COVID-19 in Sask: Internal draft gov't document outlines 'worst case scenario' of up to 15,000 deaths

Click here for the latest: COVID-19 in Sask: Top doc recommends expanding testing to those who haven't travelled

• There are now 72 cases of COVID-19 in Saskatchewan, up from 66 on Monday. 
• Of those cases, four are instances of community transmission: cases where no clear cause of exposure, including travel, has been found.
• Two of the community transmission cases are in Saskatoon, one in Regina and one in an unspecified central Saskatchewan community.
• An early, worst-case scenario drafted by the province says as many as 15,000 Saskatchewan residents may die from the virus. The estimate is a necessary part of planning and is being refined, the province says.
• More ventilators are on order, but the health minister said he doesn't know when they'll arrive.

An internal document from the Saskatchewan Health Authority (SHA) says that, even using conservative assumptions, "COVID-19 will almost certainly overwhelm" the province's health system.

The 20-page presentation, titled COVID-19 Planning Doc: Strategy for Continuity of Health Services and Surge Capacity, was recently circulated among SHA employees, but was leaked to the media Tuesday. 

It raises serious questions about the province's current readiness to combat the COVID-19 virus. 

"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," read one page from the PowerPoint presentation, which is dated March 19-20.

• Saskatchewan government failed to order key equipment and supplies until after COVID-19 arrived

1st sign of community transmission

The document's release came on the same day Saskatchewan reached a new milestone in its continued fight against the coronavirus. The province confirmed four cases of community transmission — instances where health officials could not determine how people got exposed.

Two of those cases are in Saskatoon, one in Regina and one in an unspecified central Saskatchewan community.

• COVID-19 in Sask: Top doc recommends expanding testing to those who haven't travelled

"You have to act anywhere in Saskatchewan as if there's unknown human transmission," said Dr. Saqib Shahab, Saskatchewan's chief medical health officer, at a news conference Tuesday.

"That's not a reason to panic," he added. "It's a reason to be very thoughtful about day-to-day activities. You're going shopping, you bring your groceries home ... you wash your hands."

On Tuesday afternoon, WestJet flagged more than a dozen of its recent flights as having had guests who tested positive for COVID-19.

Among them was flight WS3300 from Calgary to Regina on March 14.

"The safety of our guests and crew remain our top priority," the airline tweeted. 

6 new cases, 72 in total 

The Saskatchewan government announced six new cases in general Tuesday, bringing its total to 72.

Of the 72 cases, two are 19 years old or younger, 59 are between the ages of 20 and 64, and 11 are 65 years and older.

Here's how the cases break down regionally as of March 24:

Here's how the number of cases in Saskatchewan has increased over the past two weeks:

'Worst-case scenario planning' 

A health authority spokesperson said Tuesday the internal document was "a draft document based on early modelling and worst case scenarios."

• Read the full document here. 

A statement made last week by the province's chief medical health officer suggests the document — which posits a 30 per cent infection rate — may not actually depict the worst possible scenario.

"Over the course of 12 to 18 months, 30 to 70 per cent of us will get COVID-19," Shahab said at March 18 news conference. 

The internal document does note "more accurate modelling is anticipated in the coming days," but says that action must be taken regardless.

"Even if there was a 50 per cent error rate, we still need to do this," it says.

In a note Tuesday afternoon, the SHA said other jurisdictions have used a 30 per cent infection rate in their models, but added that the Saskatchewan model is being updated so it's "more specific to the situation in Saskatchewan."

"This plan will ensure we are prepared," said Scott Livingstone, the CEO of the health authority, in the note. "But it won't be enough. It has been proven over and over with this virus that no health system in the world can address this challenge alone without the sustained help [physical distancing and self-isolation] of the general public."

Steps already taken

At the news conference, Livingstone said the document did not take into account what the province has already done to prepare. That includes a slowdown of non-essential medical procedures to make more beds available, the shifting of health-care workers across the province and increased COVID-19 testing.

"We're doing surveillance in hospitals, testing for COVID-19 in all declared outbreaks in long term care homes," Livingstone added. 

Questions remain, however, about the readiness of the province's hospital system, especially when it comes to ventilators.

