What we know (and what we don't) about Alberta's ICU capacity amid COVID-19

Albertans get regular updates about the number of patients in hospital with COVID-19, and one question often asked is: How does that compare with the capacity of the health-care system?

We know, for instance, how many people are in intensive-care units on a given day with the novel coronavirus. But how many patients are in ICU for other reasons? And how many ICU beds are left unoccupied?

The short answer is: The province won't tell us.

The longer answer is: ICUs are complicated, their usage is constantly monitored, and the provincial health authority assures Albertans there will be no shortage of beds, staff or equipment in the event of a COVID-19 surge the likes of which we have yet to see.

The total number of patients in ICU can fluctuate hour by hour as people are admitted, transferred or their conditions change. Alberta Health Services has refused to make detailed occupancy data publicly available, but it says this data exists and is watched closely internally, so adjustments can be made or resources redeployed, if necessary.

There are also different levels and types of ICU, with different kinds of equipment and staff. While each has its specialities and intended uses, capacity can be transferred between units and even expanded, if need be. But there are trade-offs to be made.

Even at its peak, the number of COVID-19 patients in ICU has been relatively low in Alberta, compared with provinces like Ontario and Quebec. But the intensive-care system usually runs at near-capacity, so even a modest increase in occupancy can pushICUs beyond their normal limits.

Measures are in place to handle such situations, but it means making sacrifices in other parts of the health-care system. If needed, Alberta hospitals could nearly quadruple the number of normally funded ICU beds to handle a surge in patient volumes. So far, though, nothing close to that has been necessary.

But what, exactly, is the current ICU situation?

Here's what we know and what we don't.

How many ICU beds does Alberta have?

The simple answer to this most basic question is 272.

But it's important to unpack what that means, exactly.

Dr. David Zygun, an intensive-care physician who also serves as medical director for the Edmonton health zone,said that figure refers to the number of "funded beds" at the "highest level" of intensive care, which is typically what a critically ill COVID-19 patient on a ventilator would require.

This total includes both adult and pediatric ICU beds, and beds that are typically designed for people with other types of conditions, such as cardiacpatients, but doesn't include ICU beds specific for burn victims.

The vast majority of these 272 ICU beds are found at major hospitals in Calgary and Edmonton. Zygun said there are 12 ICU beds in theNorth zone, 12 in the Central zone and 24 in the South zone.

Again, these are the highest level ofICUs.

Zygun said there are three levels of intensive care, but lower-level units can be upgraded by adding more specialized equipment and staff,if the needarises.

And that was part of the pandemic planning.

How capacity could expand to 1,000+ beds

Back in early April, alongside the release of provincial modelsshowing the potential effects of COVID-19 under several different scenarios, Premier Jason Kenneyannounced plans to expand Alberta's ICU capacity.

By late April, the premier said, there would be as many as 1,081 ICU beds made available in the province, if necessary. This would more than meet the need under the "probable" scenario that was being forecast at the time. Actual ICU levels ended up being far lower.

This didn't mean, however, that whole new wings of hospitals were built and left sitting empty, awaiting patients, with unused equipment and doctors and nurses standing at the ready. While a smallfield hospitalwas built outside the Peter Lougheed Centre in Calgary, it was designed to serve as a "temporary emergency department," not provide intensive care.

The bulk of the ICU capacity expansion involved coming up with detailed plans for how each hospital would deal with a hypotheticalinflux of COVID-19 patients, Zygun said.

"Every site across the province is a little bit different in how we accomplished this," he said.

The first step would be to convert existing cardiac and neurological ICUsinto more generalized units. Zygun said that is relatively easy to do, but it would affect other types of patients. Heart and brain surgeries might be delayed because those patients often require ICU care after their operations.

This type of expansion could also increase the workload on the multidisciplinary teams that work in ICUs, he said, or prompt some staff to work in areas outside of the specialty where they have the most experience.

The next step would be to upgrade lower levels of intensive care so that they can accommodate higher-need patients. The physical space is there but, again, this would require devoting more staff and specialized equipment to those units.

The "most extreme stage" would be to convert "non-typical space" into ICU space, Zygun said.

For example, he said,resuscitation bays in emergency departments and post-operative recovery rooms could be turned into ICUs, but that would again mean those resources aren't available for other types of patients.

He described this as doable but not ideal.

"Thankfullywe didn't have to get there and hopefully we never do."

What about ventilators?

Early on in the pandemic, there was a lot of concern about the availability of ventilators.

In other parts of the world, there weren't always enough ventilators for all the critical COVID-19 patients, forcing some hospitals to come up with grim guidelines for determining who gets the life-saving devices and who doesn't.

But these days, in this province, that's not an issue.

"We have no concerns with our ventilator supply," Zygun said.

"I know other jurisdictions before did, but we obviously were given some lead time to prepare, given what was happening in other countries."

In addition, he said, Alberta's integrated health-care system means ventilators can be quickly redeployed from one hospital to another in different parts of the province,which reduces the risk of localized shortages.

But there's more to providing life-saving ventilation than simply having a machine.

"You also need the skilled people to run it, because they are not a routine device that everybody is trained on," Zygun said.

The availability of staff is more likely to be a limiting factor than the number of machines, he said. But again, there are plans in place to boost training and ramp up capacity, in the event of a surge in need.

Just how big is the current need? That's where things get a little fuzzier.

How many people are currently in ICU?

Alberta Health publishes new data, Monday to Friday, showing the number of patients in hospital with COVID-19, including the number in ICU.

But Alberta Health Services won't publicly reveal the latest data on ICU occupancy, in general.CBC News has been asking for this information for the past several weeks but AHS has not provided it.

Internally, Zygun said, the number of patients in ICU is "constantly monitored" by AHS staff.

But if you're looking at the daily COVID-19 updates and wondering how the ICU numbers comparewith total ICU availability, that information is not being made available in the same way.

Usually, Zygun said, ICU beds are mostly full.

"We do tend to run somewhere between 70 to 90 per cent capacity, as our routine," he said. "And, at times, certainly even over 100 per cent."

Since April, the number of COVID patients in ICU at any given time has ranged from as fewas four to as many as 22.

Zygunsaid "that does make a difference" on the overall system, especially when ICUs are running at the high end of their capacity.

Earlier this summer, for instance, he said Edmonton ICUs were unusually full of patients who had suffered traumatic injuries. He said it's also important to note that, for smaller hospitals, running at 88 per cent capacity can mean there is only a single ICU bed available.

So far, though, Alberta hospitals have avoided the disastrous situations experienced in some parts of Spain, Italy and the United States, where the need for critical care exceeded capacity.

And, even if severe COVID-19 cases surged to unprecedented levels in this province, ICU capacity could be expanded to meet needsmuch higher than we've seen to date.

But it would come at a cost not just in terms of the extra spending, but also in terms of diminished health care for other patients.