The COVID-19 pandemic will require intensive care units and ventilators in the province’s hospitals, but a Glacier Media investigation has found that British Columbians are receiving unclear or inadequate information to let them know the local availability of those resources.
Those numbers continue to be released on a regional level, leaving communities unsure of local resource availabilities. Locations of the sick are also released on a regional level, leaving communities unaware of local health threats.
As well, municipal officials remain generally silent, with their staff referring requests to regional or provincial officials, or they tell reporters to watch Health Minister Adrian Dix and provincial health officer Dr. Bonnie Henry’s daily news conferences.
With all information going through one point, it’s hard for local people to know what’s available in their communities.
Health authorities say the ventilators are mobile and can be moved to areas as needed, but how that might happen remains unclear.
In addition, hospital beds are being cleared province-wide but how local hospitals without supplies to treat critically ill before they are possibly moved to crisis response centres also remains unclear.
B.C.’s likely scenario is more akin to that of China than Italy, officials say.
“At a Hubei epidemic level, using ICU [intensive care unit] and high acuity unit bed capacity along with vent capacity looks reasonable focused on using the 17 primary COVID-19 care sites,” the province’s COVID-19: Critical Care and Acute Care Hospitalization Modelling plan said. It can be read here.
If the situation moved more to what has happened in Italy, “B.C. would have to use all sites to meet bed demand and implement increased transportation of patients between sites,” the document said.
The numbers
As of Tuesday, British Columbia had 1,013 confirmed cases — including 24 deaths and 570 resolved cases. Nationally, as of Monday, there were 6,671 cases — 47 presumptive, 6,624 confirmed, 66 deaths and 908 resolved.
Southwestern B.C. is covered by three health authorities: Vancouver Coastal Health (VCH), Fraser Health (FH) and Vancouver Island Health (VIH).
The provincial government has said there are 1,355 ventilators across B.C. for a population of 5.07 million people. Of these ventilators, 83 were just announced today, and 30 of these are new while 53 are refurbished.
For southwestern B.C., that’s 825 ventilators for 3.84 million people.
The plan said there are 457 ventilators for critical care.
Health authorities won’t give precise hospital locations for that equipment. “Ventilators may be transferred to areas where they are needed. Not just around the Vancouver Coastal Health region but around the entire province, so the number in any given place is not representative of the work underway to meet potential spikes in demand,” VCH spokesperson Matt Kieltyka said.
Minister of Health Adrian Dix said the numbers break down like this:
• VCH – 216;
• FH – 409;
• VIH – 155;
• Interior Health – 229; and
• Northern Health – 116.
In addition, the Provincial Health Services Authority has 147.
These numbers do not include the 83 units announced today.
“We’re just releasing the total at this time,” authority spokesperson Jane Campbell said. “We’re not releasing the locations.”
Lions Gate Hospital currently has 25 ventilators and has ordered seven more. However, they are ordered through VCH once the local hospital foundation commits to paying.
“Critical-care surgical ventilators used in hospitals are 956,” Dix said. “There are transport ventilators (164); home ventilators used to manage chronic patients in their homes (120); and there is a specialized machine – the ECMO, and there are 32 of these machines – which pump oxygenate a person's blood outside of their body.”
The VIH ventilator numbers are also unsure, however. On March 21, a VIH statement said it had 140 ventilators, including 22 transport ventilators used in ambulances, helicopters and airplanes.
There seems to be some confusion as to the number of ventilators in the Fraser region. While the minister had already said there were 409, Fraser spokesperson Dixon Tam said, “We are unable to provide a breakdown of ventilators across our region at this time.”
Tam later revised himself to come in line with the minister.
VCH has not specified how many available ventilators are designed for adults and how many for children.
An additional 120 ventilators have been ordered since an inventory was completed March 5, the plan said. A further 15 arrived March 24 and another 29 are expected this week. Of those identified for refurbishment, 38 are ready with 19 in progress as of March 26.
“Ventilators at BC Children’s [Hospital] include models that could be used for adults but for planning purposes are being held for children/youth,” the plan said.
Beds
Health officials are moving to free up as many beds as possible. Here’s the full picture:
ICU Beds:
• VCH - unknown;
• FH – 80;
• VIH - 96;
• Interior Health – unknown; and
• Northern Health – unknown.
FH has said, “As part of our pandemic planning, we are in the process of setting up additional beds equipped to support people with respiratory illnesses.”
