The Saskatchewan Health Authority (SHA) believes public health measures may have pushed COVID-19 infections below a “tipping point” in the province, as authorities plan for fewer deaths and draw up a phased approach for resuming elective surgeries.
The SHA released a new modelling document on Tuesday. It is now planning for a scenario with 254,756 cases of COVID-19 and 3,050 deaths over the course of the pandemic.
That is on the mid-to-lower end of an initial range the SHA released on April 8, when it put cases as high as 408,000 and deaths as high as 8,370.
The numbers are not predictions. They are used for planning purposes to prevent the health system from being overwhelmed. The more optimistic numbers have allowed planning for resuming postponed medical services, including elective surgeries and diagnostic procedures, though there is no specific date for when that will happen.
The SHA believes it now has enough ventilators to treat everyone under the new scenario, and is able to reduce its maximum required hospital capacity by 1,000 beds.
The modelling hinges on two different numbers. One captures how COVID-19 is actually spreading in Saskatchewan, while the other warns about how it could spread if the government and public let down their guard.
The first number is called the “effective reproductive number.” It tells us how many times each infected person spreads the disease to others in actual fact and at the present time, given existing restrictions.
If that number is under one, infections will gradually peter out. Saskatchewan’s present number was 0.7 as of April 25, according to SHA data. That’s very good news.
The SHA called the number a “guidepost” for choosing measures to contain the disease, like public health restrictions.
The second number is called the “basic reproduction number.” It tells us how many times each infected person could spread the disease to others if nothing were done. The SHA relies on it to prepare for what it has called a “worst-case scenario.”
During its initial modelling in early April, the SHA used data from outside the province to arrive at a rough estimate of the basic number. It put it as high as four.
It laid out detailed plans to prepare for a scenario only slightly less catastrophic, with as many as 830 people in intensive care at a single time and as many as 800 people requiring mechanical ventilation, essentially breathing machines.
But current Saskatchewan data allows the SHA to estimate that the basic reproductive number is just over three. That would mean 412 people in the ICU at the peak of the disease and 403 people on ventilators.
That’s fewer than the 486 ventilators the SHA says are now available. About 3,050 people would die over the course of the pandemic, under the updated scenario.
Those numbers, once again, are not predictions, and current real-world data suggests that Saskatchewan is doing far better than that. Saskatchewan’s trajectory is similar to B.C., according to a comparison between provinces laid out in the presentation.
The effective reproductive number of 0.7 reflects “strong” compliance with public health measures in Saskatchewan, according to the SHA. The number has dropped from as high as two, roughly, in early March.
It fell below one around March 24, a threshold the document said puts the virus “at the tipping point.”
The presentation cited data from Google mobility reports that chart how life has changed in the province over recent weeks. Saskatchewan people are spending 43 per cent less time at retail and recreation, 53 per cent less time at transit stations and 48 per cent less time at workplaces, compared to baseline numbers from January and February.
That’s actually less pronounced that Canada-wide decreases, however.
The SHA laid out how its own measures to contain the disease are changing, including more hints on how it will expand testing. Currently, testing is available to those with symptoms of COVID-19.
But the SHA is now working on plans to test contacts of people with COVID-19 who are not showing symptoms, as well as outreach to groups that are less likely to seek testing.
There are now 50 testing sites spread throughout the province. The SHA again stressed that it has the lab capacity to meet Premier Scott Moe’s target of conducting 1,500 tests per day, though current testing numbers are far below that as fewer people seek testing.
Experts have highlighted expanding testing as a must-have for moving forward with Saskatchewan’s reopening plan. Additional testing sites are opening soon, the presentation said, and rapid access testing has already been brought to eight sites with 11 more to come.
Contact tracing — which essentially means tracking down people who came in contact with infected persons — will also be key. The SHA is now planning to use an application to streamline the process, according to the presentation.
It said current capacity is enough to keep up with a surge of 300 new cases per day.
No specific time frame was provided for the expected resumption of elective surgeries, diagnostics and other medical services the SHA put on hold in March to prepare for a potential surge of COVID-19. The presentation said officials are drawing up a “methodical and cautious” plan that will be phased in.
As of April 22, about 3,800 elective surgeries had been postponed across the health system. That included a high number of cataract procedures, joint replacements and gynecological surgeries.
The SHA will look at the risk of COVID-19 transmission, its supplies of personal protective equipment and patient needs to decide which services come back online first.
“The system must remain able to respond to potential COVID-19 surge in demand,” the presentation said.
The SHA said it is now working on adjusting local plans, which previously set out how hospitals and other health facilities would respond to a potential surge in cases. The plans are still reliant on cohorting between and within hospitals, though the timing could be adjusted.
Plans for field hospitals at Evraz Place in Regina and Merlis Belsher Place in Saskatoon are still mentioned in the document, but they are now broken down into two separate stages so capacity can ramp up according to demand.
SHA officials are expected to answer media questions about their modelling and planning efforts at roughly 2:30 p.m. on Tuesday.