A digital intensive care unit room at Cortellucci Vaughan Hospital in Vaughan, Ont., on Jan. 18, 2021.Frank Gunn/The Canadian Press
COVID-19 patients in Ontario are lingering longer in intensive care in recent days and the ranks of the newly infected are growing, putting added pressure on hospitals as they enter a third wave of the coronavirus.
Ontario already has more than 350 COVID-19 patients in its intensive care units, above the critical threshold the province’s scientific advisers set before the second wave took off.
Medical experts say faster spreading and potentially deadlier variants of the coronavirus are likely behind a sharp increase in the number of severely ill patients battling the virus, underscoring the urgency of getting people vaccinated.
Many of these patients require longer stays in intensive care units, according to a confidential daily report from Critical Care Services Ontario (CCSO), obtained by The Globe and Mail. The median number of days COVID-19 patients spend in ICU jumped to 15.6 in mid-March from 10.3 in mid-January. Over the past four days alone, 94 patients were admitted to ICU.
Median length of stay of critically ill COVID-19 patients, by Ontario Health region
Number of days
TORONTO
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
EAST
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
WEST
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
CENTRAL
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
NORTH
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
THE GLOBE AND MAIL, SOURCE:
CRITICAL CARE SERVICES ONTARIO
Median length of stay of critically ill COVID-19 patients, by Ontario Health region
Number of days
TORONTO
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
EAST
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
WEST
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
CENTRAL
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
NORTH
30
20
10
0
Dec.
2020
Jan.
2021
Feb.
March
THE GLOBE AND MAIL, SOURCE:
CRITICAL CARE SERVICES ONTARIO
Median length of stay of critically ill COVID-19 patients, by Ontario Health region
Number of days
TORONTO
30
20
10
0
Dec. 2020
Jan. 2021
Feb.
March
EAST
30
20
10
0
Dec. 2020
Jan. 2021
Feb.
March
WEST
30
20
10
0
Dec. 2020
Jan. 2021
Feb.
March
CENTRAL
30
20
10
0
Dec. 2020
Jan. 2021
Feb.
March
NORTH
30
20
10
0
Dec. 2020
Jan. 2021
Feb.
March
THE GLOBE AND MAIL, SOURCE: CRITICAL CARE SERVICES ONTARIO
The majority of people admitted to intensive care range in age from 40 to 79, according to the province’s COVID-19 Modelling Collaborative. This cohort is not currently in the priority group for vaccination, said Kali Barrett, a critical care physician with the University Health Network (UHN) in Toronto and a member of the collaborative.
“The writing was on the wall that this was going to happen,” she said. “We may be seeing a higher percentage of cases admitted to the hospital and a higher percentage dying than we saw in wave 1 and wave 2.”
During the spring, 416 COVID-19 patients in Ontario died in ICU and another 810 ICU patients were discharged from critical care, according to confidential figures obtained by The Globe. The toll has been much higher since September, with 1,008 patients dying in ICUs and 1,687 discharged from care.
COVID-19 patients currently occupy one in five ICU beds, leaving hospitals with less room and fewer nurses to care for patients recovering from surgery. Ontario’s surgical backlog has now reached more than 227,000 cases and that deficit becomes harder to make up with each day that hospitals are strained by coronavirus patients.
Cortellucci Vaughan Hospital has dedicated itself to easing the crunch caused by COVID-19 in other hospitals across the Greater Toronto Area since opening its doors in February. As of Thursday, 24 of its 35 ICU beds were filled with COVID-19 patients. It is receiving another 29 patients this week from neighbouring hospitals.
Katharina Plenk, chief and medical director of the department of medicine at Cortellucci Vaughan, said the hospital reserves some ICU beds for other COVID-19 patients in the hospital. “We know that about 15 per cent of non-ICU COVID-19 patients eventually do need ICU care, so you always need to leave that little bit of space in the ICU for our patients who deteriorate,” she said.
Thunder Bay Regional Health Sciences Centre transferred six COVID-19 patients to hospitals in London, Ont., and Sudbury last Friday to free up space in its ICU. The number of COVID-19 patients admitted to the hospital, which serves much of Northwestern Ontario, started ramping up in early March, said Michael Scott, the director of critical care.
To accommodate the higher volumes, the hospital added four beds to ICU by redeploying staff from other areas and postponing some non-emergency surgeries. It now has 26 ICU beds, with 12 occupied by COVID-19 patients.
Expanding ICU further would involve cancelling more surgeries, Dr. Scott said, adding that he hopes to transfer a few more COVID-19 patients from ICU to other hospitals in the next few days. Doing so, he said, would allow the hospital to better meet the needs of all of its patients, “with a lot of help from the rest of the province.”
The number of patients in ICU remained stubbornly high in Ontario even as the second wave of infections ebbed last month.
Ontario’s 14 local health integration
networks within 5 geographical regions
NORTH
EAST
CENTRAL
TORONTO
WEST
NORTH
THE GLOBE AND MAIL, SOURCE:
ONTARIO MINISTRY OF HEALTH
Ontario’s 14 local health integration networks
within 5 geographical regions
NORTH
EAST
CENTRAL
TORONTO
WEST
NORTH
THE GLOBE AND MAIL, SOURCE: ONTARIO MINISTRY OF HEALTH
Ontario’s 14 local health integration networks
within 5 geographical regions
NORTH
EAST
CENTRAL
TORONTO
WEST
NORTH
THE GLOBE AND MAIL, SOURCE: ONTARIO MINISTRY OF HEALTH
As a general rule, decreases in cases are followed by lower admissions to hospitals and ICUs. In Ontario, the seven-day average of new cases peaked at 3,555 on Jan. 11 before dropping to roughly 1,000 in mid-February and hovering around that level until about 10 days ago. Cases have since started to rise again.
But the number of COVID-19 patients in Ontario’s ICUs did not fall in lockstep with the drop in cases.
“We were really surprised to see that, against our expectations, the ICU occupancy was not following the downward trend in cases and hospitalizations,” said Peter Juni, scientific director of Ontario’s COVID-19 Science Advisory Table and a professor of medicine and epidemiology at the University of Toronto.
“The most valid hypothesis right now is that the length of stay for some severely ill patients has increased,” he said. “We are hypothesizing right now that this could be also an early association with B.1.1.7, the variant of concern originally identified in the U.K.”
The first wave of the pandemic in Ontario ended at the end of August with only two COVID-19 patients in intensive care. There has been no such respite for hospitals during the second wave.
After peaking at 415 on Jan. 16, the total number of patients in intensive care began declining the following month, hitting a nadir of 310 on Feb. 19, the CCSO report says. As of Wednesday, the total number was back up to 361.
The median length of stay peaked at 21.3 days on Feb. 20 and hovered around 19 days in early March. UHN’s Dr. Barrett said the “outliers” who spend several weeks in ICU can skew the numbers.
Toronto General Hospital, which is part of the UHN, treats some of the sickest COVID-19 patients transferred from other hospitals. It is the only hospital that offers patients support with extracorporeal membrane oxygenation, or ECMO, essentially an external artificial lung.
“We are seeing a bit of an increase in those referrals in the last week or two,” said Niall Ferguson, head of critical care at the UHN and Sinai Health System. “I think what we’re noticing in this phase is people arriving at that point of being extremely sick and coming to us a little faster than in previous waves.”
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.