Front Burner - Coronavirus: mortality, beds and respirators

Episode Date: March 19, 2020

As deaths and confirmed cases rise the number of ‘Acute-care’ beds and ventilators in Canada is causing concern. On this episode of Front Burner we zero in on Canadian deaths and discuss whether hospitals are ready to cope with the rise in cases. Infectious disease specialist Dr. Isaac Bogoch talks to host Jayme Poisson about the latest ‘outbreak modelling,’ and how many new cases, hospitalizations and critically ill patients we are prepared for. **Case and death numbers change quickly with this story. Please take that into consideration.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi everyone, Jamie here. So we have another nighttime drop for you. Today, Ontario reported another COVID-19 related death. It was a man in his 50s who lived in Halton Region. Health officials say it was a case of community transmission. At this time, what we know is that the individual did not travel outside of Canada recently,

is that the individual did not travel outside of Canada recently, nor was he a contact of a known case of COVID-19. Meaning they don't know how he was infected. So given that, we thought it would be useful to look at some recent research to try and understand the death rate and our hospital's capacity, in particular for critical care beds and ventilators. Dr. Isaac Bogosh is back. He's an infectious disease specialist at the University Health Network in Toronto.

This is FrontBurner. Hi, Isaac, thank you so much for coming back onto the podcast. Oh, thanks for having me back. So the first case appeared in Canada at the end of January, and a month and a half later, we've had 10 deaths across the country. And I'm hoping we can start today with this question. What does that tell you, the death rate, about where we are in the arc of this epidemic? It unfortunately tells me that we're still very early on in the epidemic in

Canada. And, you know, we will certainly be seeing more and more cases of this in Canada, as we have been this past week. We've just seen an increased number day after day after day. And I really think those numbers are going to continue to rise until we start to see the effects of our public health initiatives, the social distancing measures and these travel restrictions until, you know, it's going to take about seven to 14 days after these have been enacted before we start to see the fruits of our labor. Okay, before we see any sort of dips, essentially. Exactly. Okay. I want to ask you about some research out of the University of Toronto, Sunnybrook, and the University Health Network that has just come out.

And this research, it focuses on Ontario. And I should note, it hasn't been peer reviewed. So we need to be cautious here. And I know that this is a model. It's modeling. And this is not a perfect science. It's not a crystal ball. But the research finds that even in the conservative scenario, that there is only a 7.5% increase in daily infections, Ontario will run out of ICU beds and ventilators in 37 days.

So first, can you tell me about this 7.5% daily increase? What does that mean? Why do they call that conservative? Yeah, so this is a modeling study. And I think it's important that we're transparent that, you know, of course, this isn't peer reviewed. This is a mathematical modeling exercise to look at our, you know, capacity of healthcare and in particular, our healthcare capacity for intensive care unit beds in Ontario and the growing epidemic here in Canada and also in Ontario. And, you know, what they're really doing

is they're looking at a couple of scenarios. They're looking at the Italy scenario where there was a growing number of cases day after day of about 33 percent. And they compare that to, you know, a more conservative scenario where there's just about a seven and a half percent rise in the number of new cases per day. And they, you know, they were saying that in this modeling study, that even in the conservative scenario where there's only seven and a half percent rise in case numbers per day, that we will meet our capacity in the intensive care unit in about 30 to 35 days into this epidemic. You know, obviously, that's nerve-wracking. You know, I still think we need to take a step back and appreciate that,

you know, there are, these are potential scenarios that we might face, but there's a lot of the citizens of Canada and, of course, you know, around the world have some determination in how this plays out. And we know what to do. We've been given clear instructions about social distancing, about working from home, and we really can mitigate the spread of this infection in community settings if we all really buy into this. Before we talked about, you know, seven to 14 days, it might take that long before we see any kind of dips. But I guess it is also possible that we don't see any kind of dips, or are you very, very confident that we will? Like, I guess

my question is, is this 7.5% increase daily very plausible? It could be. It certainly could be. And you know what? In all fairness, my crystal ball is not clear whatsoever. I mean, I think we all have the little bubbles that we live in. And certainly within the bubble that I live in, you know, my friends, my family, the people that I work with, we are all doing our part. I know of everyone working from home. I know the people that can't work from home because they just don't have those types of jobs, have, you know, strategies at work such that there's hand sanitizer and people are spaced out. I know everyone's kids are out of school and not mingling outside of school. They're really,

you know, abiding by these social distancing principles. So, you know, I appreciate that's the small little bubble that I'm living in, and that might not be reflective of elsewhere in Canada. But truly, if we are all abiding by these principles, we really can significantly limit the degree to which COVID-19 is transmitted in communities. And we really can facilitate the, you know, appropriate care that people need in a healthcare setting, because we're not going to have these rapid rises and these rapid spikes in cases. But your point is really well made because, you know, all these interventions, you know, that we've enacted, there's a lag time. And what we're

