An ominous quiet has descended upon many of British Columbia’s hospitals.
Across the province, hospital wards that would normally be full to bursting have emptied, relatively speaking. Long-term patients have been shuffled out. Others have never shown up for their now-cancelled surgeries.
Usually, British Columbia’s hospitals operate beyond their capacity. Now, nearly 4,000 beds sit empty across the province. There are still patients, and still some noise, but they “feel empty, they feel quiet,” Health Minister Adrian Dix said on March 23.
Health workers, Dix said, “feel as if they’re anticipating something to come.” That (relative) calm is temporary, everyone knows. The storm will come. The question is just how big the storm will be, and whether the public’s social-distancing efforts will hold.
So the empty beds aren’t a source of relaxation. Instead, they are an anxiety-provoking reminder of what is to come.
But they – along with, critically, the staff one includes when writing or talking about hospital beds and capacity – are B.C.’s best weapons against the virus.
B.C.’s hospitals normally operate at around 103 per cent capacity. As of March 26, B.C. had 3,900 empty hospital beds. Seventy-three beds, as of Friday afternoon, were occupied by COVID-19 patients. That number is growing at about 19 per cent every day.
This – through preparation, hard work, sacrifice and fortune – is how the province emptied its hospitals, and prepared to fight a war against a virus.
This article is based on statements by Dix and provincial health officer Dr. Bonnie Henry, an interview earlier this month with seniors advocate Isobel Mackenzie, and information provided at a technical briefing Friday morning. Background information relies on several years of reporting on hospital capacity.
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Two weeks ago, the news out of Northern Italy had become increasingly dire.
On March 6, 49 people in the country had died of COVID-19. A week later, on March 13, 250 people died in a single day. On March 15, that number was 368.
Early efforts at social distancing had failed and the virus had spread rapidly. Patients numbered in the dozens, then hundreds, then thousands. COVID-19 quickly overwhelmed that region’s hospital system.
A shortage of hospital spaces and, most critically, ventilators had forced doctors to begin to make wrenching decisions about who would receive life-saving care and who would not. And so patients died – so many that morgues could no longer hold them.
Just to the south of B.C., Washington’s hospitals were also facing a significant space crunch due to COVID-19 outbreaks there.
And in B.C., hospitals were also lacking space because B.C.’s hospitals are always lacking space. For more than six years the province’s hospitals have operated over capacity. Bad flu seasons compromise treatments for dozens and leave people waiting, for days on end, in emergency rooms for admission to hospital.
When a hospital is operating over capacity, that means they have more in-patients than they have funded space for. Those patients end up in hospitals and other areas not designated for ongoing care.
A second flu would be bad. But COVID-19 isn’t the flu. It’s much, much deadlier. It kills seniors at an alarming rate, but also regularly hospitalizes, and sometimes kills, younger people for whom the flu is usually not a worry.
Any spike in patients due to the spread of COVID-19 would leave such facilities scrambling for space.
So, on March 15, health officials made one of their biggest decisions to that point as they sought to prepare for, and respond to, the spread of COVID-19.
Elective scheduled surgeries, they determined, would be stopped. While urgent scheduled surgeries, including for those with cancer, could proceed, anyone waiting for hip replacements, knee surgeries and other physical repairs would have to wait.
The surgeries are important for people to maintain or improve their standards of life, Dix acknowledged. When the COVID-19 crisis passes, the province will face a backlog of such surgeries.
But officials determined that, for now, those patients must be de-prioritized to ensure that doctors and nurses can save as many lives as possible in the continuing pandemic, whatever it looks like.
“Cancelling them to ensure we have the appropriate space in hospitals … is a necessary step. It’s a step that wasn’t taken in other jurisdictions that dealt with an influx of COVID-19 patients while their hospitals were at 100 per cent capacity. That’s not what we’re prepared to do in B.C.,” Dix said.
But it’s not one without painful consequences for many.
“We’re talking about the cancellation of thousands of surgeries,” Dix said this week.
“That tells you effectively how seriously we take the situation, how seriously we take the need to be prepared, and how difficult these decisions are not just for hospitals, and for doctors and for nurses who are not doing the work that they were born to do to restore life and movement to people who were waiting for surgeries, but for the many, many people who will be affected by this for the days and months to come.”
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Not every patient in a B.C. hospital needs to be in a hospital. On a normal day, roughly 1,000 patients in acute-care beds are ready to be discharged but remain in hospital because they are waiting for support to be set up in their community.
Some are waiting for home care services that will allow them to return to, and keep living in, their house or apartment. Many others wait weeks for a bed to become available in a long-term care or assisted-living facility.
