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Douglas Todd: Few ventilators used in Canada’s COVID-19 outbreak – The Kingston Whig-Standard

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The bad news is Canada’s public health officials are having trouble predicting how hard COVID-19 will hit the population.

Yet it’s also good news that they’re having trouble predicting how hard COVID-19 will hit.

Take concerns about a rush on ventilators, the mechanical breathing machines that can pump air into the lungs of desperate coronavirus patients.

In March, Canada was reported to have more than 5,000 ventilators, with B.C. hospitals in possession of 710 of them. Prime Minister Justin Trudeau soon announced in early April he would be ordering the manufacture of 30,000 more ventilators, without saying when they’ll be ready. Ontario alone brought in 500 extra.

The urgent buying grew out of public health officials’ fears that Canadian medical personnel would end up having to triage ventilators, denying the artificial breathing apparatus to some suffering patients so they could be attached to those who could benefit from them more.

That’s the terrible dilemma that news stories said some front-line health workers in New York and the Lombardy region of Italy were being forced into to handle an agonizing torrent of COVID-19 patients.

But little-known data from the Public Health Agency of Canada show that ventilators have, as of mid-week, been required for only 153 patients with COVID-19 in this country. That’s out of about 50,000 Canadians who have tested positive for the novel coronavirus, including 2,853 who have been hospitalized, according to data compiled by Alberta’s University of Lethbridge sociologist Reginald Bibby.

The veteran statistician has dug deeper than most into the detailed reports of the federal government’s public health body and found that, as of Tuesday, official government data shows 2,853 COVID-19 patients have been hospitalized in Canada, 708 have gone into intensive care and just 153 required a ventilator.

Thankfully, neither Canadian COVID-19 patients nor hospital staff have come close to having to face the ordeal that would be caused by a scarcity of ventilators.

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There appear to be three reasons that the vast majority of ventilators are remaining untouched on Canadian hospital shelves during this pandemic: Government lockdowns have cut into the spread of the virus, forecasting about infection and fatality rates was excessively high and ventilators are only helpful to certain types of coronavirus patients.

It’s a huge relief that hospital ethics teams in Canada have so far not been pressed into having to make the grave decisions about who deserves, medically speaking, to get a ventilator over someone else.

I wrote about this looming peril a month ago, describing the heartbreaking choices medical ethicists have to begin making if masses of struggling humans begin needing help when life-saving medical resources are scarce.

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Source: Prof. Reginald Bibby, University of Lethbridge.

Just as triage protocol prioritizes battlefield casualties in war and patients hoping for organ transplants, applied ethicists offered reasons why certain patients should get precedence for the country’s limited supply of ventilators.

At the time, B.C. Health Ministry officials told me they were working on a protocol for ventilator rationing should there be a need for triage. Their framework hasn’t yet been made public.

And this week a Health Ministry official said her department doesn’t keep data on how many COVID-19 patients in the province have had to use ventilators, “because they (the numbers) fluctuate too much.”

So it’s helpful to know the little-known federal numbers obtained by Bibby, which were confirmed Thursday by ministry officials, indicate every patient across Canada who needs a ventilator has been getting one, regardless of whether they have COVID-19 or some other need for the last-resort breathing apparatus.

“It’s an unexpected good-news finding — (the numbers are) way less than what we had been led to expect. But it is really tough to plan in the face of so many unknowns,” says Michael McDonald, University of B.C. professor emeritus and former head of the Centre for Applied Ethics.

The fortunately low need for ventilators so far is likely one of the factors behind the decision this week by B.C.’s chief public health officer, Dr. Bonnie Henry, and Health Minister Adrian Dix to start scheduling tens-of-thousands of elective surgeries that have been delayed because of the epidemic. The government hadn’t wanted to tie up medical resources that might have been needed for a flood of COVID-19 patients.

“We needed to prioritize the use of critical-care resources,” Henry said in her media briefing this week, without mentioning ventilators. “We had to be sure we had the surge capacity in critical care, should we start to see a surge in cases of COVID-19.”

The other reason not many ventilators have had to be used is that they’re often not necessary or beneficial, even for critically ailing COVID-19 patients.

Many Canadian families are foregoing the grim treatment afforded by critical-care units and breathing machines, which require a wide tube to be pushed down the patient’s throat and into their lungs to help them breathe. Patients are often sedated for the difficult procedure. They’re also unable to talk while attached to the device.

Four of five of the 2,766 coronavirus deaths that have occurred in Canada up to mid-week have taken place in nursing homes. And many of those patients and their families, if not most, have chosen to die in long-term care rather than submit to entering critical-care wards where ventilator use might have made their passing more painful.

One of the things we can take away from Canada’s extremely low use of ventilators so far is that we’re in strong shape as we head into the months ahead and try to avoid a second or third wave of coronavirus, which could be worse than the original.

McDonald for one will not be quick to criticize Canada’s leaders for ensuring a possible overabundance of ventilators:

“Which side do we want our public officials to err on in the face of great uncertainty: Saving money or saving lives?”

Dtodd@postmedia.com

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