Ontario's current wave of COVID-19 infection is expected to peak on October.
Ontario's 2nd wave of COVID-19 forecast to peak in October
Researchers have outlined four scenarios on how the second wave will play out here. I should point out that these scenarios are for planning purposes rather than saying that there are only four possible paths the pandemic could follow.
Best case scenario is where it follows the same path as in Ontario during March and April, where numbers rose rapidly but then also fell rapidly after a lockdown.
The best-case scenario would mimic Ontario's first wave in March and April, when case numbers increased rapidly but were then reined in by a lockdown.
In the two medium cases the second wave resembles what happened in Melbourne Australia or Michigan US.
Two moderate scenarios would resemble how a second wave hit jurisdictions comparable to Ontario: the Australian state of Victoria (home to Melbourne, a city of five million), and the U.S. state of Michigan.
The worst case scenario is a second wave which resembles the first wave seen in Italy.
... the modellers' worst-case scenario: a second wave as severe as the first wave that hit Italy when the pandemic began.
Under the best case scenario ICU capacity is not pressed to the point where normal surgeries need to be cancelled.
Under the medium scenarios, ICU capacity is pushed to the point where surgeries, including high risk cancer surgeries, have to be postponed.
The consequences of the worst case scenario were not detailed.
They mention that the second wave in Spain and France started among younger age groups but spread to the elderly. The said that this seems to be happening in Ontario as well.
"The second wave in Spain and France started in the younger populations, but it is spreading to the elderly and the people who are more at risk of ending up in the intensive care unit or in the hospitals," said Barrett in an interview with CBC News.
"It is just a matter of time until this virus, if it's affecting the young populations, spreads into the elderly population," she said. "We're already starting to see that happening in Ontario."
The number of people age 70 or over in Ontario with an active case of COVID-19 is now 227, an increase of 34 percent in one week.
The latest figures from the province's Ministry of Health show 227 people aged 70 or older with an active confirmed case of COVID-19. That number has increased 34 per cent in the space of a week.
Ontario has roughly 2,000 ICU beds, and more are being added. Typically 2/3rds are occupied by people who have nothing to do with COVID-19. Taking in to account that ICUs can't actually operate at 100% of capacity, if only 100 people with COVID-19 require ICU care this competes with other uses, such as scheduled (non-emergency) surgery.
Ontario has around 2,000 intensive care beds, and the province plans to add 139 in October. The province's ICU beds are typically two-thirds occupied by patients whose cases have nothing to do with COVID-19, whether it's a heart attack, car accident, or another critical illness.
Since ICUs can't actually function at 100 per cent occupancy full time, the researchers calculate that Ontario has around 475 beds available for non-emergency surgery patients and COVID patients. When scheduled surgeries are running at full pace, those patients take up all but 100 of those beds.
Their conclusion: if more than 100 people with COVID-19 need ICU care, they'd be competing for space with scheduled surgery cases.
"Then we would have to make decisions in terms of who to treat," said Sander. "Do we admit COVID patients or do we do (non-emergency) surgery?"
So, if Ontario's second wave follows the Melbourne scenario, 350 to 400 COVID-19 cases will require ICU beds at the peak in late October.
The projections suggest if Ontario's second wave follows what happened in the Australian state of Victoria — a sharp spike in new infections that drops off quickly after a strict lockdown — some 350 to 400 people will need an ICU bed at peak demand in late October.
If it follows the Michigan scenario, peak demand for ICU beds will be more than 200, but the demand will be extended over a longer period of time than in Melbourne.
If the second wave in this province plays out as Michigan's did — a rise in new infections that levels off but doesn't slow down for a long time — the forecast is for more than 200 patients with COVID-19 in the ICUs from late October onwards.
There are currently 28 COVID-19 cases in ICU in Ontario at present.
Figures published Sunday by the Ministry of Health show 28 ICU patients with a confirmed case of COVID-19.
In the first wave demand peaked at 264 ICU beds.
In Ontario's first wave, the number of COVID-19 patients in ICU peaked at 264, while the number of people in hospital at one time peaked at 1,043. Non-emergency surgeries were postponed across the province.
ICU occupancy rate is more important than general hospitalisation rates because it is easier to free up or expand general hospital beds than it is ICU beds.
The modellers say ICU occupancy numbers will be of more critical concern than total hospitalization numbers because Ontario's hospital system can far more easily free up general ward beds than it can make space in intensive care.
The issue is not so much beds and ventilators as it is trained and experience staff. The latter aren't something that can be expanded at short notice.
That's less about the available beds and ventilators, and more about the having enough doctors and nurses capable of the specialized care that ICU patients need.
"You can't just train people overnight to do this type of thing," said Sander. "You can buy a lot of beds and you can buy a lot of ventilators, but you can't get these highly qualified staff on the ground within a very short period of time."
The effects on staff are another bottleneck in a second wave. Many of the people working in hospitals have children. A widespread outbreak among younger age groups will result in them bringing their infections home and giving it to their parents, causing serious staff shortages in hospitals at a time when they're already under stress due to staff limitations.
Barrett agrees that human resources are the key limiting factor, and is concerned about how the second wave could hit hospital staff and their families.
"The majority of people working in hospitals are in their 30s, 40s and 50s, so many of them have children who go to school," she said. "If there is a massive outbreak amongst the younger population and school children, that's a whole sector of our health workforce that won't be able to come to work."