Thousands of hospital beds have been freed up to prepare for a potential influx of COVID-19 patients. (File photo)

Thousands of hospital beds have been freed up to prepare for a potential influx of COVID-19 patients. (File photo)

IN DEPTH: How B.C. emptied its hospitals to prepare for COVID-19

Thousands of beds have been freed up, but patients and seniors have had to sacrifice

An ominous quiet has descended upon many of British Columbia’s hospitals.

Across the province, hospital wards that would normally be full to bursting have emptied, relatively speaking. Long-term patients have been shuffled out. Others have never shown up for their now-cancelled surgeries.

Usually, British Columbia’s hospitals operate beyond their capacity. Now, nearly 4,000 beds sit empty across the province. There are still patients, and still some noise, but they “feel empty, they feel quiet,” Health Minister Adrian Dix said on March 23.

Health workers, Dix said, “feel as if they’re anticipating something to come.” That (relative) calm is temporary, everyone knows. The storm will come. The question is just how big the storm will be, and whether the public’s social-distancing efforts will hold.

So the empty beds aren’t a source of relaxation. Instead, they are an anxiety-provoking reminder of what is to come.

But they – along with, critically, the staff one includes when writing or talking about hospital beds and capacity – are B.C.’s best weapons against the virus.

B.C.’s hospitals normally operate at around 103 per cent capacity. As of March 26, B.C. had 3,900 empty hospital beds. Seventy-three beds, as of Friday afternoon, were occupied by COVID-19 patients. That number is growing at about 19 per cent every day.

This – through preparation, hard work, sacrifice and fortune – is how the province emptied its hospitals, and prepared to fight a war against a virus.

This article is based on statements by Dix and provincial health officer Dr. Bonnie Henry, an interview earlier this month with seniors advocate Isobel Mackenzie, and information provided at a technical briefing Friday morning. Background information relies on several years of reporting on hospital capacity.

Latest COVID-19 news

RELATED: COVID-19: Here are the measures being taken at B.C. care homes

RELATED: B.C. COVID-19 contact restrictions working, Dr. Bonnie Henry says

• • • • •

Two weeks ago, the news out of Northern Italy had become increasingly dire.

On March 6, 49 people in the country had died of COVID-19. A week later, on March 13, 250 people died in a single day. On March 15, that number was 368.

Early efforts at social distancing had failed and the virus had spread rapidly. Patients numbered in the dozens, then hundreds, then thousands. COVID-19 quickly overwhelmed that region’s hospital system.

A shortage of hospital spaces and, most critically, ventilators had forced doctors to begin to make wrenching decisions about who would receive life-saving care and who would not. And so patients died – so many that morgues could no longer hold them.

Just to the south of B.C., Washington’s hospitals were also facing a significant space crunch due to COVID-19 outbreaks there.

And in B.C., hospitals were also lacking space because B.C.’s hospitals are always lacking space. For more than six years the province’s hospitals have operated over capacity. Bad flu seasons compromise treatments for dozens and leave people waiting, for days on end, in emergency rooms for admission to hospital.

When a hospital is operating over capacity, that means they have more in-patients than they have funded space for. Those patients end up in hospitals and other areas not designated for ongoing care.

A second flu would be bad. But COVID-19 isn’t the flu. It’s much, much deadlier. It kills seniors at an alarming rate, but also regularly hospitalizes, and sometimes kills, younger people for whom the flu is usually not a worry.

Any spike in patients due to the spread of COVID-19 would leave such facilities scrambling for space.

So, on March 15, health officials made one of their biggest decisions to that point as they sought to prepare for, and respond to, the spread of COVID-19.

Elective scheduled surgeries, they determined, would be stopped. While urgent scheduled surgeries, including for those with cancer, could proceed, anyone waiting for hip replacements, knee surgeries and other physical repairs would have to wait.

The surgeries are important for people to maintain or improve their standards of life, Dix acknowledged. When the COVID-19 crisis passes, the province will face a backlog of such surgeries.

But officials determined that, for now, those patients must be de-prioritized to ensure that doctors and nurses can save as many lives as possible in the continuing pandemic, whatever it looks like.

“Cancelling them to ensure we have the appropriate space in hospitals … is a necessary step. It’s a step that wasn’t taken in other jurisdictions that dealt with an influx of COVID-19 patients while their hospitals were at 100 per cent capacity. That’s not what we’re prepared to do in B.C.,” Dix said.

But it’s not one without painful consequences for many.

“We’re talking about the cancellation of thousands of surgeries,” Dix said this week.

“That tells you effectively how seriously we take the situation, how seriously we take the need to be prepared, and how difficult these decisions are not just for hospitals, and for doctors and for nurses who are not doing the work that they were born to do to restore life and movement to people who were waiting for surgeries, but for the many, many people who will be affected by this for the days and months to come.”

