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

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 Nova Scotia News.

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 between 93 and 95 ICU beds, and an expansion plan is in place that would see that figure grow to 200.

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.

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.

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.

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."