Alberta ICU admissions could double in 2 weeks, leaked AHS email says

An Edmonton hospital is readying new surge measures as it braces for Alberta's COVID-19 intensive care admissions to potentially double in the next two weeks, according to an email obtained by CBC News. 

Donalda Dyjur, an executive director at the Royal Alexandra Hospital, sent the email to staff Saturday afternoon, the same day Alberta hit a single-day record of 1,026 new cases. 

The hospital is one of 10 in the province grappling with a COVID-19 outbreak.

"Based on this current trend, it is projected that COVID cases will double within the next two weeks if the curve does not flatten," said Dyjur, addressing hospital ICU admissions. 

"We need to be prepared." 

• Alberta shatters daily COVID-19 records with more than 1,000 new cases
• 3 COVID outbreaks force south Edmonton hospital to divert critical patients to other facilities 

The email contains a graph that lays out three potential ICU scenarios over the next two weeks. At the current rate, the province could see admissions hit 120 by early December, 50 more than Alberta's current capacity. 

If that trend starts to level out, the projection drops to around 78 occupied beds. The most optimistic of the three scenarios projects 45 COVID-19 patients will be in intensive care by early next month. 

"I know that these are times of uncertainty and that many are having feelings of worry and stress," said Dyjur, the hospital's executive director of medicine and adult critical care.

"The coming weeks will be our time to demonstrate just how much skill, grit and resiliency we have and we will work together to get the job done." 

New surge measures as COVID-19 ICU nears its limit

The province hit nearly 82 per cent of its COVID-19 intensive care capacity Sunday with 58 of 70 beds filled across Alberta, according to numbers posted to the provincial website.

Alberta Health Services confirmed there are 11 patients admitted to the Royal Alex. The hospital has 25 beds in total in its ICU.

According to the email, new surge measures will increase Edmonton's critical care capacity in three stages, adding 10 beds with each step for an eventual total of 30. The Royal Alexandra will host three beds in the first stage, and 11 beds by the third stage, Dyjur wrote.

With new intensive care beds comes a rise in demand for additional ICU health-care workers. 

According to AHS, the actions outlined in the email are "proactive planning for a potential surge of patients in Edmonton zone."

AHS says its initial response to a surge is often maximizing existing capacity and limiting admissions by temporarily rescheduling complex surgeries. In Edmonton, AHS confirmed that surge capacity measures are in place with up to 30 per cent of non-urgent surgeries postponed.

As cases rise, the next phase would be to use existing space that is equipped but not in use. If the number of patients keeps increasing, hospitals will then use non-traditional ICU spaces, and have staff normally not involved in care of patients — such as anesthesiologists — to staff the space.

In the email, employees in the Royal Alex ICU are being asked to pick up shifts to staff up to 28 beds as soon as possible. People with ICU experience along with surgical staff are being redeployed to intensive care. 

Every day that we stall, things will get worse and inevitably I think we have to head down to a complete lockdown.- Dr. Darren Markland

The hospital's ICU is already running full out with about half of the patients being treated for COVID-19, said Dr. Darren Markland, an intensive care physician at the Royal Alex. Without new beds, doctors will be looking to treat intensive care patients in areas such as recovery rooms, operating theatres or cardiac units, he said. 

"We know that we're following this growth rate and we know that this is where we're heading," Markland said in an interview Saturday. 

'Tired, frustrated and scared' 

The plan to add ICU beds comes after Alberta Health Services said late last month it was postponing up to a third of non-emergency surgeries at Edmonton-area hospitals, which are routinely running at 120 per cent capacity.

Hospitals are operating with fewer beds due to COVID-19 isolation demands, while some continuing care beds across Edmonton are closed due to site outbreaks. Keeping units well-staffed as workers fall ill or quarantine is an increasing challenge, AHS said this week.

Six hospitals in the Edmonton zone have at least one unit on outbreak protocol, according to an update posted to Alberta Health's website Friday.

A Covenant Health spokesperson said on Sunday that four units at Grey Nuns hospital are on outbreak protocol — up from three on Thursday — involving 12 active cases among patients. The Misericordia hospital is also responding to outbreaks on two units with three active COVID-19 cases among patients.

Thirteen staff at Misericordia had also tested positive, but have since recovered and are back at work, according to Covenant Health. Covenant Health said 21 staff at the Grey Nuns have tested positive for COVID-19 in connection to the outbreak, but as of Sunday could not confirm how many of those are active cases and have many are recovered and have returned to work, following their isolation.

The Grey Nuns emergency department began accepting ambulances again on Friday morning, ending a temporary directive rerouting EMS to other hospitals due to capacity strain. 

Premier Jason Kenney introduced some additional mandatory public health measures Thursday, including a suspension of fitness classes and a reduction in operating hours for bars and pubs. The measures fell short of a sharp two-week emergency lockdown called for by dozens of physicians this week. 

"I think that everybody is tired and frustrated and scared and nobody wants to go to a lockdown. If this was two weeks ago, we could've done things that would've prevented it. But we haven't," Markland said.  

"As a result, every day that we stall, things will get worse and inevitably I think we have to head down to a complete lockdown. My hope is that when it happens and we do this circuit breaker, people now realize the seriousness of it and start to follow the rules again."