Contagious COVID-19 variants continue to cause cases to surge across Saskatchewan and intensive care unit admissions reached dangerous record-highs this week.
Global’s Roberta Bell sat down with the Saskatchewan Health Authority’s chief medical officer, critical care physician Dr. Susan Shaw, on Wednesday to talk about the implications.
Question: Regina, for now, continues to be bearing the brunt of this. But how is the entire system coping?
Answer: Regina certainly has far more patients in the intensive care unit right now than they’ve ever looked after before. But that’s also true across the entire province and we’re really trying to work as a team to ensure all patients get the best care that they can. But we anticipate in our centres, more in the northern half — like Saskatoon, Prince Albert and the other sites — that more patients with COVID are expected to be admitted in the days to come.
Q: How will what’s been going on in Regina translate further north as we introduce new variables into the system, such as the P.1 variant?
A: I’m really worried about that because we’re already at a really high number of critically ill people in our intensive care units and patients that are admitted to the medicine wards who are also very sick and are at risk of needing intensive care.
Q: Entire families are being infected with these variants. Are we seeing multiple family members being admitted to hospital at this point — and how sick are they?
A: We are seeing very sick members of the same household and the same family presenting to hospital and it’s creating real challenges and worries, like: Who’s going to look after their children? Who’s going to help support their families while they’re admitted to hospital?
Q: We’ve heard that other provinces have started warning about triaging as a real possibility at this point. How is Saskatchewan managing that risk?
A: We’re at a level of people who are sick enough to need intensive care unit that we’re already having to make decisions, like: Who can have this surgery safely delayed or can patients be transferred to another hospital site or can we actually bypass a hospital, such as the ones in Regina, to make sure that site doesn’t get too overloaded. The next step will need to be — and I don’t want to go there, but if we need to, we will — is to actually make decisions together using an ethical framework to determine who’s most likely to survive their intensive care unit stay.
Q: What is our threshold for that here in Saskatchewan and has it evolved at all since the framework was created here a year ago?
A: Our triggers, I think, need to be adjusted for that and our ability to safely manage patients in that COVID and non-COVID setting has changed. And we need to be mindful and thoughtful about that. The other thing that we’re seeing, though, is patients that are presenting with COVID and severe disease needing ICU are younger. They don’t have a lot of chronic illness. They haven’t lived as many years. And it makes us really think about, again, how do we safely and ethically provide care to the most people, aiming to help the most people survive to discharge?
Q: If we continue on the trajectory that we’re on, is there any sort of timeline that doctors have been briefed on about when this might have to be activated?
A: We’re not at that position yet of actually activating the triage framework, but we are in the position of needing to review it and make sure it’s still ethically sound and meets the needs of the patients that we are starting to take care of and I anticipate that in the days to come, if we don’t see changes in the numbers of admissions, the numbers of new cases, the volume of people who need care, that we will need to move in to more actively talking about — and possibly even activating — a triage framework.