COVID-19 Planning Strategy for Continuity of Health Services and Surge Capacity Healthy People, Healthy Saskatchewan The Saskatchewan Health Authority works in the spirit of truth and reconciliation, acknowledging Saskatchewan as the traditional territory of First Nations and Métis People. Situation March 20, 2020 • The SHA response to the COVID-19 pandemic is based on a strategy of contain, delay, and mitigate. • The application of public health and community measures are in full application to detect and contain to the extent possible. These results of these efforts will have a significant impact on the scale of mitigation required. • In all modelling scenarios, the COVID-19 pandemic will have a significant impact on acute care health service delivery across the province. • Demand for acute services will exceed existing capacity for hospital beds, ICU beds, ventilators as well as creating a major burden on other acute services, supports, HR, supplies, and equipment. Situation March 19, 2020 In response to this demand, exceptional measures are required to ensure success in the following areas: • Create acute care capacity to meet the clinical needs of pandemic patients. • Maintain non-pandemic related acute care services • Align capacity with epidemiological modeling of an outbreak. • Protect the physical and mental health of our allied and health care workers which will be critical to maintaining care capacity. Current Capacity Area ADC acute beds Acute 3: sub acute beds Catchment [tntal] Saskatchewan 2315.3 2452.3 133.3 Seuth East Area 234.5 42}r 453 33324 4 Seuth West Area 132.3 241 231 33235 12 Nerth East Area 252.? 233 233 133523 3 Nerth West Area 155.3 213 223 35535 2 Regina Area 331.1 532 E21 333525 3? Saskateen Area 321.3 223 343 453333 33 Athabasca Area 1.3 3 14 333 3 109 ICU Beds Province Wide Saskatchewan Health Authority Key Takeaways on Incoming Demand • Early social distancing will delay and lessen the peak of the outbreak • However, even under conservative assumptions, COVID-19 will almost certainly overwhelm the health system • There will likely be pronounced loss of life and health • Estimates over the course of the event • 30% infection rate (300,000) • Of those, 80% at home (240,000) • 15% require hospitalization (45,000) • 5% require ICU (15,000) • Fatality rate of 3-5% (9,000-15,000) Facility Planning Tool Facility number 120 Edit this 1.ralue pull facility area specific data Facilityfarea Autcr filled ADC 155.? Autcr filled Beds [acute 8: sub acute] 14E Autcr filled Typical ayailable capacity minus beds] Calculaticrn Pcrpulaticrn Autcr filled [tcrtal- in use and available] 8 Autcr filled [in use] 5 Autcr filled Ventilatcrr capacity [tcrtal minus in use] 3 Calculaticrn $6 catchment pcrpulaticrn impacted phaseO 0.000% Edit this 1.ralue based mcrdelling 9E- catchment pcrpulaticrn impacted phase 1 0.025% Edit this 1.ralue based mcrdelling $6 catchment pcrpulaticrn impacted phase 2 0.050% Edit this 1.ralue based mcrdelling ?36 catchment pcrpulaticrn impacted phase 3 0.100% Edit this 1.ralue based mcrdelling 9E- catchment pcrpulaticrn impacted phase 4 0.250% Edit this 1.ralue based mcrdelling if per case: 10 Edit this 1.ralue based mcrdelling ?36 patient managed hcrme 80% Edit this 1.ralue based mcrdelling $6 patient requiring general 15% Edit this 1.ralue based mcrdelling 9E- patienE requiring ICU admissicrn 5% Edit this 1.ralue based mcrdelling $6 ICU patienE requiring ECMO Edit this 1.ralue based mcrdelling Triggers Occupancy trigger Acute Occupancy Ac ute trigger leyel Uentilatcrr Occupancy Uentilatcrr Trigger leyel Trigger 1- ADI: Ccryid patienE 9096 capacity 90%. 111.9% 3 T496 - Trigger 2- ADC Ecryid patienE 111396 capacity 100% 113.8% 3 85% - Trigger 3- ADC Ccryid patienE 110?36 capacity 110% 115.73% 3 109% 2 Trigger 4- ADC Ccryid patients capacity 125% 119.5% 3 REHE- Anticipated demand. based the assumpticrns abcrye. in Cases :13 Hcrme treated ita I ized Ventilated ECMO PhaseO - - - - - Phase 1 1'3 13? 15 1 0.05 Phase 2 3? 3?4- 343 2 1109 Phase 3 F5 Til-E EU 11 4- 1119 Phase 4- 18? 1.359 154] 23 El 114-? Mission Statement Continuity of Health Services and Surge Capacity SHA acute services will adapt and expand to meet the projected COVID-19 patient demand while continuing to deliver acute services to non-pandemic patients throughout the duration of the pandemic in order to minimize loss of life. Concept of Operations Concept of operations: • SHA acute facilities will create additional capacity within existing facilities and other suitable external spaces to respond to forecasted COVID-19 service demand in all integrated health areas. Additional capacity will be based on an understanding of forecasted peak demand at the provincial, area, and facility levels. This will be accomplished through a variety of means including: o A province wide slowdown of non-essential services to increase bed availability, preserve supplies, and support a labour pool for reallocation. o Creation of dedicated spaces for cohorting of COVID-19 within facilities. o Creation of COVID-19 designated hospitals in Saskatoon and Regina. o Creation of additional community based acute care capacity where warranted (e.g. field hospitals). • Continuity of health services will be