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ST. JOHN'S. N.L. — The short-term outlook for COVID-19 spread in Newfoundland and Labrador looks promising under current health emergency measures.
But even the best-case long-term projections suggest a likely squeeze for intensive care unit (ICU) beds by the fall.
The projections were presented to reporters and to the public Wednesday by Dr. Proton Rahman, a clinical scientist with Eastern Health. The information was assembled through various local agencies with help from the University of Toronto and the Canadian Institute of Health Information (CIHI).
Even with current emergency health measures, long-term modelling showed the province needing about 200 ICU beds at peak coronavirus levels in November. That’s three times what is currently available, although there would still be enough ventilators.
Overall bed capacity would not be exceeded in this scenario, but Rahman said ICU care depends primarily on the number of nurses and specialists available.
“It’s not just about beds,” he said. “With each individual bed there’s human resources involved, such as respiratory technicians, which is going to be critical to this. We really have to rethink, to some extent, how to deliver these services.”
A more dire scenario presented Wednesday, in which half the population got sick, showed catastrophic results, with not nearly enough beds, staff or ventilators to go around.
“We will simply not be able to cope without drastic changes, and even then it is unlikely we would be successful,” Health Minister Dr. John Haggie said during a later video address.
Rahman warned that the CIHI models are likely “off a fair bit.”
“We’re looking well beyond the time frame that we have any certainty about.”
He said Newfoundland and Labrador is at least three weeks behind other provinces in terms of usable date.
In particular, while tragic in themselves, the fact there has only been two deaths so far makes it impossible to offer accurate projections of mortality rates.
He said the higher rates of high blood pressure and diabetes in this province don’t bode well, since those underlying conditions increase the chance of severe symptoms or death.
But the virus can affect anyone.
“The experience that’s been reported in numerous states in America and also in Canada (is that) a lot of young, healthy people are actually ending up in the ICU. Most don’t, but it can happen to anyone,” Rahman said. “The people that we’re worried about the most are the old, the vulnerable, people with multiple medical conditions, but anyone can get in trouble and you really have to respect what this virus can do.”
Rahman said the Caul’s Funeral Home cluster — a mid-March exposure that accounts for 75 per cent of subsequent COVID-18 hospitalizations — also makes it difficult to interpret the province’s numbers with any accuracy.
Models are usually based on more evenly distributed infections.
Rahman said emergency measures imposed by the province could buy time to accommodate demand ahead of the surge.
“The time is key in terms of the health care capacity to be able to manage large amounts of patients,” he said. “The other reason why time is important, if we’re looking at an 18-month to two-year time period, lots could happen in terms of maybe a potential therapy, something that’s been repurposed in terms of a drug coming into it, some antibodies that you can take or possibly a vaccine. You’re buying time for potentially a therapy and you’re also buying time in terms of our health care capacity to adapt to this.”
Rahman wouldn’t speculate on how long current health measures would be in place, especially if the peak doesn’t arrive until November.
But he cited a scenario posed by some experts in which individual measures could be lifted temporarily and re-imposed if the number of cases rises again.
Chief Medical Officer of Health Dr. Janice Fitzgerald was not available for questions during the Wednesday evening briefing.
For now, Rahman said, it’s important to stay put.
“It just takes one small indiscretion to create a large increase,” he said.
“So, please, please follow the health guidelines put in place by Dr. Fitzgerald.”
With files from David Maher
Peter Jackson is a Local Initiative Reporter covering health care for The Telegram