Inside Ontario’s strained intensive care units

By Anna Mehler Paperny

TORONTO (Reuters) – Over the course of a single shift final week, vital care doctor Laveena Munshi noticed her intensive care unit (ICU) at Toronto’s Mount Sinai Hospital fill with pregnant and post-partum COVID-19 sufferers.

During that week, the ICU doubled the whole variety of pregnant COVID-19 sufferers it had beforehand seen all through the whole pandemic. Swamped with sufferers with advanced medical wants, in the future Munshi ended up pulling a 36-hour shift.

“You do what you have to do,” she mentioned.

Ontario’s hospitals and ICUs have been crushed by a punishing third coronavirus wave, as depleted sources and overworked employees push Canada’s healthcare system – typically held up as a mannequin for the remainder of the world – to the brink.

Last week, Munshi and her colleagues spent agonizing hours discussing what to do if a pregnant girl wanted a synthetic lung to assist her get sufficient oxygen.

“Having delivery equipment outside an ICU room is never a thing you want to be walking into at the beginning of your shift,” she mentioned. “It just adds an added layer of unnecessary sadness to this whole pandemic.”

By Thursday, ICUs in Ontario, Canada’s most populous province, had 800 COVID-19 sufferers, with such admissions on the highest level for the reason that pandemic started.

Patients are coming in youthful and sicker, pushed by extra extremely transmissible virus variants. Hospital employees say they’re seeing entire households contaminated because of transmission at front-line workplaces which have remained open by way of lockdowns and stay-at-home orders.

Mount Sinai Hospital simply added a 3rd ICU. It has seconded non-ICU nurses to assist ship vital care to essentially the most significantly ailing sufferers because it braces for the worst.

“The next couple of weeks are going to be extremely busy, there’s no question,” Munshi mentioned, including that individuals most affected by the present wave don’t come from privileged backgrounds that might enable them to guard themselves, for instance by working from dwelling.

The provincial authorities has promised extra ICU beds and requested medical employees from different provinces.


Ramping up vaccinations focusing on high-risk communities will assist carry the third wave underneath management, specialists mentioned. But that won’t relieve the instant stress on hospitals.

Exhausted employees are pulling time beyond regulation shifts and medical doctors are bracing for the tipping level nobody needs to speak about: The activation of a “triage protocol” that can dictate who will get vital care when there is not sufficient for everybody who wants it.

Ontario’s Ministry of Health didn’t reply when Reuters requested what standards would activate that protocol.

The protocol supplies a standardized option to predict who’s extra prone to survive the following 12 months, “trying to prioritize so that the most lives could be saved,” defined Dr. James Downar, considered one of its authors.

It doesn’t embrace a provision for withdrawing life-sustaining measures, he mentioned.

Raman Rai, supervisor of the ICU at Toronto’s Humber River Hospital, mentioned she has by no means seen such a quantity of vital care sufferers.

The hospital has redeployed employees, is treating individuals in “unconventional spaces,” and is stretching sources so a nurse who may need been chargeable for one or two sufferers now has three, Rai mentioned.

“We have already gone over capacity,” she mentioned. “How much more can we stretch?”

Hospitals have been conducting drills and workouts in preparation for the triage state of affairs, mentioned Ontario Hospital Association Chief Executive Anthony Dale.

“If it is used, it means we’ve failed as a province,” he mentioned. “This did not have to happen. But are we preparing with everything we’ve got? Yes.”

In Toronto’s Sunnybrook Hospital on Wednesday morning, the ICU was buzzing with health workers having bedside discussions, punctuated by alarms from pumps and various equipment monitoring patients’ vital signs.

“It’s notably distressing after we see somebody who’s 30 years previous and wholesome who is available in unable to breathe,” said intensivist doctor Hannah Wunsch. She is also seeing younger patients, pregnant patients and whole families with COVID-19.

From a medical perspective much of the work is the same, Wunsch said – save for ubiquitous masks.

“I have never seen anybody smile in a very long time.”

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Bill Berkrot)

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