COVID-19 rapid response report on healthcare resources
Author: NB-IRDT
Posted on Apr 21, 2020
Category: Health
Does having dedicated resources – spaces and services – for COVID-19 effectively control the spread, decrease the severity, and mitigate the cost of the disease in terms of costs to health care, societal disruption, health outcomes and lives lost?
The NB-IRDT Team examined evidence for the separation of healthcare resources during pandemic medical management to prevent overlap and exposure between point sources of care and health personnel. The Team looked at current evidence for both physical separation (separate structures for dedicated COVID care) as well as strategies to create separation within existing structures.
Countries further ahead in the spread of COVID-19 have begun to recommend dedicated health care resources for COVID patients – especially in the form of facilities and personnel. In Italy, for instance, the vice-premier of Lombardy recently announced that sending COVID-19 patients into hospitals alongside uninfected patients was “the biggest mistake” they made. He recommended setting up separate, COVID-exclusive structures as an alternative.
In Canada, similar realizations are starting to emerge, with epidemiologists suggesting British Columbia’s measures to prevent health care workers from working at multiple sites from March 26 onwardii may have played a key role in ‘flattening the curve’ in the province, while other provinces continue to see surging numbers.
In Ontario, where the case rate continues to grow, separation measures were enacted much later than in BC. For example, isolation measures separating infected residents from healthy residents at Pinecrest Nursing Home in Bobcaygeon were only implemented on April 3, after 16 residents had died from the virus – a number which rose to 26 by April 7. Previously, many residents were only separated from one another by a curtain.
New Brunswick (NB) began to introduce measures to separate resources even prior to announcing a state of emergency on March 19, 2020:
- ALC patients were actively moved to available care homes to create more space in hospitals.
- NB also put measures in place to keep COVID-19 out of doctors’ offices and hospital waiting rooms, including virtual appointments with family doctors;
- Symptomatic individuals were instructed early on to call 811 for a triage and to arrange an appointment at one of the Regional Health Authorities’ COVID-19 Assessment Centres;
- Patients with extreme symptoms were advised to call ahead to emergency departments so that personnel could prepare for their arrival.
However, if cases increase in the province, hospitalizations are likely to increase as well. To that end, we're reviewing health care separation measures implemented around the world and potential, or anticipated, outcomes related to theses practices.
To this end, this rapid response explores:
- Where dedicated health care facilities/separation measures are being implemented,
- How these measures have been put into practice, and
- Why countries are implementing them, including early evidence of potential outcomes.
COVID-19 projected outcomes to April 24
This rapid response report provides updated projections estimating the trajectory COVID-19 could follow in New Brunswick (NB) if the province has outcomes similar to those of countries and provinces that have to date contained infections relatively successfully.
Studying the experiences of the different locations further along in the infection outbreak helps inform how the disease could continue to progress in NB. Variables considered include COVID-19 infections, hospitalizations, critical care cases, and cases requiring mechanical ventilation. The regions considered in the most recent projection estimates include South Korea, Germany, Australia, Denmark, and British Columbia (BC) as well as Nova Scotia (NS) as our Maritime neighbour.
As background to our projections and to motivate our choice of comparison group of countries, we present data on a range of measures for NB and select countries, as well as the other Canadian provinces. Those measures include rates of infection, testing, critical care, mortality, and the number of daily new cases since preventive measures were first implemented.
We examine how NB compares to South Korea, Germany, Denmark, Australia, Canada as a whole, and the individual Canadian provinces. We also include Iceland, as it was one of the first countries to conduct testing across a random sample of its entire population.
Our key conclusion is that NB’s case levels will remain relatively low and within the health system’s capacity to provide necessary treatment to those who need it. Social distancing and related measures, tracking and quarantining of affected individuals, and NB’s population density have resulted in an incidence rate that is predicted to remain among the lowest in Canada.