The province has a long-running and an as-yet-unresolved shortage of such beds and getting so-called “alternate level of care” (ALC) patients actually out of hospital has been a years-long challenge for health officials.
Keeping them in hospital costs far more than caring for them in the community, but health authorities have been unable to build residential care beds quickly enough to significantly reduce their numbers.
The COVID-19 crisis has shown that there is some room to get such people out of hospital.
Dix has spoken of the “decanting” of such patients to places outside hospital.
The province hasn’t provided many specifics about how many ALC patients have gone to what type of facility or housing type. But while there has been some suggestion that hotels and motels could be used as temporary landing spots, seniors advocate Isobel Mackenzie suggested earlier this month that the province would likely first look to private care residences.
The province and its health authorities maintain a public residential care system that runs parallel to, and sometimes crosses paths with, a private system. The province already funds large numbers of beds in private facilities.
The COVID-19 crisis has likely seen the province dramatically increase the number of such beds it pays for in private facilities. Cost and ideology, which may normally discourage an NDP-led province from effectively privatizing residential care, will be less of a factor than the urgency of the matter and the need to avoid an Italy (or New York) space crunch.
The province has also recently designated Summit at Quadra Village as a hospital. That 320-unit facility had been slated to replace two aging Victoria-area care homes.
But instead of residents being transferred from the old facilities to the new ones, ALC hospital patients from around the region are being moved into the Summit. That, in turn, will free up hundreds of hospital beds in the region.
But seniors who had anticipated a move into a more modern facility next month are now stuck in facilities that officials have declared to be “no longer suitable for residential care.”
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Then there are more than 1,200 new hospital beds that have been created more or less out of thin air. Dix has spoken about about 1,200 “surge” capacity beds that have been brought online.
There are few details about what, exactly, these beds look like, but they likely include the formalization of many unfunded-but-often-occupied beds and locations that hospitals normally turn to when they are over capacity.
Formalizing and declaring those beds to be available and open for use will allow for better planning and co-ordination across hospitals.
Concerns abound over supplies of personal protective equipment for hospital workers, as well as the potential for COVID-19 to spread within hospitals. A key way to reduce demand for face masks – and to decrease the potential for the spread of the virus within a hospital – is to separate COVID-19 patients from those who don’t have the virus.
That can allow a health-care worker treating someone with COVID-19 to keep a single mask on throughout his or her shift. That both preserves the supply of protective gear, while decreasing the chance that a health-care worker would infect themselves when they touch their face to remove or apply a new mask.
But these and other plans to “cohort” patients together require both flexibility and clarity in the location and number of hospital beds across the system. Identifying “surge” beds will also allow officials to determine just how close they are to genuinely running out of space in the 17 largest hospitals that have been designated as primary COVID-19 locations.
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There’s another big component at play: luck.
Because British Columbia wasn’t so unfortunate as to be one of the first locations to see the virus spread rapidly, officials here have been able to learn lessons from the tragedies that have occurred in those locations that have seen COVID-19 kill hundreds each day.
The danger posed by the virus, both to individuals and to entire health-care systems, is now proven. But Henry has spoken repeatedly about how officials in B.C. have been able to look at how the virus has progressed elsewhere.
And that data has played a key role in determining how the province proceeds – and whether it thinks its efforts are working.
The increased capacity in hospitals is just one slice of that, but like other orders and directives, it’s an element that has had significant negative consequences on thousands of people.
In the best of times, British Columbia’s hospitals – and long-term care homes – face a space crunch and pressures that ends up leaving some patients feeling as if they are being rushed out the door or that their care isn’t sufficiently prioritized.
Every one of those challenges has been upped by the arrival of COVID-19.
Everyone who needs a hip or knee surgery will have to wait longer for the freedom that those repairs can give. Seniors are being sent to care homes far from their loved ones. Others must remain longer than anticipated in substandard spaces. And the bar to be admitted to hospital will also inevitably rise.
But, Dix and Henry have said, these measures should provide enough bed capacity for British Columbia to deal with a very serious COVID-19 epidemic that would normally overwhelm the province’s hospital system.
The public’s co-operation and continued efforts to practise social distancing are critical in those efforts, Dix said. Should those efforts fail – and should the public slacken in their efforts to flatten the curve – health officials would need to shuffle patients from region to region to deal with outbreaks.
As it stands, though, they say the hospitals should hold – as long as the public’s determination doesn’t waver.
“We are absolutely determined to prepare for the worst even as everyone works their guts out to ensure that the best scenarios emerge,” Dix said. “We need everyone to be all in now, 100 per cent all in now, every day. That’s how we are true to our families, the ones we love, to health-care workers.”
