Medical Leader COVID-19 Modelling Town Hall March 27 | Summary

Dr. Ben Williams, interim VP of Medicine Quality and Academic Affairs, discussed the provincial COVID-19 Critical Care and Acute Care Hospitalization Modelling presentation. The presentation was shared with the public and health professionals to demonstrate transparency during the pandemic.

The curve may be flattening in BC. Early signals show some optimism that we might be starting to see a flattening but it is important to note, every model is going to be wrong, but these are our best estimates based on the experience of other jurisdictions.

The modelling is based on the experience of other areas (South Korea, Hubei and Northern Italy) have had with COVID-19.

Island Health’s public health officials, Dr. Stanwick and all MHOs and our clinical leaders, Dr. Wood, Dr. Ahmad, and Dr. Kibsey have worked with the BCCDC models to inform our planning.  

The four scenarios in the presentation examine both critical care capacity, ventilator capacity and medical unit needs.

Scenario one (based on South Korea) is the best-case model. For Island Health this would mean 5 additional ICU patients at day 29 and 23 ventilated patients at peak.

Scenario two (based on Hubei) for Island Health would mean 27 additional ICU patients at peak and 41 ventilated patients at peak.

Scenario three (based on Northern Italy, case-based) for Island Health would mean 36 additional ICU patients at day 29 and 48 ventilated patients at peak.

Scenario four (based on Northern Italy, hospital-based) for Island Health would mean 60 additional ICU patients at day 29 and 67 ventilated patients at peak.

A large number of patients will not require ventilation. Some will choose not to, and some will not need to be ventilated. The following numbers show-estimated increases in hospitalizations.

  • South Korea: 15 additional patients at day 29 (not critical care)
  • Hubei: 95 additional patients at day 29 (not critical care)
  • Northern Italy case-based:  117 additional patients at day 29 (not critical care)
  • Northern Italy hospital-based:  456 additional patients at day 29 (not critical care)

Our data show that we are likely to experience a scenario below or at the Hubei level. Our capacity looks good across the province.

Our primary COVID-19 sites are RJH and NRGH. We will cohort COVID-19 patients in critical care at these sites to ensure patient and medical staff safety and to optimize PPE use. If BC moves to a Northern Italy scenario, we would use all sites and bed capacity off-site from hospitals for less acute medical and surgical inpatients to open up additional capacity

Island Health is using these potential scenarios regarding demand/capacity to plan for a cascading response based on demand as it emerges over the coming four to six weeks.

Our total capacity for critical care is more than 281 beds across all Island Health sites. Ventilators are the limiting factor, we have 57 available. In addition, we have ventilators that we could use. We have capacity for the worst-case scenario. An additional 120 ventilators have been ordered for BC to enhance health authority stock – with 15 having arrived and 29 more expected next week.

Under the Northern Italy hospital-based scenario, we would move non-acute patients out of hospital. Right now, we’re under 80% capacity due to cancelled elective surgeries and other measures. This gives us a significant degree of buffer. Gets us half way there. About 200 patients short still. The delay of opening the Summit LTC in Victoria provides 320 beds for non-acute patients.

We don’t know where COVID-19 will hit. Patients will likely move outside of their communities. We may also ask staff and medical staff to move between facilities. Not ideal IPC, but we have to respond.

If the modeling is correct, we believe we can manage the worst-case scenario. It won’t be without impacts, including patients who will pass away. The biggest risks to our response are people, transport and PPE - we need to make sure it’s there when we need it. Preserve and use appropriately at all times. 

We have been working for 10 weeks to prepare. Every facility has plans on where to put patients with respiratory disease. Tough decisions on stopping services to preserve our bed capacity were made to help us prepare.

Overall, our plan has been:

  • Clearing out space (now 75-80%)
  • Establish two primary sites (Work is being finalized at these primary sites – and at all acute care sites should they be required – to provide robust capacity and staffing plans by early next week)
  • HR plan finalized early next week (redeployed staff, retired staff, others)
  • Enhancing primary and community monitoring (including virtual care)
  • Enhancing PPE supply and sustaining existing supply.

The basic three critical things remain and apply to all of us; wash your hands, maintain physical distancing and stay home if you’re sick.


For children needing COVID-19 care, will they go to VGH or Children’s?

Dr. Ben Williams: We are preparing to treat COVID-19 pts in the VGH PICU. We do need a pediatric strategy.

There’s an interdependence between acute and primary care, why is the planning so hospital-centric? Dr. Ben Williams: Our Island Health primary care team have partnered with primary care physicians and it’s been tough to supply enough PPE. Virtual care is key but some patients need a physical visit.

Dr. William Cunningham: family physicians will continue working with 85% of their visits occurring virtually. The remaining visits are divided into low and high risk. Low risk will go to Victoria Assessment Clinic. The high-risk centre is being built.

What’s value of the South Korea and Hubei models if we’re not implementing as strict measures?

Dr. Ben Williams: BCCDC chose the models, BC practiced physical distancing earlier in Canada, we may get a less burden of disease but we are ready for the worst-case scenario.

What if lack of staff limits our ability to provide care?

Dr. Ben Williams: Human resource capacity is our biggest risk; we need to stay safe at work and home. Critical care teams have put together a solid plan and we need to be prepared.

We are prepared for the worst-case scenario, Italy’s death rate is 10%, US death rate is 1.5%, is it unrealistic to compare ourselves to Italy?

Dr. Ben Williams: I’m not an epidemiologist, we need to trust our experts in this field.

Kathy MacNeil: The purpose of this meeting is to share what we know, based on the best evidence we have. We are dependent on you to deliver safe care. Thank you.

Dr. Ben Williams: Island Health continues to refine plans for the models. We rely on medical leaders in each site to inform our plans, through each EOC. Tell us where the holes are and where we can do better. We’re doing our best based on expert advice. Thank you for what you do.