BY PAMELA FAYERMAN
Hospitals around the world are now so overwhelmed by COVID-19 surges they’re resorting to desperate measures like sending patients across borders or utilizing specially erected disaster medicine field hospitals.
In Canada, surging coronavirus cases and hospital outbreaks have led to cancellations of non-emergency surgery at one hospital in Toronto, delays in other hospitals, and this week, dire warnings by B.C. health minister Adrian Dix after new case records were set this week.
COVID-related hospitalizations across B.C. have been steadily climbing since September. So if hospitals in the Lower Mainland are further deluged, the 271-bed field hospital built inside the cavernous Vancouver Convention Centre could be activated.
The B.C. government spent nearly $2 million in early April to have it built just in case it’s needed. It’s been on standby for seven months – at a leasing cost of $88,000 a month – a “relatively nominal fee by Vancouver real estate value standards,” as health minister Adrian Dix said.
It will remain available for several more months since conferences won’t be resuming any time soon.
Hospitalizations due to COVID-19 are rising and Dix said in an interview that once influenza season begins, it may become necessary to use the convention centre facility.
“We have to prepare for all possibilities but our preference is to continue to use our existing hospitals.
“Opening this facility will be done on the advice of the senior medical leaders at St. Paul’s Hospital and Vancouver General. It’s going to be their call and it will be supported by me.”
The field hospital also includes morgue space but Dix said he doesn’t envision it as a place where those who are severely ill or at risk of dying will go. It would be used for patients who still need some hospital care and rehabilitation services.
The province has just over 5,600 acute care beds and 200 beds in intensive care units. There are currently 92 COVID-19 patients occupying hospital beds, including 22 in ICU beds.
In the Spring, when the government made the decision to postpone tens of thousands of elective surgeries, there were as many as 149 COVID-19 patients in hospitals; that level remained for a month before it started to drop as you see from this graph by CBC. Dix said that even when there were 149 COVID patients in hospitals, there wasn’t a dire need for a field hospital but it’s prudent to have it in a worst-case scenario.
So what kind of ill people would it serve, if and when it does open? A recent article by the B.C. health professionals who created the makeshift hospital – called the Vancouver Convention Health Centre (VCHC) – sheds some light on that.
In their article published in the American Journal of Disaster Medicine, the team that built the makeshift Vancouver field hospital explain how they came up with a hypothetical Four Box COVID concept – 1) medical or surgical patients who are COVID negative; 2) stable COVID patients who require some minimal hospital care; 3) palliative (or nursing home patients) COVID patients, and 4) COVID patients at risk of declining or who can’t be at home because they could spread COVID-19 to their household contacts.
Having COVID and non-COVID patients under the same roof may sound both counter-intuitive and overly complex but it is “feasible” since the environment was planned for physical separations and indeed, hard walls between patient areas with dedicated streams of medical and nursing staff.
The site has four nursing stations, patient and staff showers and washrooms, oxygen and other medical supplies. Beds are set-up in a pod format with a dedicated health care team assigned to units of 25.
The site can also accommodate B.C.’s Mobile Medical Unit for patients who may need a higher level of care before being transferred to a regional hospital. The MMU is on standby for use anywhere in the province.
While the downtown field hospital is already equipped with isolation areas for medical procedures and Red Cross-loaned wheelchairs and walkers, many supplies are not on site. Indeed, supplies like medications would have to be delivered only at the time of activation, the article notes, because “diversion of supplies, equipment and human resources for already strained hospital systems in a disaster for an alternate care site/field hospital is of major concern.”
As to who would work in the field hospital if it’s activated, besides physicians, nurses, respiratory care therapists, and others, the article says St. John Ambulance volunteers could also be “rapidly onboarded” and used as Disaster Care Aides “to avoid cannibalizing staff from the hospital system.” Contact lists have already been developed.
Dix said in a health care system already stretched, he agrees that the issue of who would staff the facility is a concerning issue. “That’s why this is not a desirable result.”
The article was co-authored by Dr. Ross Brown, director of the Vancouver Coastal Health/Providence Health Care Emergency Operations Centre, Dr. Doug Nottebrock, an emergency physician at Kelowna General Hospital who is aligned with the Canadian Red Cross contingent at the field hospital; Peter Hennecke, clinical operations director of the BC Mobile Medical Unit/Health Emergency management BC; and Dr. Paul Dhillon, who has various titles and roles. He is medical director of the VCHC, and is a Captain in the Canadian Armed Forces.
Read his co-authored article about the Vancouver field hospital in the medical journal here.
Click here to see photos of field hospitals erected in cities around the world.
This is the first story I wrote about Dhillon, eight years ago, when he was a mere Boy Wonderkid.
Paul is taking on Covid-19 this year just as he did Ebola in 2014. Without fear or favour. He just keeps calm and carries on. A very British — and Canadian — thing to do. God’s speed, my friend.