Faced with coronavirus, some Canadian hospitals have extensive pandemic plans, but most say they’re just making do
VANCOUVER—The procedure ran like clockwork: Identify the coronavirus patient. Isolate. Put in a breathing tube. Bring them to the intensive care unit.
That’s how things went Friday, when doctors, nurses, transportation specialists and respiratory technicians practised a COVID-19 simulation at The Ottawa Hospital in preparation for a possible community outbreak of the virus. Front-line professionals made full use of isolation rooms, protective equipment and ventilators.
Monday’s simulation helped them realize they would need more lead vests for an X-ray than they initially thought. Noted for next time. Rinse and repeat.
The doctor who runs the simulations hopes they’ll become a national standard within the next decade.
“We were early adopters in 2014, we’re still kind of on the leading edge,” said Glenn Posner, the medical director of the hospital’s skills and simulation centre. “If we go full Italy here — in Italy they’ve got orthopedic surgeons stepping in as emergency doctors.”
That’s a lot of doctors who will need to practise how to insert breathing tubes.
Posner’s program is well suited to making sure medical staff are prepared for outbreaks, but it’s still rare in Canada, with only a handful of similar programs at places like St. Michael’s Hospital in Toronto. And it’s not the only case where potentially useful pandemic planning measures are the exception, not the rule, at hospitals across the country.
In some places, doctors and experts warn the hospital buildings just aren’t equipped to contain an outbreak.
An hour away, the hospital in the small town of Perth, Ont., paints a starkly different picture. With only one isolation room, limited ventilators and an emergency department that is crowded on a good day, medical staff don’t have the bandwidth to run realistic simulations. They’re meeting to discuss setting up pop-up coronavirus testing sites in tents and hockey arenas.
Anything to prevent the possibility of an influx of COVID-19 patients to a hospital that does not have the capacity to contain a major outbreak.
“Current hospital capacity is unsafe on a good day,” said Alan Drummond, a Perth emergency doctor who co-chairs the public affairs wing of the Canadian Association of Emergency Physicians. He said the hospital, which aims to operate at 85 per cent capacity, is regularly 100 per cent full.
Perth’s hospital got retrofitted with its only negative-pressure isolation room in the wake of the SARS crisis in 2003, but doesn’t have the ability to keep a potentially deadly virus contained if two, three, or a dozen people need to be isolated in hospital, Drummond says. Patients are crowded in the emergency room, and with intensive care beds constantly full, there’s nowhere else to put them.
“If we ever get something like the Spanish flu in our community, we are screwed,” he said.
Rural health practitioners are used to making do with limited resources, and in places such as Perth, the medical community is often helping its own neighbours and friends, making home calls when needed. With coronavirus concerns mounting, the community is already doing things such as sending paramedics and public health nurses to test people in their homes.
Making ad hoc arrangements is not what medical practitioners want during a pandemic. But it’s the reality for hospitals across the country.
In B.C., health minister Adrian Dix said hospitals are operating at 100 per cent capacity or more through ordinary flu season, and that capacity remains a persistent challenge in hospitals.
Designing hospitals with an eye to pandemics is relatively new to Canadian health-care — and it’s expensive.
A team of engineers, architects, and health industry experts developed a national standard for hospital design called the CSA Z8000. First released in 2011, it gives detailed instructions on how to handle outbreaks.
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“Infectious disease outbreaks of course affect all hospitals, all health-care facilities,” said Gordon Burrill, an engineer and health sciences quality expert who helped develop the standard. “So we learned from the experience of SARS in 2003 and we’ve incorporated a lot of those learnings into the hospitals in terms of providing separation of the patients.”
From an outbreak standpoint, the most important pieces of the standard are its requirement for a vast majority of patient rooms to be single occupancy, and the ability to isolate infected people in the emergency department from the general population.
Burrill said these recommendations should really be seen as a minimum standard rather than best practice. But since adoption of the standard is not universal across Canadian provinces, and many hospitals were built before the standard was released in 2011, most Canadian hospitals do not yet comply.
Burrill said the single-occupancy room requirement is a particularly difficult one to implement because it’s much less expensive per-bed to build hospitals with multiple-bed rooms.
The Star reached out to all provinces and territories for information on how many hospitals adhered to the standard. Of seven jurisdictions that replied, only the Yukon was able to indicate how many of its three hospitals adhere to the CSA Z8000 — one of the territory’s three hospitals meet the standard.
Marco Buccini, the former executive director of facilities planning at the Fraser Health Authority, described in an interview when the coronavirus outbreak came to Canada the difference between an outbreak taking place in a hospital that has outbreak protection built into its design, and one that does not. He oversaw the construction of Surrey Memorial Hospital in 2012, which adheres to the Z8000.
“Let’s say the coronavirus keeps going here and 20 people present at Surrey Memorial. It’s all … partitioned off,” Buccini said. “Even the treatment bays in the Emergency Room, they generally can have at least three walls around them so they’ve become more like rooms.”
Though not a silver bullet for preventing transmission, the design of the hospital gives health-care workers and other patients extra barriers with infectious patients compared to other hospitals.
A pandemic outbreak in a hospital without those protections, like Drummond’s hospital in Perth, would have a different experience, Buccini said.
“Let’s say an outbreak took hold there and suddenly 20, 30, 40 people present at that hospital. That hospital is going to basically have to quarantine itself,” he said. “When you start to get close to doing that, now everyone’s at risk.”
Drummond said that rural emergency doctors are looking for clarity from public health officials on how they should be prioritizing their limited resources if they have to face that kind of patient influx due to COVID-19.
“It’s a risk to staff and to other patients,” Drummond said. “We sort of worry how are we going to cope.”
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