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Alberta doctors support new COVID-19 restrictions but express frustration in delayed action

Click to play video: 'Edmonton ICU doctor praises AHS for COVID-19 response, but cautions every system has a breaking point' Edmonton ICU doctor praises AHS for COVID-19 response, but cautions every system has a breaking point
There are more than 100 COVID-19 patients being treated at Edmonton's Royal Alexandra Hospital, where intensive care physician Darren Markland works. He said Alberta Health Services has done a remarkable job sourcing supplies and staff, but cautioned "every organization has its physical limits" when speaking about the possibility of needing field hospitals as the second wave of the pandemic grows – Dec 9, 2020

On Tuesday, the Alberta government announced the toughest COVID-19 restrictions since spring: a province-wide mask mandate, ban on all indoor and outdoor social activities, the closure of many personal services like hair salons and barbers, and a 15 per cent limit on customers in stores and for worshipers in churches.

Many of these restrictions align with recommendations made by hundreds of Alberta doctors in a letter to the Premier Jason Kenney in early November.

Read more: ‘Canary in the coal mine’: Alberta doctors sound alarm on rising COVID-19 cases

This latest announcement came on the heels of weeks of record-breaking daily case counts, hospitalizations, ICU admissions, and double-digit daily deaths from the novel coronavirus in Alberta.

Click to play video: 'Many businesses to close as Alberta government enacts strict new COVID-19 restrictions' Many businesses to close as Alberta government enacts strict new COVID-19 restrictions
Many businesses to close as Alberta government enacts strict new COVID-19 restrictions – Dec 8, 2020

Less than two weeks earlier on Nov. 24, Kenney announced targeted measures he called “the minimum restrictions needed” which were slightly stricter than measures announced Nov.12.

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Read more: Alberta enacts 2nd COVID-19 state of public health emergency. Here’s what it means

Alberta’s chief medical officer of health Dr. Deena Hinshaw admitted Monday the current restrictions were not making enough of an impact and hinted tougher regulations would be shared soon. That happened one day later.

The reaction to the Dec. 8 announcement from many Albertans doctors has been mostly positive.

“I’m optimistic — I’m more optimistic about these steps than I have been about the previous announcements.” Calgary infectious disease specialist Dr. Craig Jenne told Global News on Wednesday.

“This is, for the most part, what other provinces have done and they have seen a positive effect.”

Click to play video: 'Alberta could see more than 1,000 COVID-19 hospitalizations by Dec. 24: AHS' Alberta could see more than 1,000 COVID-19 hospitalizations by Dec. 24: AHS
Alberta could see more than 1,000 COVID-19 hospitalizations by Dec. 24: AHS – Dec 9, 2020

Dr. Darren Markland is an ICU physician at the Royal Alexandra Hospital in Edmonton — a facility that currently has over 100 COVID-19 patients and multiple COVID wards.

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On Tuesday, Hinshaw said the central Edmonton hospital had 13 units on outbreak or watch, so the entire facility was placed on watch status, which brings enhanced measures to every unit in the facility.

Markland has been advocating for more lockdown decisive action from the province for weeks and is also relieved with Tuesday’s announced measures.

“At least there is hope now. Before, we were flying into the great wide open with really no sense of where the ground was. At least there are now concrete measures in place that have legitimacy and will do something to reduce the spread.”

Read more: Alberta’s COVID-19 positivity rate rises to 10.5%; health system under ‘enormous strain’

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Both Jenne and Markland cautioned the new restrictions will not translate to an immediate change in the increasing number of patients requiring hospitalization or critical care from COVID-19.

“We cannot break the law of mathematics here,” said Markland.

“So once an infection happens, it plays a two-week course and we know by statistics that of those people infected, some will eventually end up in hospital and also into the intensive care unit.”

Read more: Edmonton ICU doctor warns COVID-19 second wave is turning into a ‘tsunami’

Markland warned Alberta will most certainly run out of room in hospitals soon, in part because he says Canada has one of the lowest ratios of hospital beds per capita in the developed world.

“This is why we’re talking about field hospitals because we will run out of physical space,” he said, adding Alberta Health Services has done a remarkable job sourcing supplies and staff, but every system has its limits.

Read more: Alberta’s COVID-19 ‘contingency plan’ includes requests for field hospital

At the daily briefing Dec. 9, Health Minister Tyler Shandro denied the province has any plans to add field hospitals to Alberta: “We have never had a field hospital planned.”

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He further clarified Alberta has one field tent at the Peter Lougheed Centre in Calgary that was installed in the spring.

