The missing human connection is one of the things Jonathan Lee finds hardest about working as a paramedic during COVID-19.
Conversations with family members about their sick loved ones used to take place quietly and gently inside hospitals. Now, Lee gets flagged down in parking lots, frantic family members wondering, “Hey, are you going to pick up my mom? Are you the one who’s going to pick up my wife?” asking him to pass on deeply personal messages: “They told me that they were waiting for you to get here and then they were going to intubate her. I just really need you to tell her that I love her before she gets intubated.”
A critical care paramedic for more than 20 years with Ornge, Ontario’s air ambulance and medical transport service, his job is to transfer COVID patients between hospitals to make room in intensive care units. Nearly all of them are sedated and on a ventilator. It’s not easy.
“These patients are super sick, and they’re sitting in a hundred-thousand-dollar hospital bed with a hundred-thousand-dollar ventilator and all of the staff around them, and a lot of those patients with all of those resources are barely holding on,” Lee said.
“Now you are asking me to put that patient just with me in the back of an ambulance.”
Ornge transported a record 327 patients in the first two weeks of April to create space in ICUs as hospitals struggle to withstand a crushing third wave with record infections and hospitalizations. As of Friday, 701 COVID-19 patients are in Ontario ICUs, up 51 per cent in the last two weeks, with hospitals rapidly making space for more by adding field hospitals and tents and accommodating adults in pediatric facilities.
Premier Doug Ford announced provincial border restrictions and additional limits on the economy Friday as modeling predicted daily new infections could top 30,000 by the end of May without further interventions.
The province recently issued an emergency order allowing hospitals “at significant and immediate risk of becoming overwhelmed” to transfer patients without their consent to free up space in ICUs — the first time such an order has been issued in the pandemic.
The vast majority of patients are sent from overburdened hospitals in the Greater Toronto and Hamilton Area (GTHA), and while most people are transferred to hospitals within the area, as ICUs fill up more and more patients are being sent to cities as far as Kingston and London. Data from Ornge shows outside of the GTHA, 42 patients have been transferred to Barrie, 39 to Peterborough, 35 to Kingston, 33 to London, 14 to Kitchener, 12 to St Catharine’s and six to Orillia.
All hospitals requesting transfers are located within the GTHA, except for Thunder Bay Regional Health Sciences Centre which has transferred nine patients. (Ornge does not provide data on hospitals with fewer than five transfers for privacy reasons.)
Renate Isle, vice-president of patient care at Kingston Health Sciences Centre, which encompasses Hotel Dieu Hospital, Kingston General Hospital and the Cancer Centre of Southeastern Ontario, said patient transfers from Toronto have ramped up considerably in the past two or three weeks as COVID-19 numbers have risen across the province.
As of Friday, Kingston’s ICU was sitting at about 80 per cent capacity with 20 of its 95 critical care beds filled by COVID-19 patients from the GTA, though numbers change every day, Isle said. Kingston General also sends patients to neighbouring Brockville and Belleville to manage capacity.
Kingston has been able to maintain relatively low COVID-19 rates throughout the pandemic, but recently, the city has been experiencing rising infections and just saw its second COVID-19 death. On April 8, Kingston Public Health declared a COVID-19 outbreak in the University District associated with Queen’s University, on the same day hundreds of young people gathered at Kingston’s Breakwater Park, prompting the city to temporarily close the park to the public.
“We’ve got more people on ventilators than we’ve ever had in the past,” said Dr. John Drover, ICU physician at Kingston General and physician lead for critical care in Southeastern Ontario.
While there has been a handful of acute patients coming to the hospital, Drover says the majority are critically ill COVID-19 patients on ventilators, who stay for an average of about 13 days.
Many of the Kingston doctors and nurses caring for Toronto COVID-19 patients aren’t fully vaccinated. Because of Kingston’s low infection rates, health workers there weren’t prioritized for a second shot, Drover said, and while a single dose of Moderna or Pfizer is said to be 80 per cent effective against symptomatic COVID-19, there’s still a chance of getting sick.
As Kingston’s local cases rise, Isle said she’s always looking ahead to make sure she has space for the next 10 ICU patients.
“As long as I’ve got that plan for the next 10, then I know that if our local situation suddenly deteriorates that we would be able to take care of them.”
Often patients who are intubated are the easiest to transfer, Isle said, since the ventilator keeps them stable. But with critical care patients, conditions can change quickly and that often means Lee has to act as “the last line of defence.”
“Those decisions to weed out the really sick ones are made long before it gets to me but sometimes those conversations have to be (had). Like, it’s, I don’t feel comfortable moving this patient. This patient is too sick to move. That’s happened a couple of times.”
Rosemary, who asked to use just her first name to protect her family’s privacy, said “there was no option” for her uncle when he was told he would be transferred from the Scarborough hospital where he was being treated for COVID-19 to Kingston. While she immediately felt worried, doctors assured her that her uncle was in stable enough condition to travel, and the hospital needed the ICU space.
Rosemary’s uncle is now recovering at Kingston General, and he’s been well enough for Zoom video calls with his family.
“For him to be able to wave on the camera at his children, seeing him, his eyes are open, you can at least have a bit of relief,” she said.