• • • • •

Not every patient in a B.C. hospital needs to be in a hospital. On a normal day, roughly 1,000 patients in acute-care beds are ready to be discharged but remain in hospital because they are waiting for support to be set up in their community.

Some are waiting for home care services that will allow them to return to, and keep living in, their house or apartment. Many others wait weeks for a bed to become available in a long-term care or assisted-living facility.

The province has a long-running and an as-yet-unresolved shortage of such beds and getting so-called “alternate level of care” (ALC) patients actually out of hospital has been a years-long challenge for health officials.

Keeping them in hospital costs far more than caring for them in the community, but health authorities have been unable to build residential care beds quickly enough to significantly reduce their numbers.

The COVID-19 crisis has shown that there is some room to get such people out of hospital.

Dix has spoken of the “decanting” of such patients to places outside hospital.

The province hasn’t provided many specifics about how many ALC patients have gone to what type of facility or housing type. But while there has been some suggestion that hotels and motels could be used as temporary landing spots, seniors advocate Isobel Mackenzie suggested earlier this month that the province would likely first look to private care residences.

The province and its health authorities maintain a public residential care system that runs parallel to, and sometimes crosses paths with, a private system. The province already funds large numbers of beds in private facilities.

The COVID-19 crisis has likely seen the province dramatically increase the number of such beds it pays for in private facilities. Cost and ideology, which may normally discourage an NDP-led province from effectively privatizing residential care, will be less of a factor than the urgency of the matter and the need to avoid an Italy (or New York) space crunch.

The province has also recently designated Summit at Quadra Village as a hospital. That 320-unit facility had been slated to replace two aging Victoria-area care homes.

But instead of residents being transferred from the old facilities to the new ones, ALC hospital patients from around the region are being moved into the Summit. That, in turn, will free up hundreds of hospital beds in the region.

But seniors who had anticipated a move into a more modern facility next month are now stuck in facilities that officials have declared to be “no longer suitable for residential care.”

• • • • •

Then there are more than 1,200 new hospital beds that have been created more or less out of thin air. Dix has spoken about about 1,200 “surge” capacity beds that have been brought online.

There are few details about what, exactly, these beds look like, but they likely include the formalization of many unfunded-but-often-occupied beds and locations that hospitals normally turn to when they are over capacity.

Formalizing and declaring those beds to be available and open for use will allow for better planning and co-ordination across hospitals.

Concerns abound over supplies of personal protective equipment for hospital workers, as well as the potential for COVID-19 to spread within hospitals. A key way to reduce demand for face masks – and to decrease the potential for the spread of the virus within a hospital – is to separate COVID-19 patients from those who don’t have the virus.

That can allow a health-care worker treating someone with COVID-19 to keep a single mask on throughout his or her shift. That both preserves the supply of protective gear, while decreasing the chance that a health-care worker would infect themselves when they touch their face to remove or apply a new mask.

But these and other plans to “cohort” patients together require both flexibility and clarity in the location and number of hospital beds across the system. Identifying “surge” beds will also allow officials to determine just how close they are to genuinely running out of space in the 17 largest hospitals that have been designated as primary COVID-19 locations.

• • • • •

There’s another big component at play: luck.

Because British Columbia wasn’t so unfortunate as to be one of the first locations to see the virus spread rapidly, officials here have been able to learn lessons from the tragedies that have occurred in those locations that have seen COVID-19 kill hundreds each day.

The danger posed by the virus, both to individuals and to entire health-care systems, is now proven. But Henry has spoken repeatedly about how officials in B.C. have been able to look at how the virus has progressed elsewhere.

And that data has played a key role in determining how the province proceeds – and whether it thinks its efforts are working.

The increased capacity in hospitals is just one slice of that, but like other orders and directives, it’s an element that has had significant negative consequences on thousands of people.

In the best of times, British Columbia’s hospitals – and long-term care homes – face a space crunch and pressures that ends up leaving some patients feeling as if they are being rushed out the door or that their care isn’t sufficiently prioritized.

Every one of those challenges has been upped by the arrival of COVID-19.

Everyone who needs a hip or knee surgery will have to wait longer for the freedom that those repairs can give. Seniors are being sent to care homes far from their loved ones. Others must remain longer than anticipated in substandard spaces. And the bar to be admitted to hospital will also inevitably rise.

But, Dix and Henry have said, these measures should provide enough bed capacity for British Columbia to deal with a very serious COVID-19 epidemic that would normally overwhelm the province’s hospital system.

The public’s co-operation and continued efforts to practise social distancing are critical in those efforts, Dix said. Should those efforts fail – and should the public slacken in their efforts to flatten the curve – health officials would need to shuffle patients from region to region to deal with outbreaks.

As it stands, though, they say the hospitals should hold – as long as the public’s determination doesn’t waver.

