The day after Premier Jason Kenney addressed the province with Alberta Health novel coronavirus modelling, the province is giving Albertans a closer look at the various scenarios, as well as the plan to increase beds, ventilators, personal protective equipment (PPE) and front-line staff.
The province has modelled three scenarios: probable, elevated and extreme. Modelling is done to allow the government to anticipate and prepare for the demands on the province’s healthcare system.
Infection scenarios
The probable scenario is the one the government expects to happen, provided Albertans continue to follow chief medical officer of health Dr. Deena Hinshaw’s advice.
“The most important factor of how big or small the impact of COVID-19 is in this province is the behavior of each and every one of us,” Hinshaw said Wednesday. “If Albertans stop following public health restrictions and guidelines, we can expect to experience a higher impact than the data currently suggests.
“If Albertans strictly follow health guidance we, collectively, can further reduce the impact from what the modelling is currently predicting.”
Under the probable scenario, it is projected the virus could peak in mid-May with a total of 800,000 infections and between 400 and 3,100 deaths. Peak hospitalizations would be seen in late
May and would see between 736 and 900 people hospitalized with 220 to 244 of those needing care in the intensive care unit.
It’s important to note infection numbers in Alberta’s modelling include all infections. Hinshaw has encouraged people with mild symptoms to stay home, so many people who have COVID-19 would never be tested and would not be included in the daily confirmed numbers reported.
Under an elevated scenario, Alberta would see the virus peak in early May with as many as 1,060,000 total infections and between 500 and 6,600 deaths. Between 1,491 and 1,649 Albertans could be hospitalized, with the peak coming at the beginning of May. Of those, between 372 and 412 people could require critical care.
The extreme scenario sees the peak in just a few days in mid-April with as many as 1.6 million Albertans infected and between 16,000 and 32,000 deaths.
Officials say it’s incredibly difficult to model the amount of deaths, which is why the numbers are so broad. The modelling information was done using only Alberta’s data.
There would be a smaller range if officials had overlaid another jurisdiction’s data, but those doing the modelling felt it was best to only use information from Alberta. As more data is received, the range of deaths will tighten up in future models.
On Wednesday, Hinshaw said the number of deaths greatly depends on what age group of Albertans gets sick. If more cases occur in the over 65 group, she says we will see more deaths.
The numbers will also be used to determine when Alberta can start to relax public health measures like bans on large groups and physical distancing, but Hinshaw cautioned there will need to be a drop in cases for several weeks before those measures are loosened.
“We have to see at least two to three weeks of cases starting to drop because that will tell us – because every case we’re seeing now has been exposed in the previous two weeks,” she said.
“So we have to see two to three weeks of case counts coming down before we have a really solid sense that we have turned that corner.”
NDP Leader Rachel Notley said it’s clear measures the government has put in place are helping to flatten the curve. However, she said the government needs to do more to protect the most vulnerable.
“I call on the government once again to use its authority to take control over the staffing crisis that exists at our seniors centres,” Notley said, adding she would like to see workers banned from working at more than one seniors facility.
Health care capacity
These numbers bring about questions on how Alberta’s health care system could react.
Currently there are 100 hospitals with 8,483 beds across the province. Of those, 295 are ICU beds and there are 509 ventilators.
AHS plans on having 2,250 COVID-19 designated acute care beds by the end of April. As of April 3, 1,935 spaces were available for COVID-19 patients and new dedicated spaces continue to be brought online.
“We are actively increasing capacity in Alberta Health Services facilities by postponing non-urgent surgeries and diagnostic imaging, reducing a number of non-emergency services offered in hospitals, relocating patients to continuing care spaces where possible and enhancing the use of videoconferencing and telephone care to connect physicians and health professionals with patients remotely,” AHS president and CEO, Dr. Verna Yiu said Wednesday.
As for ICU beds, AHS aims to increase capacity by 1,081 beds for COVID-19 patients by the end of April, if necessary.
This will be done by adding ICU beds to existing ICU rooms, converting operating rooms and recovery rooms to ICU capacity, converting procedure and treatment rooms to ICU capacity and following new models of care like a more aggressive use of step-down care. Step-down care is where people do not require full intensive care, but cannot be safely cared for on a normal ward.
Equipment needs
Another step is for AHS to continue to build its ventilator capacity. Right now, the plan is for AHS to have 761 ventilators available by the end of April for COVID-19 patients, up from the current 314 dedicated to those patients.
AHS has ordered new ventilators and is also receiving more from the NAIT and SAIT Respiratory Therapy programs, STARS and the Alberta Aids to Daily Living Respiratory Outreach Program.
Some have also been repurposed from charted surgical facilities and the Public Health Agency of Canada. AHS will also get some alternative devices capable of mechanical ventilation including transport, anaesthetic and pediatric devices.
In an effort to make sure there are enough front-line workers as the pandemic continues, AHS has taken several steps to ensure the province has the workforce needed, including:
- Accelerated training for ICU nurses
- New models of care to expand the reach of existing ICU nurses
- Working with faculties of nursing to complete senior practicums to enable nurses to start working
- Cotacting former RNs with ICU experience another other recently retired staff
- Redeployment of anesthesiologists, other physicians, other nurses, respiratory therapists and other allied health professionals and other staff with appropriate skills to work in a critical care environment.
The province’s stocks of personal protective equipment will also need to be increased. Based on inventory in place now, front-line workers will have 12 more days of single-use face shields, for example, at the end of April, under the probable model.
N95 masks will run out 32 days after April 30 and there will only be 39 more days worth of gowns or coveralls.
To alleviate some of the pressure, the government is tracking PPE inventory and distribution across non-health sites and is reusing PPE were safe and appropriate, like the sterilization of N95 masks.
The number of domestic and global suppliers of PPE will also be increased, and the government is looking at working with local companies to increase the production of things like face shields, scrubs, gowns and hand sanitizer.
Officials have said the best way to ensure Alberta remains on the probable path is to continue to follow the guidelines set out by Hinshaw:
- Practice physical distancing,
- Stay home and away from others if you are sick,
- Wash your hands for at least 20 seconds,
- Cover coughs and sneezes with your elbow and avoid touching your face
- Monitor for symptoms such as cough, fever, fatigue or difficulty breathing.
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