinces have done.

Carr said Nova Scotia has signalled to Ottawa that federal help would be required, should things escalate to the point that field hospitals are needed.

"That would be one of the extreme measures, but it's definitely something we've planned for and if we have to, we would move in that direction," he said.

COVID-19 field hospitals have been built in Ontario and Alberta.
COVID-19 field hospitals have been built in Ontario and Alberta.(Nathan Denette/The Canadian Press)

Critical-care triage — deciding which patients get an ICU bed and which do not because resources are so stretched — has also been part of planning discussions, Carr said. That kind of difficult decision-making would only happen "very late in the game," after other steps fail to meet demand.

Hard-hit provinces like Alberta and Ontario have recently approached the need to triage critically sick COVID-19 patients.

Demographic shift paints a 'worrisome' picture

COVID-19 cases requiring hospitalization are rising quickly in Nova Scotia, and Carr said modelling shows cases rising for the next few weeks.

The speed with which the situation is changing was evidenced Monday when 40 hospitalizations were reported in the early afternoon, and an additional two cases had been admitted by the time Premier Iain Rankin and Chief Medical Officer of Health Dr. Robert Strang addressed the province at a COVID-19 briefing just a few hours later.

Those numbers, alone, set the third wave apart from the first and second waves when Nova Scotia saw relatively few hospitalizations. Strang has said variants are a key factor in the current wave. Nova Scotia is primarily recording cases of the B117 variant, which originated in the U.K.

For Carr, the most important takeaway about the shift in characteristics in this third wave is that younger, otherwise healthy people are getting sick.

"It's a very different and in some ways much more worrisome picture this time," he said.

ICUs across Canada, like this one at the Jewish General Hospital in Montreal, are seeing younger patients in the third wave, who often require critical care for longer periods of time.
ICUs across Canada, like this one at the Jewish General Hospital in Montreal, are seeing younger patients in the third wave, who often require critical care for longer periods of time. (Alison Northcott/CBC)

Carr said the majority of hospitalizations in Nova Scotia right now are people between the ages of 40 and 60. At least one person in their 20s has been admitted to the ICU in Nova Scotia. Hospitalizations and deaths have been trending younger across Canada during the third wave.

In the first wave, most hospitalizations were people with pre-existing medical conditions, Carr said.

In the third wave, "we're seeing otherwise healthy people that are coming in contact with this virus and they're becoming dramatically ill very quickly and presenting to hospital."

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