I want to shed some light on why we are up in arms about our ICU numbers. The ICU is basically the backstop of a hospital, where the sickest patients go to get 'intensive' therapy to get stabilized and hopefully discharged home or to rehabilitation facilities.
This is where incredible resources, expertise and equipment are used to do what would have been impossible even 20 years ago. Beds are scarce as a result. The CCU is a similar unit but meant for heart attack and other cardiac patients. Staff are full time 1:1 and highly trained
This is the situation now in Ontario. Roughly half of ICU beds are occupied by Covid patients, surgeries are getting cancelled, and the wards are filling up. In Toronto, most of the ICUs are already full with Covid and other patients.
This is us in a few weeks; ICU patients will be moved to the CCU, into the PACU to use monitoring equipment there, even the OR. New staff will have to be drafted in, but won't have the training to work effectively. The ER will fill up, and there'll be no space to see anyone.
This is Brazil now, every possible space in the hospital is being used to keep Covid patients alive. Ambulances can't leave new patients, and anyone with any other problem, be it broken bones, appendix rupture, cancer, is out of luck. This is what we are fighting to avoid.
We are all dreading the day when we have to start picking and choosing who gets ICU level care or not. Criteria are controversial, and currently based on determining who has the strongest chance of surviving to the next 12 months.
tvo.org/video/is-ontar…
Here is a possible scenario in a couple of weeks: You have one ICU bed left. Which patient gets it?
Now you have some idea of why we, as frontline ER and critical care physicians, are dreading the next few weeks...

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More from @KashPrime

4 Apr
Rapid tests need to be used ASAP to get workplace outbreaks under control. Many are sitting unused in warehouses across the country. You can combine the rapid strips (like the Abbott Panbio) with much more accurate molecular tests onsite to recheck positive results (Abbott IDNOW) Image
These were used in Nova Scotia to get their outbreaks under control. @michaelmina_lab has been a tireless advocate of these tests, and they can now be accessed in the US without prescription. Businesses and individuals can't easily get them in Canada.
One possible success story in Canada is Manitoba, which has been using rapid molecular testing in its schools since January.
gov.mb.ca/covid19/testin…
Read 7 tweets
4 Apr
We are facing a reckoning in Canada, a highly contagious, deadly variant is firmly rooted in BC and spreading eastwards. We were shocked when UK variant Covid starting targeting young people, this will make it much worse. We need action now!
What's happened to the Vancouver Canucks is just the beginning. More young people will get very sick until we take decisive action to contain this threat.
We need to address these underlying issues with at-risk populations. These measures will protect all of us:
Read 8 tweets
2 Apr
Let's go over some simple reasons why this new 'lockdown' won't work and what we can do about it:

Essential workers 30s-50s are the bulk of new ICU admissions. There's been no change in working conditions to protect them from an airborne virus. They are at huge risk right now
1) This virus is airborne, like SARS1 before it. That's why these new variants are more contagious. Distancing won't cut it, being in closed, poorly ventilated spaces is hugely dangerous. As @AndrewChangCBC describes, we need to up our game on masks:
2) Wear a better mask, like a tightly fitting N95 or equivalent. All workers should be provided with these now. Wear one to your grocery run, or switch to pickup or delivery if you can't. They are plentiful now.

Here's a list of Canadian suppliers:
docs.google.com/document/d/1ma…
Read 10 tweets
31 Mar
We are facing our 3rd lockdown in parts of Canada. It sucks, could have been prevented, but here we are. How can we make sure this is the last time this happens? With vaccines and summer weather coming, we have a golden opportunity to eliminate Covid completely...
We should adopt common sense measures used by Nova Scotia, Newfoundland, Australia etc. to hammer case numbers down. Life in these places is mostly normal, with brief lockdowns whenever an outbreak happens. Schools are safe, businesses are thriving, and no one is dying
Why is it important to do this? Although most adults will be vaccinated, children will be left unprotected. Most don't get seriously ill with Covid, but they can get disabling long-term symptoms. No one knows for how long, but can we take that risk with 10% of all children?
Read 10 tweets
30 Mar
Canada is having its wave ahead of America... something we haven't seen before. Usually we benefit from 2-4 weeks of warning from the US, now roles are reversed: we're the under performers, the canaries in the coal mine. h/t @jkwan_md for the figures.
And we we're the first in North America to see the new variants absolutely ravage younger and younger people:
And we are steadily seeing our ICU system fill up. We have far fewer critical care beds per capita than in the US
Read 4 tweets
21 Mar
This is thread of cases to get the point across that variant Covid is brutalizing young people. Please post your own cases in the replies.

35 year old teacher with no medical problems got severe Covid from a student. 65% sat on room air, went straight to our ICU. UK variant.
A colleague's case, 30 year old man admitted with Crohn's flare, deteriorated over night, required high flow oxygen and is now in the ICU
Read 8 tweets

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