Hospitals face `enormous pressure'

As COVID-19 cases mount, off-site solutions sought for overcrowding

Emergency physician and senior researcher Dr. Ian Stiell calls it the worst crowding he has seen in his 35 years at The Ottawa Hospital.

Ottawa has become the epicentre of second wave health-care pressures in Ontario, with more outbreaks, more long-term care deaths and a disproportionate number of COVID-19 cases compared with the rest of the province, not to mention hospitals at more than 100 per cent capacity.

There is growing concern about the situation, said Anthony Dale, head of the Ontario Hospital Association.

In addition to hospital crowding, Dale noted that The Ottawa

Hospital is running the biggest COVID-19 testing and assessment centre in Eastern Ontario, is managing two long-term care homes and is trying to catch up on thousands of backlogged surgeries.

Queensway Carleton Hospital faces similar pressures, although it isn't overseeing long-term care homes.

And public health officials have been warning that the second wave could be worse than the first, with the potential of more than 2,000 cases a day in Ontario by the end of this month.

“There is a deep level of anxiety among the hospital leadership community, senior clinicians, front-line clinicians and healthcare workers,” said Dale.

“Everyone sees what is happening first hand. They are experiencing it, they are doing their very best to care for people, but it is not right to ask the hospital sector to try and absorb such enormous pressure and the risks that come along with it while doing nothing to improve the public health measures that are needed.”

Growing concern about hospital crowding led Stiell, a respected emergency physician and researcher who has helped develop protocols used around the world, to issue a kind of SOS on Twitter.

“The Ottawa Hospital needs provincial help urgently. Twenty per cent of beds taken by people who should be in LTC. Little room for sick ED patients and limited surgery. Need LTC beds now!” he tweeted.

With the second wave of the COVID-19 pandemic rapidly growing and cold and flu season expected on its heels, the overcrowding at hospitals in Ottawa and across the province led the Ontario Hospital Association to call on the province to return to targeted Stage 2 lockdowns in hot spots, including Ottawa. The move is, in part, to prevent hospitals from becoming overwhelmed.

Other health leaders have supported the call for tighter restrictions, but there is little sign the province is planning to do so soon. On Thursday, in response to a question, Premier Doug Ford said he did not plan to close indoor service at restaurants and bars “right now.” Quebec did so this week.

The situation is particularly severe in Ottawa where both The Ottawa Hospital and Queensway Carleton are at close to or above 100 per cent occupancy most days and St. Vincent Hospital has a COVID-19 outbreak. As a result, a high proportion of patients who no longer need acute care are using hospital beds and have nowhere else to go.

When the first wave of the pandemic hit, non-essential surgeries and procedures were quickly shut down and some patients were moved out of hospitals to nursing homes. As a result, occupancy rates plummeted as hospitals prepared for what some feared could be a situation like those seen in Italy and New York, in which hospitals were overwhelmed by COVID-19 patients.

That didn't happen. But this time, hospitals face greater pressure, including trying to catch up on postponed surgeries and procedures. And with long-term care homes now limiting three- and four-bed rooms, there are fewer beds for frail elderly patients in the community, which is one reason so many are in hospital beds.

Cameron Love, president and CEO of The Ottawa Hospital, said the hospital would normally have between 150 and 180 so-called ALC (alternate level of care) patients. In the past few weeks, it has had up to 250 ALC patients.

“We have every possible bed open and surge plans in place,” he said, which includes hospital beds “not traditionally used.”

Plans to open 120 beds at recently built Greystone Village Retirement residence near Main Street this month will reduce some of the pressure on The Ottawa Hospital, he said. Bruyère Continuing Care is overseeing that move. Queensway Carleton Hospital also continues to run off-site hospital wards at a hotel near the Canadian Tire Centre to reduce crowding.

Even so, occupancy at both hospitals has been over 100 per cent in recent weeks.

Love said The Ottawa Hospital is looking at other possible options if needed. He said there have been some discussions about setting up a field hospital, as some communities have done, but that isn't being considered right now.

Meanwhile, he said, staff are

working overtime to clear surgical backlogs and maintain ongoing procedures while making sure the hospital is prepared for an increase in COVID-19 patients. The hospital is also hiring to ramp up staffing.

Love and others want to avoid seeing patients staying away from hospitals the way they did during the first wave.

“We really want the community to know that in any scenario during the second wave, we are here to support them.”

Dr. Andrew Falconer, president and CEO of Queensway Carleton, said the number of so-called ALC patients there and at other hospitals in the region is rising at an “alarming rate.” The hospital is looking at expanding the number of off-site beds it has at Fairfield Inn and Suites in Kanata and is adding beds and shifting the timing of some procedures on site.

Although the majority of those infected so far in the second wave are younger than in the first wave, Falconer warned that could soon change, which will mean more COVID-19 patients in hospitals.

How much pressure hospitals face “depends on how bad the second wave is, which is largely dependent on our citizens following public health advice,” he said. epayne@postmedia.com