Saskatchewan currently has 91 adult intensive care ventilators, 80 subacute ventilators and dozens of ventilators inside operating rooms across the provide, said Dr. Susan Shaw, the SHA's chief medical officer. 

Every jurisdiction on the planet right now is trying to get ventilators.- Saskatchewan Health Minister Jim Reiter

The document estimated Saskatoon alone would need between 500 to 600 ventilators once the pandemic reaches its peak. 

Some 250 ventilators are on order for the province, health officials have said. But Health Minister Jim Reiter was unsure Tuesday when they would arrive, and how many.

"Every jurisdiction on the planet right now is trying to get ventilators," Reiter said. "We're dealing with our normal suppliers, we're dealing the federal government because they're trying to co-ordinate and do bulk purchasing.

"I'm optimistic we're going to get some. I don't know if it'll be full orders and again it's virtually impossible."

Up to 15,000 deaths estimated

One page of the internal document, titled "Key takeaways on incoming demand," estimates 9,000 to 15,000 people will die from the virus in the province.

"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."

The same page says that "over the course of the event," if 30 per cent of the province's population is infected, approximately 15,000 people will require ICU beds. 

It says Saskatchewan currently has 109 intensive-care (ICU) beds province-wide.

As of Monday, the health authority had 91 ventilators, with more on order. 

"At the peak of the pandemic, Saskatoon will need the capacity to provide ventilatory support [for] nearly 500-600 patients daily (ventilation and non-invasive ventilation)," according to the document.

The document also outlines a plan to significantly expand COVID-19 bed capacity to around 2,900 beds through the use of field hospitals at potential sites including gymnasiums, leased commercial space, community centres and arenas.

The first step, however, is to increase the number of beds at existing hospitals, where specifics areas will be reserved for COVID-19 patients, Livingstone said during the news conference. 

The province's mission statement is stated as follows in the document:

"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."

One page suggests using rinks to house casualties.

Read the full document below. Don't see it? Click here.

Ryan Meili reacts to estimates

Saskatchewan NDP Leader Ryan Meili offered his take on the estimates shortly after they were made public.

"I think the government should be sharing all of the information they have if they have modelling about what's likely to happen under different scenarios," Meili said. 

"That projection would likely be a conservative projection based on a certain model. So if we do the things we're doing now, that's the kind of numbers we might expect to see. But we don't have to see that. This is a critical moment. This is the moment at which we decide which track we're on." 

First recoveries expected soon

Some good news about the pandemic's status in Saskatchewan may come by the end of the week, Shahab said. 

"We are now at the point where some of our initial cases are going to be screened," Shahab said Monday. "And if they are well, they'll be reported as recovered. We will be getting that information towards the end of this week."

The province announced its first case of the novel coronavirus on March 12: a 60-year-old man who had recently travelled to Egypt and tested positive in Saskatoon on March 9.

Patients will be declared recovered once they test negative on a subsequent test, the health ministry has previously said. 

As of Friday — when there were only 26 reported cases — the vast majority of those cases (24) were well enough to self-isolate at home. 

No such insights have been offered since.

Regular updates on in-hospital patients coming

On Monday, Shahab said updates on how many cases are in hospital versus how many are self-isolating at home will be provided at least twice a week. 

There are at least two COVID-19 cases in Saskatchewan hospitals, according to the latest information provided. Both are there because of pre-existing medical conditions.

However, the Saskatchewan Health Authority has not answered whether either of those cases has needed to go into intensive care, citing patient privacy concerns.

Shaw said Monday that she did not have that information, and that if she did, "it would not be appropriate to share it because of the importance of protecting our patients' personal health information."

In a later note, Jim Billington, press secretary for Premier Scott Moe, said "it is our intent to provide information for the total number of cases in hospital and the total number of cases requiring ICU admission, when the information is reported [to the minister by the Saskatchewan Health Authority]."

CBC News has directly re-asked the health authority whether any patients are now under intensive care.

As of Tuesday, 5,757 COVID-19 tests had been performed in Saskatchewan.

Below is a graph showing how the cumulative number of tests has shot up in just a short while.