Alberta’s fourth wave of COVID-19 has put the greatest strain on the province’s health-care system to date, with about 200 patients now being treated in intensive care units and internal modelling suggesting the situation could get worse for weeks to come.
New data released Monday afternoon by Alberta Health shows 198 patients in ICU across the province, eclipsing the previous high of 182 set back in May, amid the pandemic’s third wave.
Meanwhile, Alberta Health Services (AHS) — the arm’s-length agency that administers health care in the province — said Monday there were 202 COVID-19 patients in ICU.
The exact numbers can fluctuate hour-by-hour so the precise count can vary depending on when it is taken.
Alberta’s health-care system typically includes 173 general, adult ICU beds but the actual capacity has expanded and contracted at various points during the pandemic, as hospital space is reconfigured and health-care staff are redeployed.
AHS said Monday 113 additional ICU spaces were available on top of the regular beds, for a total capacity of 286.
These beds are not just used to treat COVID-19 patients, but also people suffering from a wide variety of ailments, injuries and post-surgery complications. All told, AHS said there were 256 patients in ICU as of Monday.
Internal AHS modelling obtained by CBC News suggests the ICU demand could continue to grow in the coming weeks.
The modelling suggests there could be as many as 365 patients in ICU with COVID-19 by early October under the “high” scenario, 280 under the “mid” scenario, and 191 in the “low” scenario.
AHS spokesperson Kerry Williamson said the modelling is part of an “early warning system” used to “predict hospitalization and ICU numbers, to help us plan for changes in demand.”
“AHS is already increasing capacity to meet this forecast, and the potential for higher demand due to COVID-19,” he said.
“The current situation is serious and we are extremely concerned with the rapidly rising hospitalization and ICU numbers. We continue to do all we can to increase capacity, particularly in our ICUs.”
The worry of even more critically ill COVID-19 patients arriving in hospital comes as doctors say the health-care system is already buckling under the weight of current ICU demands.
‘We are in the midst of a disaster’
“Alberta hospitals really are on the brink of collapse,” said Dr. Ilan Schwartz, a physician and assistant professor in the division of infectious diseases at the University of Alberta.
“I think it’s important that Albertans know just how deep we are into this disaster. This isn’t something that we are projecting. This isn’t something that is potentially down the road. We are in the midst of a disaster.”
Schwartz was one of 65 infectious disease physicians to sign an open letter to Alberta Premier Jason Kenney Monday, calling for stronger actions to curb the spread of COVID-19, in particular restrictions on non-immunized individuals to access non-essential public, indoor spaces.
“This measure can immediately decrease new infections, thereby alleviating pressure on hospitals, while avoiding widespread lockdowns, now and in the future,” the physicians wrote.
Kenney has repeatedly rejected calls for provincial vaccination requirements, which are increasingly common in other provinces when it comes to accessing bars, restaurants, gyms and other public venues.
CBC News has requested a response from the premier’s office to the physicians’ letter.
Consequences of ICU expansion
While more ICU space has been made available, physicians say staffing those additional beds is already a challenge.
Dr. Erika MacIntyre, president of the Edmonton Zone Medical Staff Association, said nobody can predict for certain what will happen but the ICU projections are troubling because staff are tired after coping with three previous waves.
“We’re running out of ICU nurses and we’re running out of respiratory therapists,” she said.
“They’re done; they’re burned out,” she said of the ICU nurses. “They have worked every day this summer and this is the fourth wave so this isn’t the first time this has happened.”
MacIntyre said there used to be one ICU nurse for each patient but, as hospitalizations of COVID-19 patients increased, it went to one nurse to two patients and now it’s one to three patients.
“What this means is that the public and those coming to the hospital will see a reduction in services,” MacIntyre said.
As demand grows, staffing ranks may need to be increasingly bolstered by calling in doctors and nurses who aren’t specialists in intensive care.
“You can imagine if you’re not trained for a task, it’s going to be hard to do,” said Dr. Joe Vipond, an emergency physician in Calgary.
“The quality will suffer.”
The reallocation of health-care resources has also led to reduced levels of care and cancelled surgeries for non-COVID patients.
Albertans awaiting procedures such as kidney transplants and brain-cancer operations have recently seen their surgeries postponed.
AHS announced Monday that all elective surgeries and most outpatient procedures in Calgary will again be postponed this week, as staff are redeployed to intensive care duties.
‘On the cusp’ of running out of ICU capacity
During the height of its largest COVID-19 wave earlier this year, Manitoba’s ICUs were overwhelmed and patients had to be flown to other provinces for intensive care.
Schwartz worries Alberta may soon face the same situation.
“We’re really on the cusp of no longer being able to accept any patients into the ICU,” he said.
“This is what we mean when we talk about health care collapse. We’re talking about evacuating sick patients out of the province.”
Vipond noted both of Alberta’s neighbours — British Columbia and Saskatchewan — are also dealing with significant surges in COVID-19 and their own ICU capacity may be limited.
The result, he said, may be the rationing of intensive care to those who need it most.
“I think the reality is we’re looking at triage,” he said. “And we’re looking at preventable deaths that will be occurring over the next few weeks in Alberta.”