Pandemic Response Unit at the Peter Lougheed hospital in Calgary on November 14, 2020. Leah Hennel, Government of Alberta

Shandro said while AHS has explored the option of whether further field tents might be needed, but, “at this time there doesn’t seem to be a need for a further field tent to be erected.

AHS released updated hospitalization and ICU projections Dec. 9 that showed multiple scenarios, including low-to-high anticipated demand for hospital space and critical care over the next few weeks.

At the low end, hospitalizations are projected to reach the mid-500s by Christmas, and at the high-end see over 1,000 COVID-19 patients in hospital.

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Read more: AHS projections show more than 1,000 COVID-19 hospitalizations by Dec. 24

Jenne said it is unlikely Alberta’s ICU numbers will be in that projected low range for at least another six to seven weeks.

He stressed it is important to understand how COVID-19 works. “Many of the people who will be admitted (to hospital) in the next two weeks have already contracted the virus and are already represented in the daily case counts.”

Dr. Ilan Schwartz, an infectious disease specialist and doctor at the University of Alberta, agreed.

“Any intervention now is not going to have any effect for at least three or four weeks.”

Click to play video: 'Alberta health minister says ‘AHS is ready’ for increased COVID-19 cases' Alberta health minister says ‘AHS is ready’ for increased COVID-19 cases
Alberta health minister says ‘AHS is ready’ for increased COVID-19 cases – Dec 9, 2020

Did Alberta wait too long?

All four doctors we spoke with expressed frustration that the measures were not implemented between four to six weeks ago, when the situation was not as critical.

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“At that point it would have been a circuit-breaker so just a short period,” Schwartz said.

Read more: Alberta identifying ‘unconventional ICU spaces’ as COVID-19 cases, hospitalizations rise

The University of Alberta physician spoke of the current situation in the province as a “dire crisis” and said he believes the health-care system is on the verge of collapsing.

“ICU’s are doubled up. We’re running out of oxygen and long-term care facilities are in complete disarray.”

According to Schwartz, the most recent COVID ward to open up at the U of A hospital filled up in just 36-hours. He spoke of COVID wards expanding and taking over certain hospitals, forcing other services to move to new facilities, and said “even that is not going to be possible soon.”

He called the timing of these measures “way too late” and said he is glad they have been announced, “but I sorely wish these had already been in place.”

Read more: COVID-19 could be one of the leading causes of death in Alberta in 2020

Dr. Stephanie Smith is an infectious disease specialist with the University of Alberta and she likened the COVID-19 situation to a wildfire.

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“We had a situation where we were trying to use buckets to put out the forest fire and now we have maybe been given a fire hose to put out the forest fire.” Smith said.

“It’s obviously a bigger forest fire now so we need these bigger tools.”

Read more: AHS projections show more than 1,000 COVID-19 hospitalizations by Dec. 24

Markland expressed concern over the way the pandemic has been managed in Alberta.

“This government has been classified as one of the most secretive governments in Canada and the politicization of COVID is a huge issue and it will remain a huge issue.”

He went on to say, “that’s my biggest fear — is if we stay partisan about a health-care problem, we’re not going to solve it.”

Jenne said by waiting to implement stronger COVID-19 measures in our province we started to run out of options in how to manage this virus. “The longer it’s taken to bring these restrictions on has really forced the hand, so that there is not a lot of (other) options.”

Click to play video: '‘Just rip the Band-Aid off and just deal with it’: Edmonton ICU doctor on Alberta’s new COVID-19 rules' ‘Just rip the Band-Aid off and just deal with it’: Edmonton ICU doctor on Alberta’s new COVID-19 rules
‘Just rip the Band-Aid off and just deal with it’: Edmonton ICU doctor on Alberta’s new COVID-19 rules – Dec 9, 2020

Do these measures go far enough?

Smith expressed concern with the decision to allow things like malls to remain open, while social gatherings are not allowed.

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This is a sentiment the other doctors echoed.

On Tuesday, Dr. Ilan Schwartz expressed cautious optimism at the latest announcement by the province.

Schwartz said he does think these new restrictions are meaningful and will hopefully reduce the spread of the virus, “however the Devil is in the details.”

“We know that this government has a way of performing sleights of hand when they announce certain things and there’s a lot of asterisks and small print that suggest the true situation is actually the exact opposite of what they just announced.”

Schwartz referenced the “no social gatherings restrictions” announced two weeks ago that had the loophole of allowing casinos and malls and restaurants to remain open.

Markland spoke of the challenge in allowing people to still honour their faith through in-person worship, but said this can bring a significant number of people together.

“If you reduce a congregation that can hold 7,000 by 15 per cent, you can still pack a lot of people into spaces.”

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