“We are absolutely determined to prepare for the worst even as everyone works their guts out to ensure that the best scenarios emerge,” Dix said. “We need everyone to be all in now, 100 per cent all in now, every day. That’s how we are true to our families, the ones we love, to health-care workers.”

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Photo: Carl Heyerdahl on Unsplash
Kootenay angler winner

Grand prize draw to be held in June 2021

Every year on Dec. 6, Canada observes National Day of Remembrance and Action on Violence Against Women. The day commemorates the anniversary of the École Polytechnique massacre in 1989. To recognize this day, the City of Trail lights the bridge red. Photo: Trail Times
Trail advocates call attention to violence against women

“The 16 Days are an opportunity to unite with others,” saya Ann Godderis.

Crews retrieved the overturned commercial truck from the crash scene on Friday, Nov. 20. Photo: Betsy Kline
UPDATE: Kootenay woman dies in Genelle collision

The incident occurred Thursday, Nov. 19.

A man wearing a face mask to help curb the spread of COVID-19 walks in downtown Vancouver, B.C., Sunday, Nov. 22, 2020. The use of masks is mandatory in indoor public and retail spaces in the province. THE CANADIAN PRESS/Darryl Dyck
104 new COVID-19 cases in Interior Health

IH is reporting the new numbers since Friday, Nov. 20

Trail RCMP seized illicit drugs, cash and a weapon following a traffic stop in West Trail on Nov. 18. Photo: Trail RCMP
West Kootenay man, woman face drug charges after traffic stop

Police report that three types of illicit drugs were seized as well as cash and a Taser

People wearing face masks to help curb the spread of COVID-19 cross a street in downtown Vancouver, on Sunday, November 22, 2020. The use of masks is mandatory in indoor public and retail spaces in the province. THE CANADIAN PRESS/Darryl Dyck
B.C. reports 17 COVID deaths, 1,933 new cases as hospitalizations surge over the weekend

There are 277 people in hospital, of whom 59 are in ICU or critical care

An aerial shot of Cedar Valley Lodge this past August, LNG Canada’s newest accommodation for workers at the project site in Kitimat. This is where several employees are isolating after a COVID-19 outbreak was declared last Thursday (Nov. 19). (Photo courtesy of LNG Canada)
Forty-one positive COVID-19 cases associated with the LNG Canada site outbreak in Kitimat

Thirty-four of the 41 cases remain active, according to Northern Health

7-year-old Mackenzie Hodge from Penticton sent a hand-written letter to premiere John Horgan asking if she’d be able to see her elf, Ralph under the new coronavirus restrictions. (John Horgan / Twitter)
Elf on the shelf an acceptable house guest, B.C. premier tells Penticton girl

A 7-year-old from Penticton penned a letter asking if she’d be allowed to see her elf this year

Workers arrive at the Lynn Valley Care Centre seniors home, in North Vancouver, B.C., on Saturday, March 14, 2020. It was the site of Canada’s first COVID-19 outbreak in a long-term care facility. THE CANADIAN PRESS/Darryl Dyck
Rapid tests ‘not a panacea’ for care homes, Dr. Bonnie Henry says

B.C. lacks capacity for daily tests of thousands of workers

(Delta Police Department photo)
Cannabis edibles found in Halloween bag lead B.C. police to illegal lab

Delta police arrested a man and a woman while executing a warrant at a residential property Nov. 20

A woman being arrested at a Kelowna Value Village after refusing to wear a mask on Nov. 22.(@Jules50278750/Twitter)
VIDEO: Woman arrested for refusing to wear mask at Kelowna Value Village

RCMP claims the woman was uncooperative with officers, striking them a number of times and screaming

B.C. Liberal MLA Shirley Bond questions NDP government ministers in the B.C. legislature, Feb. 19, 2020. (Hansard TV)
Cabinet veteran Shirley Bond chosen interim leader of B.C. Liberals

28-member opposition prepares for December legislature session

Motorists wait to enter a Fraser Health COVID-19 testing facility, in Surrey, B.C., on Monday, November 9, 2020. THE CANADIAN PRESS/Darryl Dyck
COVID-19: What do rising positivity rates mean for B.C.? It’s not entirely clear

Coronavirus cases are on the rise but the province has not unveiled clear thresholds for further measures

A rider carves a path on Yanks Peak Saturday, Nov. 21. Two men from Prince George went missing on the mountain the next day. One of them, Colin Jalbert, made it back after digging out his sled from four feet under the snow. The other, Mike Harbak, is still missing. Local search and rescue teams went out looking Monday, Nov. 23. (Sam Fait Photo)
‘I could still be the one out there’: Snowmobiler rescued, 1 missing on northern B.C. mountain

As Quesnel search and rescue teams search for the remaining rider, Colin Jalbert is resting at home

Most Read