Hospital staff bracing for the worst as ICU beds fill up

As the unrelenting surge of COVID-19 patients including a growing number from outside Ottawa continues to push the city's intensive care units toward capacity, some health-care professionals say they're worried about how much more they can handle.

When shefinished her shift at The Ottawa Hospital's Civic campus on Sunday night, ICU nurse Alicia Robblee said half of the unit's 30 beds were occupied byCOVID-19 patients.

"We are now facing our biggest surge yet of COVID patients in the unit, and it's really scary not knowing how bad it's going to get," Robblee said.

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As of Monday, 56 of The Ottawa Hospital's68 ICU beds were occupied, nearly half by COVID-19 patients. At the time, seven of those patients were from the Greater Toronto Area (GTA) and four more were expected within 48 hours.

At the Montfort Hospital,12 of 17 critical care beds were occupied Monday, including three by patients from outside the region, with another two expected by Wednesday.

The Queensway Carleton Hospital has 12 ICU beds, but as of Monday had 14 patients in intensive care including three from out of town. CHEO, eastern Ontario's children's hospital in Ottawa, also has 12 ICU beds, and has offered to make room for adult patients if needed.

Triage based on provincial needs

Dr. James Downar, a palliative care doctor at the University of Ottawaand a member of the provincial bioethics table, is also an authorof Ontario'striage plan, which sets out guidelines for access to critical care.

Under theplan, regional hospitals can't prioritize ICU beds or ventilators for their own residents, and must instead consider the provincewide need.

"We are all Ontarians contributing to the same health-care system, and we are all relying on the same pool of resources in the event of a serious crisis," said Downar.

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Alicia Robblee, an ICU nurse at The Ottawa Hospital, says its frustrating to hear about people flouting public health rules given her experience caring for a rising number of critically ill COVID-19 patients.

Downar said reserving ICUcritical care beds for local residents would be "manifestly unfair" to Ontarians living in higher-risk areas of the province.

"We see the real hot spots in certain parts of the GTA and southern Ontario, where you see high concentrations of racialized people with lower socioeconomic status and crowdedcommunities where there is traditionally poor access to health," he said.

According to The Ottawa Hospital's president and CEO Cameron Love, the situation therehasn't yet reached the point where doctors assigning critical care beds would have to decide betweenlocal residents and patients from out of town.

Patients younger, sicker

Robblee, who has worked in the ICU for the past nine years and is now training nurses diverted from other units to work in critical care, said under normal circumstances,each nurse is responsible for one patient. Robblee said hermanagers have told her that she could be asked to care for as many as four patients at once.

Robblee said she's concerned aboutthe way things are trending.

"We are seeing patients younger and younger," she said. "When patients come to us they're coming because they need to be intubated and put on life support. They're fighting for their lives, and a lot of them don't make it."