Staggered Start: Variations in Hospital Bed Capacity
April 9, 2020
As people cope with public health measures such as social distancing and 14-day self-isolation periods, provinces and territories across Canada are working hard to anticipate how many people might require hospitalization from COVID-19. As projections in Ontario and other provinces are being released, health care systems need to determine if they have the capacity to treat a potentially large influx of patients over the coming weeks.
There are large variations in the number of hospital beds available in different parts of the country. This means some health care systems could become overburdened before others, leading to inequal access to care for some Canadians.
It’s important to view the capacity issues and fiscal constraints at play through a national lens to safeguard against variations in provinces’ and territories’ ability to respond to the epidemic. While health care systems may not have the same starting point, understanding the different contexts in which they operate can help health care decision-makers level the playing field.
Provinces and territories are also in the difficult position of planning to treat a large volume of COVID-19 patients while also protecting people who need care for other health conditions. People are still having accidents and women are still delivering babies. As hospitals focus on freeing up acute and critical care beds in more general areas, there may be unintended consequences to patients waiting for surgery or other procedures.
Furthermore, health care systems are not starting off with the same supply of hospital beds relative to their population. These variations can be even more pronounced at the local level. Based on the latest data available from the Canadian Institute for Health Information and the Ministère de la santé et des services sociaux, the number of acute beds and critical (intensive care unit) beds per 100,000 people ranges from 82 in Quebec to 211 in Newfoundland and Labrador. (See chart.)
However, Quebec has the largest number of critical care beds, followed by Ontario, British Columbia, and Alberta. In contrast, the Prairie and Atlantic provinces have proportionally more acute care beds, but fewer critical care beds, than the rest of the country.
The supply of hospital beds is only one measure of health care system capacity. Other factors, like the occupancy rate of beds (how many are actually available) and the ability to fund additional beds, also play a factor. For example, while Ontario has 16 intensive care unit (ICU) beds per 100,000 people (which represents around 1,725 beds), the province stated it has 410 ICU beds available for COVID-19 patients (in addition to beds currently occupied by COVID-19 patients). The province also said it can make an additional 900 ICU beds available if needed over the next month.
With the current hospitalization rate for confirmed COVID-19 cases estimated at 10.6 per cent for acute care beds and 4.8 per cent for critical care beds, provinces and territories are using various strategies to plan for a worst-case scenario. Strategies include redeploying and training health care workers, and finding ways to acquire new staff. Acquiring medical equipment, such as ventilators and personal protective equipment, is also a top priority.
No one knows yet the full burden that health care systems will need to bear. But it will be influenced by the rate at which COVID-19 spreads, as well as the systems’ capacity and strategies underway to increase it.
And while the country’s attention is focused on winning this important fight, we must not forget about individuals battling other health issues who need access to care. The impacts of this novel coronavirus will surely be felt for years to come—not just by the families directly affected by it, but by the millions of Canadians whose physical, social, and economic well-being are being put on pause.