York Region is the coronavirus hot spot in Ontario, health officials say

'Hold fast' on COVID-19 fight; officials see light at end of tunnel

Yorkregion.com
April 8, 2020
Kim Zarzour 

Region’s diverse population played a role, as early COVID-19 cases were linked to travel to Italy, Iran and China, countries with close connections to area residents, said Altaf Stationwala, president and CEO of Mackenzie Health. - Alexandra Heck/Torstar

York Region is the Ontario hot spot for COVID-19 infections and hospitals are preparing for the peak later this month -- but there is a glimmer of hope on the horizon.

The three area hospitals -- Mackenzie Health, Markham Stouffville and Southlake -- all report higher intensive care unit occupancy rates for coronavirus than other areas of the province.

At the same time, the region’s medical officer of health is reporting the first local signs of “flattening the curve.”

“I am cautiously optimistic that we may actually be reaching the peak, or the plateau, in York Region, so that’s great news,” Dr. Karim Kurji said in a video released Monday, April 6.

But Kurji said there are pockets of concern.

Vaughan, Richmond Hill and Newmarket have higher trajectories, plus there are outbreaks at four long-term care homes, group homes and clusters at grocery stores and gyms -- and he warns residents not to let their guard down.

The region has three assessment centres that have loosened their criteria for testing. Kurji encouraged anyone with COVID-like symptoms to visit the region's website, york.ca, to find out how to be assessed in order to put “rings” around all cases and contacts.

“Every case we prevent also prevents 60 to 100 cases down the road.”

Community spread of COVID-19 began earlier -- and lasted longer -- in York Region than anywhere else in the province, local hospital officials said.

“We don’t know why this area is so hard hit,” said Southlake’s president and CEO Arden Krystal. “Toronto is starting to get more, but they have more capacity. Central East area of Oshawa has a high number of cases, too.”

Altaf Stationwala, president and CEO of Mackenzie Health, said the region’s population diversity played a role, as the first cases of coronavirus were linked to travel. Early hot spots were Iran, China and Italy, which have close connections for many area residents.

“The subsequent community spread led to increased volume in assessment, admissions and ICU cases,” he added.

Mackenzie Health was the epicentre for the SARS outbreak .nd the biggest lesson learned from that experience, Stationwala said, was the importance of staying vigilant.

“We must never let down our guard.”

SARS came in two waves; the first wave was milder and people relaxed, and the second wave hit much harder, he said.

We might appear to be recovering in a couple of weeks, but he warned the community must hold fast. He stressed the importance of staying committed to public health directives, hand hygiene and physical distancing so we don’t get knocked down a second time.

Arden agreed, saying this virus is unique.

“What happens is people may stay at home because it’s a mild case, and then when it gets bad, it gets bad quickly and they can end up going directly to ICU.

“This is why I can’t reiterate enough that the public needs to follow the (public health) directives and stay home, wash your hands, do the proper distancing.”

Krystal said hospitals are opting not to test all staff because it could bring an inaccurate number of negatives.

When you are asymptomatic, you won’t show positive test results unless it’s 24 hours before symptoms appear -- but you could still be transmitting the virus. This would bring a false sense of security, she said.

Hospital staff monitor their health diligently, some taking their temperature twice daily, she said, and if they show any respiratory symptoms -- even if they’re not typically COVID-like -- they are tested.

Stationwala and Krystal both say they’ve been impressed with what they’ve seen in their hospitals and in their communities.

“I want to give a shout-out to staff,” Krystal said. “We are experiencing the lowest number of sick calls than we’ve ever had … Not just doctors and nurses, but also respiratory therapists, housekeepers, food services, many people behind the scenes are showing how dedicated, they are. They know they are needed to help other people and help their team … It’s just an amazing show of team work. Our community should be very very proud.”

“We have been overwhelmed by support from the community,” Stationwala added. “From notes of support, to gifts, food donations and offerings of PPE (personal protective equipment), and the Saturday motorcade -- I had to make sure no one could see me crying. To watch the first responders and then the community drive by … Sometimes we forget what we mean to the community.”

If the community really wants to show it support, he added, they can do so by adhering to what our leaders say, from Premier Doug Ford, to local health departments and municipal politicians, and stay vigilant to fight the virus.

As the region's medical officer of health said, “it's all in your hands -- literally.”

IS YOUR HOSPITAL READY?

