It’s likely too late for Ontario to avoid the milestone of 150 COVID patients in ICU. What does that mean for hospitals?

On Friday, the province took hasty steps to try to avoid the grim scenarios projected by new modelling, including a daily case count in Ontario that could hit 6,500 by mid-December.

But when it comes to ICU capacity, the province’s latest measures are already too late to avert a worrisome milestone, experts say: 150 COVID patients in critical care, a threshold that would necessitate the cancellation of elective surgeries and other life-saving procedures.

“Even in our best-case scenario, we will exceed the 150-patient threshold,” said Dr. Michael Warner, medical director of critical care at Michael Garron Hospital. “By definition, this will lead to limitations in access to the ICU for non-COVID-related care, and that has real consequences for people in terms of missed treatments, further illness, and potentially death.”

On Friday, Premier Doug Ford and Health Minister Christine Elliott announced that the province would be tightening restrictions for several jurisdictions across the province and lowering thresholds in its controversial COVID-19 “framework” for imposing control measures.

The move comes after the province was criticized for rejecting advice from its own public health agency, and dire new projections presented on Thursday by expert disease modellers.

Hospitals are now bracing for what many predict will be a rough road ahead. While the number of COVID hospitalizations across Ontario is still low, it has grown by 61 per cent over the past three weeks alone, Adalsteinn Brown, co-chair of Ontario’s COVID-19 Science Advisory Table, said in a press conference Thursday.

For ICU capacity, his group projected that the province could see 150 critical care beds filled in two or three weeks, a milestone that would require hospitals to cancel procedures like cancer surgeries and neurosurgeries. That’s an outcome that Anthony Dale, CEO and president of the Ontario Hospital Association, described as “a horrifying scenario that looks like it’s about to become real.”

Within roughly six weeks, almost every modelling scenario pointed to “well over 200 ICU beds being occupied,” according to Brown. And under the worst-case scenario presented on Thursday, Ontario will see close to 450 patients with COVID-19 in critical care units by mid-December.

These projections were made before the province announced its new measures Friday, however. With the added restrictions now in place, it’s no longer clear if the worst-case scenarios are still plausible in the same timeframe, said Beate Sander, co-chair of the Ontario COVID-19 Modelling Consensus Table and a scientist with the University Health Network.

But this latest round of restrictions has likely come too late to avert the milestone of 150 ICU patients by late November or early December, she said. This is because interventions take time to kick in and it would be roughly three weeks before they start having an impact on ICU occupancy levels, she said.

As of Friday, critical care units across the province were already treating 110 COVID patients, according to a daily report by Critical Care Services Ontario.

Most hospitals still have relatively low numbers in their ICUs but those in hotspot areas are already feeling the strain. At Scarborough Health Network, there are already 22 COVID patients in ICU across three hospital sites, according to the CCSO report — accounting for 20 per cent of the province’s total.

This mirrors the hospital network’s experience from the early part of the first wave, when it was also caring for roughly one-fifth of the province’s total number of COVID patients in critical care, said ICU chief Dr. Martin Betts in an interview late last month.

And at Humber River Hospital, which serves the city’s hard-hit northwest corner, Dr. Jamie Spiegelman said the latest COVID projections are unsurprising “based on what we’re seeing in the hospital.”

“Every day at our hospital, we’re admitting anywhere between five to 10 people with COVID-19,” said Spiegelman, an internal medicine physician and critical care specialist. “And out of those, one or two come to ICU, either requiring higher oxygen requirements or intubation. So that’s the general trend we’re seeing right now.”

When the province’s load of critical COVID patients hits the 150 mark, hospitals will have to start turning off other services, like cancer surgeries and other advanced surgeries that might see patients winding up in critical care, said Kevin Smith, CEO and president of the University Health Network.

This will mostly impact the large acute-care hospitals, he said. But with that kind of demand on these hospitals, it would mean offloading complex patients into smaller hospitals, which may already be operating at full capacity themselves.

Smith says, however, that the worst-case scenarios recently projected are “not Armaggedon” — Ontario has an ICU capacity of 2,000 beds, so there’s still room to scale up. He said the province’s plans were also crafted to accommodate the hellish scenarios seen in hospitals around the world back in March, which never materialized in Ontario and are still not expected, even in the second wave.

But Smith’s biggest concern under the model’s worst-case scenarios is that there won’t be enough health workers to staff ICU wards and other programs providing complex care.

At UHN, there are currently 220 to 250 nursing vacancies, and some 125 frontline health workers are currently unable to work, perhaps because they’re symptomatic and awaiting for a COVID test result or self-isolating as a close contact of a confirmed case, Smith said.

If Ontario reaches a point of seeing 6,500 new cases a day, “providers will be a component of that,” he said.

“One of the highest-risk groups of infection are health-care providers, and so will we have people available to provide care if they’re getting sick at the same rate?” he said. “Frankly, the big discussion is health-care human resources much more than beds.”

For many health workers, the reality of a coming second-wave hospital surge is difficult to take in. Like everyone else, health workers are suffering from COVID fatigue but they’re also feeling “disappointed and distraught that the necessary steps weren’t taken” to avoid the scenarios now being projected for their hospitals, Warner said.

“The novelty of having to battle this very challenging disease has worn off and we’re left with the scars” from wave one, he said. “People really suffer by watching their loved ones dying on Zoom, and that’s what’s going to happen in the next couple of months.

“The fear of not being able to save people because they can’t treat COVID — I think that’s gone,” he continued, adding that doctors now have a much clearer understanding of what to do when a COVID patient lands in ICU.

“But the fear of being the only person to hold a patient’s hand while they’re dying, while their family watches on an iPad, you never get over that. And to know that’s in our future is difficult and dispiriting.”

Jennifer Yang is a Toronto-based health reporter for the Star. Follow her on Twitter: