‘Unethical’ spread of COVID variants: Here’s what ICU doctors are telling the Ontario government

‘We are the last line of defence, and we are ringing the alarm bell.’
Photo: Sault Area Hospital in Ontario. By Billy Wilson.

More than 150 intensive care doctors have written an open letter to the Ontario government demanding action to break chains of transmission as COVID-19 cases explode, rather than reliance on overly burdened ICUs as a last line of defence against the disease.

Your ad here
Don't like ads?
Automated ads help us pay our journalists, servers, and team. Support us by becoming a member today to hide all automated ads:
Become a member

Dear Premier Ford, Minister Elliott, and Dr. Williams:

We are a group of intensive care physicians working in Ontario’s intensive care units (ICUs).

Ontario is at a critical point in the pandemic, and we are being led down a very dangerous path by using ICU capacity as a benchmark for tolerance of COVID-19 spread. We do not agree with this approach and believe new public health measures are required immediately in order to regain control of the pandemic and save lives.

Variants of concern (VOCs) have taken over and are spreading exponentially all over the province. This matters because VOCs spread more easily, creating rapid growth, which becomes much harder to get back under control. In addition, each person who gets infected has a higher chance of hospitalization, ICU admission, and death.

We are seeing younger patients on ventilators—many are parents of school-aged children. We are seeing entire families end up in our ICUs. We are caring for people who have contracted COVID-19 at work, or who have followed all the rules and only gone out for groceries. The impact of this virus has been disproportionate, infecting those with highest exposure risk, commonly from lower income and racialized communities. The current measures and framework are not working to contain the spread of this virus.

Even if we had unlimited ICU capacity, allowing these VOCs to spread exponentially is unethical. About 4 in 10 patients who come to the ICU with COVID will die. More than half of patients requiring mechanical ventilation due to COVID will die. Patients who survive a prolonged ICU admission and are discharged home can have significant long-term impacts on physical or cognitive function.

The growth of VOCs in Ontario is exponential. Trying to adjust our public health response to ICU capacity will not break the chains of transmission. Countries attempting this approach faced massive numbers of deaths and had pushed hospital capacity beyond its limit. Many of those jurisdictions have more expansive hospital and ICU capacity than Ontario does.

Our hospitals generally run close to capacity with very little flexibility to increase, even before COVID-19. While we appreciate new funding to help hospitals expand, the number of staff available to take care of patients has not changed significantly. Hospitals have only made it this far in the pandemic with nurses, doctors, respiratory therapists and other members of the care teams working overtime and picking up extra shifts. We will not have enough staff to manage demand for COVID and non-COVID ICU care if COVID continues to spread at the current rate.

Increasing numbers of COVID patients on medical wards and in ICUs impacts the entire healthcare system. In order to accommodate greater numbers of patients, staff and space need to be borrowed from other crucial but non-emergent services like surgery, endoscopy, cardiology, and diagnostic imaging. As we are forced to increasingly scale back these services to treat COVID patients, non-COVID care suffers. The surgical backlog will take years to overcome. Early-stage cancers will be missed.

If we continue to allow cases to grow exponentially, the ICU demand will outstrip supply of staffed beds. Once overwhelmed, we could be forced to triage the critically ill, deciding who gets ICU care and a chance to survive, and who receives palliative care and dies. Patients who we can save today will not have access to life-saving treatment under a triage scenario.

These next few days and weeks matter. We do not have enough vaccines in arms to blunt the growth. We cannot allow this virus to run free in our population and hope that the expanded ICU capacity and field hospitals are enough. We cannot rely on the public health measures framework. It did not contain the less infectious, less deadly original variant in Wave 2 and it will not be enough to protect us from VOCs in Wave 3. Immediate public health interventions are needed today in order to curb transmission and prevent further unnecessary deaths.

As ICU doctors, we are the last line of defence, and we are ringing the alarm bell. Please hear it. We implore you to act now.

Respectfully yours,

Simon Abrahamson, MB ChB, FRCPC; Neill Adhikari, MDCM FRCPC, Sunnybrook Health Sciences Centre and University of Toronto; Najma Ahmed, MD, FRCSC, Unity Health System; Will Anderson, MD, FRCPC Thunder Bay Regional HSC; Neil Antman, MD, FRCPC, Trillium Health Partners-Mississauga Hospital; Doug Austgarden, MD FRCPC Royal Victoria Regional Health Centre; Timothy Bard, MD, FRCPC, Norfolk General Hospital; Kali Barrett, MD, FRCPC, University Health Network; Ari Bay, MD, FRCPC, Scarborough Health Network; Anas Ben Musa, MD FRCSC; Martin Betts, MD, FRCPC, Scarborough Health Network; Michael Beyea, MD PhD, FRCPC, William Osler Health System; Greg Bishop, MD, FRCPC, Peterborough Regional Health Centre; Bryce Brown, MD, FRCPC, Thunder Bay Regional HSC; Jamie Brown, MD, FRCPC, Peterborough Regional Health Centre; Melanie Brulotte, MD, FRCPC, Health Sciences North; Brian Buchan, MD, FRCPC, Scarborough Health Network; Matthew Cavanagh, MD, FRCPC, Health Sciences North; John Centofanti, MD, MHM, FRCPC, Hamilton Health Sciences; Chris Chan, MD, FRCPC; Alvin Chang, MD, FRCPC, Michael Garron Hospital; Martin Chapman, MD, FRCPC, Sunnybrook Health Sciences Centre; Sabir Chaudry, MD, FRCPC, William Osler Health Centre; Robert Chernish, MD, FRCPC, Grand River Hospital, St. Mary's General Hospital; Han-Oh Chung, MD, MSc, FRCPC, Niagara Health; Robert Cirone, MD, FRCP(C), St Joseph’s Health Centre, Unity Health Toronto; Howard Clasky, MD, FRCPC, Scarborough Health Network; Fulan Cui, MD, FRCPC, Halton Healthcare; Rhiannon Dacosta, MD, FRCPC, Michael Garron Hospital; Jesse Delaney, MD, FRCPC, Scarborough Health Network; Michael Detsky, MD, FRCPC, Sinai Health System; Shelly Dev, MD FRCPC, Sunnybrook Health Sciences Centre; Joanna Dionne, MD MSC FRCPC, Hamilton Heath Sciences; John Drover, MD, FRCSC, Kingston Health Sciences Centre; Erick Duan, MD, MSc, FRCPC, St Joseph’s Healthcare Hamilton and Niagara Health; Hy Dwosh, MD, FRCPC, Mackenzie Health; Jonathan Eisenstat, MD, FRCPC Lakeridge Health; Brooks Fallis, MD, FRCPC, William Osler Health System, Michael Garron Hospital; Bryn Fell, MD, FRCPC, Southlake Regional Health Centre; Sandy Finkelstein, MD, FRCPC, Scarborough Health Network; Alison Fox-Robichaud, MD, FRCPC, Hamilton Health Sciences; Douglas Fraser, MD, PhD, FRCPC, LHSC; Anna Geagea, MD, FRCPC, North York General Hospital; Philip George, MD, FRCPC, Thunder Bay Regional HSC; Rishi Ghosh, MD, FRCPC, Sault Area Hospital; Andrew Gibson, MD, FRCPC, William Osler Health System; Akash Girn, MDCM, FRCPC, Trillium Health Partners; Alberto Goffi, MD. Unity Health Toronto, St. Michael's Hospital; Jeff Granton, MD, FRCPC, London Health Sciences Centre; Jasmine Grenier, MD, FRCPC, Scarborough Health Network; Cameron Guest, MD FRCPC, Sunnybrook Health Sciences Centre; Ray Guo, MD, FRCPC, Scarborough Health Network; Barbara Haas, MD FRCSC, Sunnybrook Health Sciences Centre; Wael Haddara, MD, FRCPC, London Health Sciences Center David Hall, MD PhD FRCPC; Mika Hamilton, MBChB FRCA FFICM FRCPC, University Health Network; Omar Hayani, MD, FRCPC, William Osler Health System; Andrew Healey, MD, FRCPC, William Osler Health System; Margaret Herridge, MSc MD MPH FRCPC, University Health Network; Melinda Hillmer, MD, FRCPC, Michael Garron Hospital; Chris Hinkewich, MD, FRCPC, Grand River Hospital, St. Mary's General Hospital; Melanie Hollidge, MD PhD FRCPC Niagara Health; Kimia Honarmand, MD, FRCPC, London Health Sciences Center; Patricia Houston, MD, FRCPC, Unity Health Toronto; Daniel Howes, MD FRCPC, Kingston Health Sciences Centre; Terence Ip, MD, FRCPC, Southlake Regional Health Centre; Draga Jichici, HBSc, MD, FRCPC, FAHA, Hamilton Health Sciences; Tim Karachi, MD, FRCPC, Hamilton Health Sciences; David Katz, MD, FRCPC, William Osler Health System; Vik Khera, MD, FRCPC, Oakville Trafalgar Memorial Hospital; Bernadett Kovacs, MD, FRCPC, Thunder Bay Regional HSC; Peter Kraus, MBBCh, FRCP(C), Hamilton Health Sciences Rebecca Kruisselbrink, MD, FRCPC, MPH, Grand River & St. Mary's General Hospitals; Sameer Kumar, MD, FRCPC, Trillium Health Partners, Credit Valley Hospital Yogesh Lala, MBBS, FRCPC, Guelph General Hospital; Stephen Lapinsky, MB.BCh, FRCPC, Sinai Health System; Chris Lazongas, MD, FRCPC, Scarborough Health Network; Christie Lee, MD, FRCPC, Sinai Health System; Tiffany Lee, MD FRCPC, Lakeridge Health; Aleksandra Leligdowicz, MD PhD FRCPC,University Health Network; Richard Levene, MDCM, FRCPC, Unity Health Toronto; Kim Lewis, MD, MSc, FRCPC, St Joseph’s Healthcare Hamilton; Tracy Luk, MD, FRCPC, William Osler Health Centre; Brenda Lynn Rice, MBChB, FCCP, Peterborough Regional Health Centre; Jeffrey M Singh, MD FRCPC MSc, University Health Network; Farzin M Visram, MD FRCPC Hamilton Health Sciences; Nava Maham, MD, FRCPC, University Health Network; W.Neil Malcolm, MD, FRCPC, Niagara Health; Sanjay Manocha, MD, FRCPC, Humber River Hospital; Tougas Manon, MD FRCP Niagara Health System; Mark Maraschiello, MD, FRCPC, Peterborough Regional Health Centre Jonathan Marhong, MD, FRCPC; John Marshall, MD FRCSC, Unity Health; Claudio Martin, MSc, MD, FRCPC, London Health Sciences Centre; Christopher Martin, MD, FRCPC, Royal Victoria Regional Health Centre; Azad Mashari, MD, FCRPC, University Health Network; David Mazer, MD, FRCPC; Alexandra McMillan, MD, FRCPC, William Osler Health Centre; David McMillan, MD, FRCPC, Peterborough Regional Health Centre; Maureen Meade, MD, FRCPC, Hamilton Health Sciences; Damien Medina, MD, FRCP(C) Brant Community Health System/Niagara Health; Sangeeta Mehta, MD, FRCPC, Sinai Health System; Nav Mehta, MD, FRCPC Health Sciences North; Tina Mele, MD, FRCSC, London Health Sciences Center; Michael Miletin, MD, FRCPC, William Osler Health System; Yuri Moltyaner, MD, FRCPC, William Osler Health System; Laveena Munshi, MD FRCPC, Sinai Health System; Dave Nagpal, MD, FRCSC, London Health Sciences Centre; Bhanu Nalla, MBBS FRCPC, Health Sciences North; Julian Owen, MD, FRCPC, Hamilton Health Sciences; Elliott Owen, MD, FRCPC, North York General Hospital; Dave Paskar, MD FRCSC, Mackenzie Health; Janos Pataki MD FRCPC Trillium Health Partners; Alex Patel, FRCPC, William Osler Health Centre; Dominique Piquette, FRCPC, Sunnybrook Health Sciences Centre; Beth Powell, MD FRCPC, William Osler Health System; Dean Raso, MD, FRCPC, Guelph General Hospital; Sach Rehsia, MD, FRCPC, Halton Healthcare; Bram Rochwerg, FRCPC, Hamilton Health Sciences Centre; James Rogers, MD, FRCSC, Joseph Brant Hospital; David Rose, MD, FRCPC, Scarborough Health Network; Anna Rozenberg, MD, FRCPC, Brant Community Health Care System; Jill Rudkowski, MD, FRCPC, St. Joseph's Healthcare Hamilton; Corey Sawchuk, MD MBA FRCPC, Hamilton Health Sciences; Sameer Sharif, MD FRCPC DRCPSC William Osler Health System; Sunjay Sharma, MD, FRCSC, FACS. Hamilton Health Sciences; Asheer Sharman, MD, FRCPC, Trillium Health Partners; Phil Shin,MD, FRCPC, North York General Hospital; Kevin Shore, MD, FRCPC, Scarborough Health Network; Shankar Sivananthan, MD, FRCPC, William Osler Health System; Steven Skitch, MD PhD FRCPC Joseph Brant Hospital; Karim Soliman, MD, FRCPC, Lakeridge Health Mark Soth, MD, FRCPC, St Joseph's Healthcare Hamilton; Jessica Spence, MD, PhD, FRCPC; Hamilton Health Sciences; Jamie Spiegelman, MD, FRCPC, Humber River Hospital.

You might also be interested in...
Climate deaths and class divides: What we can learn from B.C.’s heat wave disaster
Derrick O'Keefe
July 6, 2021
Inside the raid on Fairy Creek’s HQ: Violence, arrests and media exclusion
August 24, 2021
Victory! Media coalition wins court fight with RCMP
Ethan Cox
July 20, 2021