A LONG explanatory 🧵 on ICU 'capacity' & 'flow' in Saskatchewan & why we need MULTIPLE interventions to avoid compromised care for ALL #SK citizens & triage.
I'm going to use an analogy of ICU capacity = bathtub. Patients = water. Health care system = house.
1/ #COVID19SK
I'm going to use an analogy of ICU capacity = bathtub. Patients = water. Health care system = house.
1/ #COVID19SK
Water is running into the bathtub. That's all the patients who need ICU care in Saskatchewan. Some have COVID, some don't. The patients have now overflowed our ICUs.
To cope, we've built walls up on our bathtub to hold more water. That's our 'surge' capacity.
2/ #COVID19SK
To cope, we've built walls up on our bathtub to hold more water. That's our 'surge' capacity.
2/ #COVID19SK
We can only build walls up on the tub so much, because there's limits on what can be done safely w/ availability of specialized staff, especially nursing & respiratory therapists (who support ventilated persons).
We've reached that limit w/ ~120 pts in #SK ICUs.
3/ #COVID19SK
We've reached that limit w/ ~120 pts in #SK ICUs.
3/ #COVID19SK
Every bathtub has a drain. In normal times, there's a predictable flow of patients in (the water tap) and out (the drain), so that the water level doesn't get too high.
The problem with COVID+ persons, is that they take a LONG time to get out of ICU.
4/ #COVID19SK
The problem with COVID+ persons, is that they take a LONG time to get out of ICU.
4/ #COVID19SK
When we have this huge surge of COVID+ persons, that means the water is running twice as fast as normal, filling the bathtub too fast.
At the same time, the drain is gummed up with debris, so the water is draining out far slower than in normal times.
5/ #COVID19SK
At the same time, the drain is gummed up with debris, so the water is draining out far slower than in normal times.
5/ #COVID19SK
Remember, we're still dealing with normal flow of non-COVID patients needing ICU care.
The drain is 'plugged' because COVID+ persons take so long to get out of ICU, unless they die.
Our ICU capacity has overflowed. Water's over the edge. The house is flooding.
6/ #COVID19SK
The drain is 'plugged' because COVID+ persons take so long to get out of ICU, unless they die.
Our ICU capacity has overflowed. Water's over the edge. The house is flooding.
6/ #COVID19SK
Let's look at our interventions.
We're transferring COVID+ patients out of our ICUs, thousands of kilometers away to Ontario. That's like taking a bucket and pulling water out of the tub.
It provides TEMPORARY relief so we can manage more patients.
7/ #COVID19SK
We're transferring COVID+ patients out of our ICUs, thousands of kilometers away to Ontario. That's like taking a bucket and pulling water out of the tub.
It provides TEMPORARY relief so we can manage more patients.
7/ #COVID19SK
Thankfully, we're getting @CanadianForces personnel likely next week.
Those additional specialized staff will allow us to build our walls on the tub a bit higher, or reinforce the walls that exist as so many of our frontline HCWs are struggling & burning out.
8/ #COVID19SK
Those additional specialized staff will allow us to build our walls on the tub a bit higher, or reinforce the walls that exist as so many of our frontline HCWs are struggling & burning out.
8/ #COVID19SK
Let's look at our tub. We can't 'unplug' the drain because we have so many COVID+ persons taking up beds, and they keep coming.
We can keep flying #SK citizens out of province to provide temporary relief, of course. Bucketing that water out of the tub helps.
9/ #COVID19SK
We can keep flying #SK citizens out of province to provide temporary relief, of course. Bucketing that water out of the tub helps.
9/ #COVID19SK
So that leaves the water taps. Throughout the majority of this 4th wave in Saskatchewan, we've left the taps running on full blast.
No public health measures till indoor masking mid-September. No private gathering restrictions. Vaccine mandates very late, etc.
10/ #COVID19SK
No public health measures till indoor masking mid-September. No private gathering restrictions. Vaccine mandates very late, etc.
10/ #COVID19SK
So the tub is overflowing, the house is flooding, and it's a complete crisis. Meanwhile, somehow, the water's still running full blast.
What our public health leaders have been calling for for weeks now, have been measures to slow the taps.
11/ #COVID19SK
What our public health leaders have been calling for for weeks now, have been measures to slow the taps.
11/ #COVID19SK
Private indoor gathering restrictions, capacity limits in public venues, distancing measures, work from home mandates, vaccine mandates... ALL of those measures help to prevent more COVID cases, and slow the water tap running into our tub.
12/ #COVID19SK
12/ #COVID19SK
We've watched as the tub has overflowed, the house
(our healthcare system) is flooding fast, and ONLY THEN called for staffing help & ICU transfers to Ontario.
But all of those measures are temporary. We can't keep flying everyone out of province forever.
13/ #COVID19SK
(our healthcare system) is flooding fast, and ONLY THEN called for staffing help & ICU transfers to Ontario.
But all of those measures are temporary. We can't keep flying everyone out of province forever.
13/ #COVID19SK
Meanwhile, the rest of Canada are watching us from their dry houses, except Alberta, who flooded a few weeks ago along with us and are picking up the pieces.
Ontario has kept tight control on their taps. They're helping us in our time of need - thank you, #ON.
14/ #COVID19SK
Ontario has kept tight control on their taps. They're helping us in our time of need - thank you, #ON.
14/ #COVID19SK
So the question that our public health & medical leaders can't answer is simple. Why, when the house is flooding, do we not turn off (or at least slow down) the taps?
The longer we wait, the more significant the damage both short- and long-term.
15/ #COVID19SK
The longer we wait, the more significant the damage both short- and long-term.
15/ #COVID19SK
FYI, monoclonal antibody therapy has no real place in this analogy. Given broken testing dynamics & the logistics required, 'early treatment' will do very little to help us in short-term.
I'd liken monoclonal therapy to a sponge, basically. A very small one.
16/ #COVID19SK
I'd liken monoclonal therapy to a sponge, basically. A very small one.
16/ #COVID19SK
Vaccinations & boosters WILL help slow the water, but only in longer-term, not RIGHT NOW.
What WILL help RIGHT NOW is private indoor gathering restrictions, capacity limits on venues, and other approaches to limit human contact, especially for those unvaccinated.
17/ #COVID19SK
What WILL help RIGHT NOW is private indoor gathering restrictions, capacity limits on venues, and other approaches to limit human contact, especially for those unvaccinated.
17/ #COVID19SK
In summary: the tub's overflowing and our house is flooding.
We're building higher walls & bucketing water out, but somehow we're NOT turning off the taps.
Put plainly, this is NON-SENSICAL. This is why the rest of Canada is looking at us and going, "For real?"
18/ #COVID19SK
We're building higher walls & bucketing water out, but somehow we're NOT turning off the taps.
Put plainly, this is NON-SENSICAL. This is why the rest of Canada is looking at us and going, "For real?"
18/ #COVID19SK
To finish this (lame) analogy, it's NOT too late to turn off the taps @SKGov. The house is still salvageable, barely.
The price of inaction is our flooded house. Wait longer, and what will be left is the flooded & unsalvageable remains of our health care system.
19/ #COVID19SK
The price of inaction is our flooded house. Wait longer, and what will be left is the flooded & unsalvageable remains of our health care system.
19/ #COVID19SK
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