TORONTO (Reuters) – Younger Canadians are hit the hardest by the latest COVID-19 surge in the country, prompting a growing demand for artificial lungs and a fight to keep staff in critical care units while hospitals They make desperate efforts to save patients.
Treatment with artificial lungs, known as extracorporeal membrane oxygenation, or ECMO, is much more likely to be implemented in patients under 65, explained Marcelo Cypel, surgical director of the extracorporeal life support program of the University Health Network Toronto (UHN).
Last week, there was a record 19 ECMO patients at UHN, 17 of them with severe COVID-19. When the lungs of the sickest COVID-19 patients fill with fluid and mechanical ventilators can no longer do the job, artificial lungs can save lives.
By Monday, doctors had removed some of the machines and it had been reduced to 14 patients with ECMO, 12 of them with COVID-19.
The need for these artificial lungs reflects a change in Canada’s epidemic, which has worsened, with new cases and outbreaks in workplaces and schools.
With many older people vaccinated and new, much more contagious coronavirus variants circulating widely, younger patients are increasingly coming to intensive care.
“It’s very different now than the first wave, when we saw older people with comorbidities,” Cypel said. “We are seeing more … young essential workers.”
The ECMO situation is under control for now, but things can change very quickly, Cypel warned.
When hospital systems in other countries were overwhelmed, they had to stop using ECMO because it requires a lot of staff – seven or more people to start treatment.
About 55% of people who receive the therapy survive, Cypel said. However, they are often left with “severe physical limitations” due to their prolonged hospital stay, he added.
Many of Canada’s provinces are experiencing a worsening third wave of COVID-19 as they struggle to accelerate vaccine launches. The country reported more than 6,200 new cases on Monday, with a percentage of people testing positive for the virus as high as 3.8%.
In British Columbia, where hospitals are bracing for a surge in demand for intensive care unit (ICU) beds caused by the highly worrisome variant of the P.1 virus, first discovered in Brazil, and now devastating, St. Paul’s Hospital intensive care physician Del Dorscheid is more concerned with staffing than the use of artificial lungs.
On any given shift, he said, a third of the staff work overtime.
“They are working very hard to find bodies to fill those empty spaces,” he said. “I wouldn’t say that we are seeing more mistakes. Anyway, not yet. But we are certainly seeing burnout. “
For ICUs, no end is in sight. As of Tuesday, there were 497 COVID-19 patients in Ontario ICUs, a new record. Last week, experts advising the provincial government said it could rise to 800 by the end of April even with a new stay-at-home order, or approach 1,000 without it. The province did not come to a new order to stay home.
New restrictions implemented in Ontario last week change little for the worst affected areas. In Toronto, courtyards for outdoor bars and restaurants were closed and a plan to reopen salons was shelved. On Monday, Peel, west of Toronto, moved on his own to suspend face-to-face classes at schools for two weeks.
Canada’s vaccination rate has recovered after a slow start, with 15% of the population receiving at least one injection. But data from the Institute of Clinical Evaluation Sciences shows that Ontario communities most at risk of COVID-19 transmission also have the lowest vaccination rates.
These communities tend to have a high proportion of residents who are unable to work from home, many of them non-white immigrants who have jobs at high risk of exposure to the virus.
Some lack cars to go to vaccination sites or paid time off to get vaccinated, said Brampton doctor Amanpreet Brar. Some of the worst-hit neighborhoods lack pharmacies that dispense COVID-19 vaccines.
“It really reflects the systemic inequalities that we see in our society,” Brar said. “They are considered non-essential, while their work is considered essential.”
Edited by Denny Thomas and Bill Berkrot