There are local reports of a decline in the volume of patients visiting assessment centres in York Region, but hospitals are expecting their numbers to go up before they go down.

Projections show demand for COVID-19 care at York Region hospitals should peak during the week of April 24.

Here's how your local hospital is preparing:

SOUTHLAKE REGIONAL HEALTH CENTRE

The Newmarket hospital has three different ICUs, with a total of 33 beds.

As of April 6, the hospital had five COVID-19 patients being cared for in the inpatient unit -- patients sick enough to require hospitals, but not sick enough for ICU and ventilators.

Seven inpatients were under investigation for COVID-19.

Ten confirmed COVID-19 patients were in intensive care.

Typically, people in ICU stay on ventilators for five days, but with COVID-19, it’s usually three weeks. CEO Arden Krystal said in an interview with YorkRegion.com.

This is the biggest concern about capacity, Krystal noted.

Southlake’s projections show peak ventilation activity occurring April 30, when they will require 66 ventilators. The hospital currently has 77 ventilators, so if everything goes well, Southlake should be equipped.

However, staffing is another issue, she added.

“We have to really stretch staff, essentially doubling our capacity.”

Southlake is conducting skill upgrades, training nurses and physicians so that they can work as a team with seasoned staff.

To accommodate critical patients, Southlake can move ventilators to other beds to set up satellite ICUs. Several weeks ago, the hospital ordered two medical field tents with 15 beds each, Krystal said.

The tents will be erected in the east parking lot, where they will have power hook up for HVAC capacity and the ability to have negative pressure areas if needed. But because of the higher technical needs of ICU, it’s expected the tents will house lower acuity patients.

The tents will be erected and ready to go next week, she said. “We believe it’s better to be more prepared than less.”

MARKHAM STOUFFVILLE HOSPITAL

As of April 6, the Markham hospital had 18 admitted COVID-19 patients, along with five suspected cases with test results pending.

“We’re working closely with other hospitals across the Toronto region to manage capacity as a group, and we have the ability to transfer patients to other hospitals to preserve capacity,” said hospital spokesperson Rebecca Mackenzie.

“Because we started surge planning early, we are able to manage well for the time being.”

Like other hospitals, Markham Stouffville reduced clinic activity to urgent needs, reduced surgeries to increase capacity, and turned an in-patient surgical unit into an overflow ICU.

“We have also renovated part of our emergency department and one of our outpatient clinics to accommodate negative pressure isolation.

“We continue to rely on the new Markham At Home Program and the Transitional Care Unit which are providing alternatives to hospital for frail, elderly patients. We have also moved some of our patients from our Markham site to our Uxbridge site.”

Next-stage planning includes looking at options to expand into the Cornell community centre, which the Markham site is attached to, building temporary structures on the hospital grounds and to consider the use of hotels in the area.

Local businesses with medical grade units or buildings have offered their spaces and will be considered as needed, she said.

MACKENZIE HEALTH

As of April 6, the Richmond Hill hospital has nine COVID-19 patients in ICU, with one patient being tested for COVID-19 in ICU.

The hospital has 31 ventilators for an expected maximum capacity of 45 beds.

Hospital spokesperson Christina Cindric said Mackenzie Health is looking to access the provincial ventilator stockpile.

The hospital has reduced non-emergent clinical activity in the hospital, including postponing some elective and surgical procedures, in an effort to build capacity for acute care and critical care beds.

A dedicated COVID-19 in-patient unit helps keep the clinical team safe, minimizes pressure in the emergency department and in-patient areas and decreases demand on supplies by reserving key materials for COVID-19 patients, she said.

In addition to redeploying staff, the hospital is preparing contingency plans to address situations where physicians may need to self-isolate; this includes using specialists with similar skill sets to step in when needed.

There are plans being developed to expand critical care space as well.

Stationwala said Mackenzie has the ability to create 160 bed spaces and has the option to erect a tent as well as use the school across the street, all part of the hospital’s pandemic surge plan.

As well, he says Mackenzie Health is part of the Critical Care Command Table -- a group working to co-ordinate GTA hospitals to alleviate those who are experiencing strain.

For the first time, last week, Mackenzie Health made use of that option and three patients in ICU were transferred to other Toronto hospitals.

“It worked perfectly …. It’s times like these we pull together,” he said. “We’ve been coping and I’m incredibly impressed with the collaboration I am seeing.”