‘The problem will be mostly staffing’: Ontario ICU doctor on hospital COVID-19 capacity concerns

As intensive care units rapidly fill up across Ontario, projections suggest even more COVID-19 patients will soon be occupying beds in ICUs.

“In a few short weeks, our hospital and ICU capacity could be overwhelmed,” said Health Minister Christine Elliott this week.

One critical care physician working in hospitals across hard-hit Peel Region is wondering who will care for all of the sick.

“In terms of my list of worries about how we’re going to care for the surge of patients … the problem will be mostly staffing based,” said Dr. Brooks Fallis.

In October, the Ford government announced a major investment to help create 766 additional beds at 32 hospitals and alternate healthcare facilities.

That was in addition to funding the province already put toward creating 139 new critical care beds and other beds.

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But bed capacity numbers only paint a part of the picture.

“If tomorrow the government came out and said, ‘We’re providing funding for another 10-thousand ICU beds’ we’d be able to staff zero of those beds so it wouldn’t really help us,” said Fallis.

ICUs are filling up, in part, because critically ill COVID-19 patients take time to stabilize and need the help of many skilled frontline healthcare workers.

“Critical care is a highly skilled area and you need nurses, you need physicians, you need respiratory therapists, you have dieticians, you have physiotherapists who are specialized in the area and the ability to expand that staff in a short period of time is very very limited,” explained Fallis.

When those frontline healthcare workers are stretched too thin, he said, “And one person is taking care of too many patients, the quality of care will eventually start to slip.”

“There will be a limit to how much we can ask people to stretch and still preserve a reasonable quality of care,” he added.

While hospitals may be able to expand on space and supplies, staff are in much shorter supply.

“Hospitals will always welcome new funding to expand their bed capacity, ability to care for their communities, but realistically if you want to expand ICU bed capacity you need to do that a minimum a year in advance to reliably staff those beds,” explained Fallis.

Fallis, who said around 50 per cent of his patients have COVID-19 on any given shift, and sometimes up to 80 per cent, wanted to share a message with the public.

“We see younger people In the ICU, we see healthier people in the ICU … a lot of them are in the prime of their life,” he explained. “Maybe they have diabetes but they’re managing it. Maybe they’re overweight but it’s not causing them any meaningful problem.

“So when we talk about comorbidities and ending up in the ICU, I think if people saw the people who are actually in our ICUs they would be pretty surprised at what excellent qualities of life they had.”

Fallis wants the public to understand the issue of staffing and filling up intensive care units affects everybody.

“The hospital system is really designed to be a mixture of acute care, elective care, investigations, testing and when you over stress the acute side, all that other stuff gets squeezed out and that other stuff is really important to the integrity of the healthcare system,” he pointed out.

Finally, like many other critical care physicians across Ontario, Fallis said he is bracing for what is to come.