seeing today is really reflective of the behavior that we had 7 to 14 days ago. You know, it's hard to know. Just to go back to ventilators and ICU beds for a moment. Can you explain to me why we're so concerned about ventilators and ICU beds? There's great data from China and, of course, from outside of China now looking at the spectrum of illness that people have with this. And fortunately, the vast majority of people do just fine. The vast majority of people that get a COVID-19 infection aren't even going to need to seek medical care. Most people will feel a little unwell and be able to recover in the comfort of their own home. But of course, we know that a small percentage of individuals will be sick enough that they're going to need hospitalization. And an even smaller percentage of individuals are going to be sick enough in the hospital that

they're really going to need the very specialized care of an intensive care unit, which, you know, if you're getting to that state, you know, you're typically having some difficulty with breathing and you may need some subspecialized equipment, such as a breathing tube to be inserted to help with getting the appropriate amount of oxygen into your lungs and into your body. And of course, that breathing tube is attached to a machine. That machine is called a ventilator. There's just, it's a finite resource. You know, it's not only, I think we're often getting a little too, there's a bit of tunnel vision here. You know, we talk about what are, how many ventilators do we have? How many ventilators do we have? But remember, every ventilator is attached to a human being and that human being is in an intensive care unit,

that you need an intensive care unit bed, you need an intensive care unit physician, you need an intensive care unit nurse, you need an intensive care unit physiotherapist, occupational therapist, pharmacist, like there's a whole team of very specialized, highly trained individuals that look after people in an intensive care unit. This is a finite resource. And it's not just a number game of how many ventilators we have. It's also do we have the human capacity as well? So these are all important questions that need to be addressed. When you look at our healthcare system, how would you compare it to other countries like France, for example, who is struggling right now and generally thought to be way ahead of us in terms

of quality? Yeah, I mean, I think our healthcare system is fairly robust. And of course, there's always this situation in Canada where we look at our healthcare system, and we look at other healthcare systems, we like to compare as ours better, as ours worse, as are the same, and how are we doing? I mean, one of the comparisons I've been making is to our closest neighbor to the south. It's fractionated. There's significant barriers to accessing care. Diagnostic tests have still not been rolled out widely. You know, it's turning into, unfortunately, a situation where certain local health care systems are starting to get overwhelmed. And, you know, that's extremely unfortunate. So, you know, I fully admit that our health care

system is far from perfect, but it's still really, really good. And I think that Canada, when we step back and we're sitting and talking about this two years from now and thinking about how we fared throughout this COVID-19 pandemic, I think Canada is going to fare better than most other places because of our healthcare system. So let me ask you more about that, because according to the Organization for Economic Cooperation and Development, Canada has about half as many intensive care beds as the average developed country. And so putting aside all the measures that we're taking around social distancing in this country, what, if anything, do you think has to be done right now to deal with this? Well, you know, certainly, you know, in the midst of a pandemic with a respiratory virus that causes respiratory distress, requiring, you know, intensive care unit level care in the sickest of the sick, you would hope that there, you know, with the two months of warning that we had that

this was coming, that people would be essentially scrambling to ensure that we have the appropriate resources. And, you know, quite frankly, I'm not 100 percent clear on what our intensive care unit level capacity is in the country. And I know that this is, you know, a point of concern amongst people in the healthcare profession. Of course, you know, we all have a role to play. We all have a role to play. As citizens, we know what to do. And of course, the government, especially the provincial governments, have a role to play. And their role is, you know, look after the citizens, you know, make sure there's enough hospital beds, intensive care unit beds, ventilators, diagnostic tests. And, you know, make sure there's enough hospital beds, intensive care unit beds, ventilators, diagnostic tests. And, you know, our response to this COVID-19 pandemic is really dependent on every stakeholder fulfilling their end of the bargain.

OK, I want to sort of picking up on something you just said, I want to talk to you about another piece of research that came out this week. Initially reported by the Toronto Star's Kate Allen. This has also not been peer reviewed, but it says that these social distancing has to cycle for like 18 months on and off. And how realistic is it that we all get back to school, back to work in four weeks, in six weeks? Oh, God. You know, again, this is tough because, you know, the crystal ball is definitely not clear on this one. But I really believe that we are in this for a longer run. And, you know, I would say this is going to we're going to be facing our current experience now for a minimum of two months, like a minimum of two months. You know, unfortunately, it stings, right? This is hard. It's not easy on anyone. And I think, you know, we're only a few

days in really to having our kids home from school and working from home and not going out to restaurants and bars. And like, this is significantly impacting all of our lives in Canada. We realize this isn't easy. The other interesting thing is, you know, if we look at China right now, you know, China is really about three months into this, maybe three and a half months into this. And they're already starting to lift their restrictions. Right. They've had the fewest cases in China than they've had throughout this entire three month ordeal. And in fact, some days in China, they have more cases imported from outside of China as they do acquired in China. And I think it was today or yesterday where they had zero reported cases. So, you know, that's a three-month marathon that they've run. Okay. Isaac, thank you so much, as always.

Anytime. Happy to chat. In the Dragon's Den, a simple pitch can lead to a life-changing connection. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Okay, so that's all for tonight. Stay tuned for tomorrow.

We're doing something a little bit different. We've got an episode celebrating all the good and weird and ingenious things we're seeing during this outbreak. I'm Jamie Poisson. Thanks so much for listening and talk to you soon.