A health care worker in a surgical mask helps unload a stretcher service vehicle at St. Boniface Hospital, which is a reported site of the coronavirus disease (COVID-19) outbreak according to local media, in Winnipeg, Manitoba, Canada, November 1, 2020. REUTERS/Shannon VanRaes/File Photo
TORONTO – Younger Canadians are bearing the brunt of the nation’s latest COVID-19 surge, creating growing demand for artificial lungs and a struggle to maintain staffing in critical care units as hospitals make last-ditch efforts to save patients.
Treatment with artificial lungs, known as extracorporeal membrane oxygenation, or ECMO, is much more likely to be deployed for patients under age 65, explained Marcelo Cypel, surgical director for the extracorporeal life support program at Toronto’s University Health Network (UHN).
Last week, there were a record 19 ECMO patients at UHN, 17 of them with severe COVID-19. When the sickest COVID-19 patients’ lungs fill with fluid and mechanical ventilators can no longer do the job, artificial lungs can save lives.
By Monday, doctors had weaned some off the machines and were down to 14 ECMO patients, 12 of them with COVID-19.
The need for these artificial lungs reflects a change in Canada’s epidemic, which has taken a turn for the worse, with new cases surging and outbreaks hitting workplaces and schools.
With many seniors vaccinated and new, far more contagious coronavirus variants circulating widely, younger patients are increasingly arriving in intensive care.
“It’s very different now than the first wave, when we saw older people with comorbidities,” Cypel said. “We’re seeing more … young essential workers.”
The ECMO situation is under control for now, but things can change very quickly, Cypel cautioned.
When hospital systems in other countries were overwhelmed, they had to stop using ECMO because it requires a lot of staff – seven or more people to start the treatment.
About 55% of people who receive the therapy survive, Cypel said. However, they are often left with “severe physical limitations” from their extended hospital stay, he added.
Many of Canada’s provinces are in the grip of a worsening third COVID-19 wave, as they struggle to hasten vaccine rollouts. The country reported more than 6,200 new cases on Monday, with the percentage of people testing positive for the virus up to 3.8%.
‘SEEING BURNOUT’
In British Columbia, where hospitals are bracing for a surge in demand for intensive care unit (ICU) beds caused by the highly concerning P.1 virus variant first discovered in, and now ravaging, Brazil, critical care doctor Del Dorscheid from Vancouver’s St. Paul’s Hospital is more worried about staffing than artificial lung use.
On a given shift, he said, a third of the staff are working overtime.
“They’re working so hard to find bodies to fill those empty spots,” he said. “I wouldn’t say we’re seeing more mistakes. Not yet, anyways. But we are certainly seeing burnout.”
For ICUs, there is no end in sight. As of Tuesday, there were 497 COVID-19 patients in Ontario’s ICUs, a new high. Last week, experts advising the provincial government said that could rise to 800 by the end of April even with a new stay-at-home order – or approach 1,000 without it. The province stopped short of a new stay-at-home order.
New restrictions implemented in Ontario last week change little for hardest-hit areas. In Toronto, patios for outdoor bars and restaurants closed, and a plan to reopen salons was shelved. On Monday, hard-hit Peel, west of Toronto, moved on its own to suspend in-person classes at schools for two weeks.
Canada’s vaccination rate has picked up after a slow start, with 15% of the population getting at least one shot. But data from the Institute for Clinical Evaluative Sciences shows that the Ontario communities at highest risk of COVID-19 transmission also have the lowest rates of vaccination.
These communities tend to have a high proportion of residents unable to work from home, many of them non-white immigrants holding down jobs at high risk of virus exposure.
Some lack cars to drive to vaccination sites or paid time off to get the vaccine, said Brampton doctor Amanpreet Brar. Some of the hardest-hit neighborhoods lack pharmacies that dispense COVID-19 vaccines.
“It really reflects systemic inequities we see in our society,” said Brar. “They’re considered non-essential, while their work is considered essential.”