Acute Care Beds:
• VCH – 1,928;
• FH – 2,577;
• VIH – 1,770;
• Interior Health – 1,447; and
• Northern Health – 571.
There are also 30 beds at B.C. Women’s and Children’s Hospital.
Dix said March 24 that in the previous two weeks, the province has cleared 3,632 empty acute-care B.C. hospital beds to prepare for what may be coming.
An issue, said former Northern Health chief medical health officer Dr. David Bowering, is the availability of resources outside infection primary care sites, where cases may have to be moved. But, until they can be moved, local facilities will have to carry acute care cases, he said.
“A shortage of supplies means we have to move people,” he said.
“We can’t create ventilators out of thin air.”
Bowering said he believes provincial officers such as Henry and Dix are doing a good job. However, in an open letter to Henry, Bowering said Victoria needs to tell people where cases are specifically, not just by health region, so residents can be prepared. Such knowledge would help flatten the disease-spread curve, he said.
And, Bowering wants resource work camps closed.
“The camps are and will be COVID-19 incubators, placing the workers, the host communities and the home communities of the workers at unacceptable risk,” he wrote
Mobilization
The province is now mobilizing hospitals province-wide to be ready for a major outbreak and implementing a contingency plan that would deal with health care professional staffing.
The COVID-19: Critical Care and Acute Care Hospitalization Modelling Plan - has two areas of focus: first, the capacity for critical care spaces and ventilators for critically ill patients, and second, focus on hospital bed capacity for less acute patients requiring hospital care.
“If B.C. was to move to a Northern Italy ‘hospitalized’ trajectory, B.C. would use all sites and bed capacity off-site from hospitals for less acute medical and surgical inpatients to open up additional capacity for COVID-19 patients in hospitals with ready access to critical care,” the plan said.
The plan can be read here.
A self-assessment tool is available here.
Depending on the result, people should consider further assessment which can be arranged by contacting a health care provider or by calling HealthLinkBC at 8-1-1. People are asked to avoid going to emergency departments.
Aging infrastructure
But what of some of B.C.’s aging health infrastructure?
If Richmond Hospital were to receive a large number of acute coronavirus cases, these would have to be treated in a seismically unsafe 54-year-old building with narrow hallways and doorways and with about 80 per cent of beds in shared rooms.
Richmond medical health officer Dr. Meena Dawar said she’s not worried that Richmond Hospital’s limitations – for example, shared rooms – would mean it can’t handle patients.
COVID-19 is managed like influenza, and, because it’s transmitted by droplets, having several people in a shared room won’t cause it to spread, Dawar explained.
“What we usually do around individuals who have respiratory infections works for COVID, fortunately,” she said, adding it’s not like tuberculosis that needs airborne precautions around an individual.
“While we like to have private rooms, we do manage [respiratory] patients successfully with shared rooms,” she said.
In smaller communities like Whistler, service is through a health centre rather than a hospital. There is no ICU and one one ventilator available. However, as soon as a Vancouver-area person needs that ventilator, it will be gone.
Whistler’s Health Care Centre is seen as a clearing house so people would come in and be immediately transported out to Squamish or Lions Gate hospitals.
Meanwhile, the Whistler Health Care Centre is “connecting very closely” with other health care centres in the region, Dawar said.
“They’re following the protocols that are evolving about providing urgent and emergent care and appropriate infection control practices etc.,” she said.
“So I’m quite sure that things are working very well in Whistler in coordination with other urgent care and emergency departments in [VCH].”
Dawar said she fully expects individuals with COVID-19-compatible illnesses to be presenting at the Whistler Health Care Centre at some point, but anyone needing intensive care would be relocated.
“[The Whistler Health Care Centre] does not run an intensive care unit, so if people needed further levels of care they would be moved appropriately, and those plans are in place,” Dawar said.
Privately run hospitals (which receive provincial funding), however, are somewhat more transparent on a granular level. Providence Health Care, which operates Vancouver’s St. Paul’s and Mount Saint Joseph hospitals, has 534 acute care beds.
Providence would not say how many ventilators it has, referring questions to the ministry.
— with files from Clare Ogilvie, Jane Seyd, Layne Christensen, Diane Strandberg, Sean Eckford, John Gleeson, Sandor Gyarmati, Ted Murphy, Bryna Hallam, Louise Dickson and Mike Howell
