Health officials in the Northwest Territories have released a plan outlining how patients with Covid-19 will be cared for as demand for health services in the territory could change.
The staged pandemic response plan details what patients can expect if the number of Covid-19 cases should escalate in the NWT, focusing on slowing the spread of new infections or “flattening the curve.” It’s a coordinated approach across the territory’s healthcare system from the NWT Health and Social Services Authority, Tłı̨chǫ Community Services Agency, and the Hay River Health and Social Services Authority.
“Covid-19 has forced health and social services systems across the globe to make difficult decisions when demand exceeds capacity. Being prepared and transparent about how the NWT would escalate care and services is important,” a summary of the plan states.
In a media briefing on Friday, Dr. Sarah Cook, the territory’s medical director, said the plan explains the “how of the pandemic response” while the chief public health officer has provided the “what.”
The plan outlines the territory’s pandemic health response across four stages, from isolated cases of Covid-19 to the “worst case scenario,” where the number of cases exceeds available resources in the NWT.
Four stages of response
The first “minor” stage is triggered by the first Covid-19 hospitalization, something the territory saw in April. In this stage, there will be a total of 72 beds available at hospitals. Health officials will focus on detecting Covid-19 and trace contacting to prevent community transmission.
The second “moderate” stage is triggered by community transmission, where all activities aim to reduce infection rates. In this stage, capacity increases to 74 beds with more space devoted to Covid-19 patients.
The third “major” stage occurs when 50 per cent of inpatient beds at Stanton Territorial Hospital are full and bed surge capacity is at 88. This stage focuses on delaying exceeding health resources in the territory.
A graphic from the plan outlines the four possible response stages.
The final “critical” stage is when some or all of the NWT’s critical health resources exceed maximum capacity. In this stage, bed surge capacity is at 92, with 84 beds dedicated to Covid-19 patients.
Cook explained the territory will increase the number of available beds for patients with Covid-19 by opening unused beds at Stanton Territorial Hospital and repurposing unused areas of the hospital.
The territory also has a partnership with Alberta, she said, so if the number of beds in the NWT is exhausted, patients can be transported to the province. Patients requiring care that is not offered in the NWT, like extracorpeal life support which provides prolonged long and heart support, will also still be sent to Alberta regardless of bed capacity.
Most cases expected to be mild
According to the plan, 80 per cent of people who test positive for Covid-19 are expected to have mild symptoms and can stay home if they can self-isolate. Otherwise, they may be offered accomodation in their community, region, or elsewhere in the territory depending on availability.
These patients will receive regular in-person or virtual assessments from a healthcare provider as required.
Fifteen per cent of patients with Covid-19 are expected to have moderate symptoms, while five per cent are expected to have severe symptoms. These patients will be able to receive active treatment only at Stanton Territorial Hospital in Yellowknife during stages one and two of the plan. Cook said that’s because Stanton has the capacity, personnel, equipment and expertise to best deal with Covid-19.
During stage three, active treatment for patients with moderate symptoms of Covid-19 in the Beaufort Delta and Sahtu regions may be offered at the Inuvik Regional Hospital due to reduced capacity in Yellowknife.
“Comfort” or palliative care for patients with moderate to severe symptoms will be provided at Stanton Territorial Hospital, Inuvik Regional Hospital, and the Hay River Regional Health Centre.
If resources are scarce and need to be prioritized, the plan outlines an ethical decision making framework which aims to make sure that healthcare decisions “rest on ethically and publicly defensible considerations rather than on arbitrary criteria or unchecked biases.” That includes minimizing barriers and harm, and respecting confidentiality and patients’ values and beliefs.
Non-Covid medical care
The plan also considers the provision of non-Covid medical care in the territory during the pandemic.
“The uncertainty of the Covid-19 pandemic has a direct impact on non-covid healthcare,” the summary states. “We must balance the public health measure to prevent viral spread with the continuation of provision of necessary healthcare services.”
This includes replacing face-to-face encounters by phone and video when possible, and reducing patient movement and unnecessary or inefficient in-person visits to healthcare facilities.
Cook said one of the benefits of the pandemic is that it has allowed the territory to advance virtual care, something she hopes will be a “lasting legacy.” She noted that providing equitable access to healthcare across the territory is a “big challenge” because of its vast geography adding the longtime practice of moving patients for care can be challenging for people and families.
Cook said the territory has been successful in advancing virtual care for rehabilitation services like physiotherapy and occupational therapy. It has allowed practitioners to assess people in their own homes, which has improved care, she said.
Cook acknowledged, however, there are challenges with virtual care when it comes to internet speeds across the North.
“Having adequate internet is foundational to that,” she said.
Cook said they’ve worked on solutions like dedicated bandwidth for tele-health and finding ways that patients can use handheld devices to access healthcare providers directly.
A number of specialists in Edmonton have also now been licensed to provide virtual care in the NWT, Cook said.