sustained for non-pandemic patients. • SHA and physician workforce will be preserved through stringent application of safety and infection control processes. Operational Plan Each Integrated Health Incident Command Centre will develop detailed implementation plans in the following areas: Stage 1: Reduce Service Demand (in progress) • Cancel elective procedures • Postpone non urgent surgery • Close patient clinics Operational Plan Stage 2: Increase Capacity for COVID-19 Care (2-6 weeks) • Review forecasted demand based on modelling information at the provincial level and Facility Planning tool on a site basis. • Develop plans for COVID-19 patient flow including cohorting strategies at area, community, and facility level. • Repurpose space in existing facilities to support cohorting in-patient COVID-19 care. • Create COVID-19 field hospitals to support in-patient treatment capacity, and potentially regular acute patients, in community settings. This may include gymnasiums, leased commercial space, community centers, arenas, etc. o Prepare for all aspects of operations including workforce, processes, materials, and equipment. • Prepare COVID-19 hospitals in Saskatoon and Regina. Other areas of the province will use the forecasting data and their current capacity to determine needs. This may include other designated COVID-19 hospitals within Rural and North. • Develop additional specialized intubation capacity for assignment to support COVID-19 care. • Plan to meet patient oxygen requirements through escalation of care needs (high oxygen delivery and ventilator equipped spaces) • Create capacity for ALC inpatients outside of areas of acute care • Implement virtual care options • Implement Ethical Framework for decision making (when it becomes available) Operational Plan Stage 3: Isolate and contain through Cohorting COVID patients (ongoing) • Develop strategy to manage COVID-19 patients through the transition from low to high volume • Initiate operations at alternate acute locations for COVID-19 patients • Implement triage/screening tool (under development) • Implement admission algorithm (under development) • Screen and test Health Care Workers • Secure the space (Security) Service and Support Requirements Human Resources Planning: • Utilize labour pools to meet workforce requirements across health system • Employee scheduling • Consider reducing shift length • Consider rotating between high and low acuity areas • Develop a current employee skills inventory • Develop COVID training • Run simulations (test training) • Establish PPE protocols • Resolve LR barriers (CBAs, refusals) Plan for Blood and Blood Product Management (2-6 Weeks) • Create strict criteria for blood and blood product usage • Local plans to triage patients for surgery if transfusion is likely Service and Support Requirements Supply planning • Procure necessary equipment to support new capacity • Active centralized inventory control for critical PPE and supplies • Secure supply chain from vendor to front line COVID-19 Planning Saskatoon Conceptual Model Healthy People, Healthy Saskatchewan The Saskatchewan Health Authority works in the spirit of truth and reconciliation, acknowledging Saskatchewan as the traditional territory of First Nations and Métis People. Current State March 19, 2020 • COVID-19 patients can access emergency care at all facilities • COVID-19 patients are not cohorted into specific facilities or units in Saskatoon but are starting to cohort into units • No community treatment centers have been created Assumptions • We are expecting exponential growth of the COVID virus in Saskatoon • At the peak of the pandemic, Saskatoon will need the capacity to provide ventilatory support nearly 500-600 patients daily (ventilation and non-invasive ventilation) • Saskatoon will need capacity for 2,000 COVID-19 patients who do not require ventilation at peak demand • Death rates will be consistent with other parts of the world • Non-COVID emergent and urgent care will still be required for a significant number of patients • We will use all available spaces for patient beds Required Patient Movements Location Moved Out Moved In Saskatoon City Hospital ALC Patients (GRU/TCU) Ambulatory surgery Ambulatory clinics Short stay surgery NIV COVID Patients Royal University Hospital Neurology Cardiac Trauma Surgery NIV COVID Patients All Ventilated Patients St. Paul’s Hospital COVID patients Ortho Trauma Neuro Cardiac Surgery Non-COVID ICU JPCH Youth COVID Patients Field Hospitals Oxygen, IV Fluid, IV med COVID patients COVID-19 Future State (draft) SPH ER SCH ER SPH 388 beds No COVID ZONE SCH 352 beds COVID NIV JCPH ER RUH 535 beds JPCH 228 beds No Adult COVID ZONE COVID NIV + Vents Field Hospitals Casualty Storage 2,000 beds (Rinks) Total COVID Capacity ~2,900 Beds Oxygen IV Fluids IV Medications Summary • More accurate modelling is anticipated in the coming days • Even if there was a 50% error rate, we still need to do this • Time is of the essence • Preparations must begin immediately • Next steps: • Develop conceptual plans by area for COVID-19 patient flow and cohorting (immediately) • EOC to issue instructions to Integrated Health Incident Command Centres (Monday) Questions Saskatchewan Health Authority