Calgary doctors are facing distressing decisions, especially in intensive care units, as hospitals fill up with COVID-19 patients.
As of Wednesday, there were 202 COVID patients in Calgary hospitals, including 36 in intensive care, pushing the facilities beyond 100 per cent capacity.
Despite new measures announced Tuesday, hospitals in the city are preparing for a potential doubling of the COVID numbers in the next two weeks because a certain proportion of cases being identified now will end up very sick.
“We worry about the number of COVID patients and seeing a lot of people decline all at the same time and that knowing we can only look after so many,” said Dr. Misty Watson, a hospitalist (family physician who looks after admitted patients, many of them elderly) at Rockyview General Hospital.
Watson watched as COVID-19 admissions gradually increased through the fall, followed by a rapid influx over the past few weeks.
“Where do we put these people? How do we look after them safely? Worrying about — is it going to get to a point where we have so many patients that it’s not safe to look after the volume that they are. Are we going to have to call in more people?”
Calgary’s adult hospitals are now swelling with patients.
According to Alberta Health Services (AHS), they had an average occupancy of 107 per cent as of Wednesday afternoon.
At noon on Thursday, AHS reported an occupancy rate of 99 per cent.
“And they’re over-full, so we’ve moved into over-capacity spaces and we’re backing up into the emergency department,” said Watson.
“Every single day, we get notifications that the hospital is full and to do our best to try and safely discharge patients.”
Deciding who gets potentially life-saving care
Beyond the stress of scrambling to free up beds and squeeze in new patients, there is another level of angst, unlike anything Watson has experienced before.
“We’re at a place where some patients who normally would go to an intensive care unit now would no longer be appropriate,” she said.
“That’s distressing for physicians. And we know that in some cases this could have been avoided. And that’s difficult to wrap our heads around.”
Watson gives the example of older people — with serious underlying health problems — who may not be able to go to the ICU even though they want every measure taken to keep them alive.
“But we know that their chance of survival is much less than, for example, someone who is 30, 40 maybe 50 years old. So we’re having to have conversations at the beginning of admissions that although they may want to go to the intensive care unit, it may not be an option. And those conversations are happening more frequently,” she said.
“And that’s not something that we’re used to saying. I mean, we’re used to being able to do everything we can.”
Young, healthy people in ICU
On the intensive care unit at Calgary’s Peter Lougheed Centre, Dr. Daniel Niven has seen a surge of very sick COVID-19 patients suffering from lung failure over the past week.
“I’m becoming increasingly concerned about the next couple of weeks,” the ICU physician said. “The volume is increasing significantly.”
AHS recently added 20 additional ICU beds to adult hospitals around the city. Niven says 20 more beds can be opened, in stages of 10 at a time, under the current surge capacity plans. And he expects the next wave of 10 will likely be necessary within a week.
While Niven hasn’t faced scenarios where people who should go to the ICU can’t, he is witnessing another startling phenomenon.
During the first wave in the spring, Niven treated mostly older patients with serious underlying health conditions, he says.
Now he’s seeing people of all ages — from their 20s to 80s — many with well managed and fairly common conditions such as high blood pressure, diabetes and asthma. And some with no underlying health problems at all.
“These people are … working [and] looking after their own loved ones and then they’re getting COVID. And they’re ending up with us in the intensive care unit on a ventilator,” he said.
“It’s very scary to see the people that are getting infected with this and that are ending up on life support.”
Niven warns the underlying health conditions can be very mild, perhaps requiring a trip to their family doctor once or twice a year for medication refills — not necessitating frequent specialist visits or high amounts of care.
“So I think that’s something that’s not perhaps as well enough known within the general public. This is not just a disease of older people with a number of medical problems. It’s not that — that’s for sure.”
Niven suspects what he’s seeing in the ICU is a reflection of just how widespread COVID-19 has become.
“Now that it’s infecting a greater number of people within the population, I think we’re seeing just, in fact, what it can do and what other jurisdictions have seen,” he said.
“This notion of comorbidities is potentially providing a reassurance when it shouldn’t.… It can really affect anybody. And it’s really humbling to see it because you see these people that are otherwise the glue within their house, so to speak, and then they get taken down.”