There exists some ambiguity across jurisdictions and thus there is no clear universal case definition of COVID-19 hospitalization.
Public Health Ontario measures hospitalization as “the number of confirmed COVID-19 cases that reported ever being hospitalized during their infection”- i.e., all cases reported as ever being hospitalized during their infection.
The category “incidental COVID-19 hospitalizations” has been proposed. This refers to patients who are primarily admitted for other ailments and test positive as part of routine screening.
Some jurisdictions and health agencies have started differentiating between those who were admitted for COVID-19-related illness and incidental admissions. Ontario and Saskatchewan have begun using this category in their regular reporting of COVID-19 statistics.
New data from Australia, New Zealand, the US, and Canada indicate that 30 to 50 percent of COVID-19 hospitalizations are “incidental COVID-19 hospitalization” – 46% of COVID-19 hospitalizations in Ontario (as of January 11th, 2022) and 40% in Saskatchewan (as of January 26th, 2022)
Some expert opinions caution that such binary categorization may oversimplify clinical reality, and suggests also employing an ‘indeterminate’ category
Asamoah, G; Badea, A; Reeder, B; Groot, G; Muhajarine, N; Howell-Spooner, B; Young, C. What is the (case) definition of hospitalization for COVID-19 in similar jurisdictions? 2022 Feb 10. Document no.: CAC220101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 9 p. (CEST rapid review report).
Consequences of delayed surgeries have potential patient-level and system-level consequences
Modelling indicates that even complete resumption of services requires additional resources to clear the backlogs caused by service disruptions
Retrospective data analysis indicates that minor delays for most cancer surgeries does not negatively impact patients, however the length of time to safely delay is largely dependent on condition and urgency
Badea, A; Groot, G; Young, C; Mueller, M. What have been the consequences of delayed surgeries due to the COVID-19 pandemic? 2021 Oct 18. Document no.: EOC210903 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols.
· It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities.
· The public should be included when creating triage protocols to create transparency and trust in the health system.
· Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians.
· Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes.
Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2
· Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
· There was no source of Canadian data (published or grey, federal or provincial) to address this question and differentiate between types of ventilation.
· There are several studies available assessing the proportions seen in other countries and a lot of theoretical literature about using non-invasive ventilation (NIV) as a first-line intervention to hopefully avoid intubation and invasive mechanical ventilation (IMV), for which there is weak evidence.
· Key studies include an analysis of 36 ICU patients in Wuhan in which 41.7% received NIV and 47.2% received MIV. Another large-scale study of 1,099 hospitalized patients reported IMV in 6.1% with no report of NIV.
Badea, A; Groot, G; Dalidowicz, M; Miller, L. In similar jurisdictions experiencing the COVID-19 pandemic, what is the proportion of patients receiving non-invasive ventilation versus those receiving intermittent mandatory ventilation? 2020 May 22; Document no.: EOC052102 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 8 p. (CEST rapid review report)