Hospitals sound alarm as cases surge
With GTA facilities near capacity, leaders plead for stricter health measures to avert crisis
Hospitals in Toronto and Peel are facing escalating pressures during the second COVID-19 wave and are calling for more stringent public health measures to prevent emergency departments, intensive care units and other services from being overwhelmed.
Most large hospitals in Greater Toronto are operating above 90 per cent capacity with some already full and experiencing patient gridlock in emergency departments, a situation the Ontario Hospital Association warns is unsafe and unsustainable during a pandemic.
“There is enormous growing risk,” said Anthony Dale, the association’s president and CEO.
“To keep hospitals functioning like they are now, rolling on all cylinders, we need to stop the community spread of COVID-19. Much more effective public health measures are needed.”
This call is being echoed by hospital leaders across Greater Toronto who are scrambling to meet the demands of caring for patients and offering additional services during the pandemic. In addition to usual patient care, hospitals are clearing a backlog of elective surgeries, running assessment centres packed with people, processing coronavirus tests in their laboratories and preparing for an influx of influenza and severely ill COVID-19 patients.
“That balancing act, hospitals being able to keep all those balls in the air, that’s what’s at risk from a COVID surge,” said Dale, noting Toronto’s medical officer of health on Friday urged the province to implement regional public health measures to curb COVID-19 spread.
On Saturday, Toronto Public Health said it has stopped reaching out to the close contacts of people with confirmed coronavirus infections outside of outbreak situations, as a result of soaring cases in the city.
“It’s quite a fragile situation here in Toronto and the Greater Toronto Area,” Dale said.
On Sunday, the province reported 566 new COVID-19 cases, including 196 in Toronto and 123 in Peel, and said 169 people with the virus are in hospital. The number of hospitalized cases has almost doubled in the past 10 days; there were 88 people with COVID-19 in hospital on Sept. 24.
At William Osler Health System, staff and resources are already so stretched, the hospital would be unable to help longterm-care homes that need assistance with COVID-19 as it did during the first coronavirus wave, said Dr. Andrew Healey, Osler’s interim chief of emergency medicine.
Another concern is the growing backlog of COVID-19 test results, which is making it nearly impossible for the hospital system. “Should there be a surge, we won’t have a warning to plan for a rise in severely ill patients needing care, Healey said. On Sunday, the province reported that 78,953 tests remain under investigation.
“Should there be a surge, we won’t have a warning because we have so many tests waiting in the system,” Healey said. “That’s the major risk we’re worried about at the moment.”
Like most hospitals across Ontario, Osler’s Brampton Civic Hospital and Etobicoke General Hospital are back to prepandemic patient volumes with a 95 per cent occupancy rate across both sites. As well, its two emergency departments are experiencing gridlock due to increased demand, leading to patients being treated in hallways while awaiting an in-patient bed, Healey said.
“To be clear, we function in gridlock many days of the year, every year, like many Ontario hospitals,” he said, noting the hospital system has a patient flow team to ensure patients get the care they need. “But the added pressure of COVID, and the need for isolation beds, makes that gridlock even more dangerous.
“Whenever you have a virus that is not easy to diagnose with a test, and you’re putting patients in a space that doesn’t have a door, or at least a room with a curtain, without appropriate physical distancing between patients, that puts us at risk of having an outbreak. We have not seen that at Brampton Civic or Etobicoke General, but we are at risk of that.”
In September, Brampton Civic had 17 days in code gridlock, nine of which were extreme gridlock, while Etobicoke General had nine gridlock days, meaning more patients were being admitted to hospital than discharged, according to an Osler spokesperson. On Saturday, Etobicoke was in gridlock and Brampton Civic was in extreme code gridlock, Healey said.
During the first coronavirus wave in the spring, hospitals across Ontario halted elective surgeries, creating space for COVID-19 patients and freeing up staff to help where needed with the response. At the same time, emergency departments saw far fewer patients during the lockdown period, with some in Greater Toronto experiencing a 50 per cent drop in patient volumes.
At Mackenzie Richmond Hill Hospital, emergency volumes are back to pre-pandemic levels, putting a strain on its already busy emergency department that typically sees between 300 and 320 patients a day, said Dr. David Rauchwerger, Mackenzie Health’s chief of emergency medicine.
“The luxury during wave one when we were at 50 per cent volumes, we could repurpose some of our space to more safely see patients. We don’t have that luxury anymore,” he said.
The Richmond Hill Hospital is currently at 89 per cent capacity and was at 104 per cent capacity on Sept. 28, according to a spokesperson from Mackenzie Health. Its two COVID-19 assessment centres are currently testing up to1,000 people a day — nearly double the number a few weeks ago, the spokesperson said.
Like many, the Richmond Hill Hospital is creating ways to see more patients outside emergency departments and has opened a cold and flu clinic to see symptomatic patients who need a COVID-19 test, Rauchwerger said.
The clinic only sees patients with symptoms who have been referred by their family physician or by the hospital’s assessment centres.
Still, Rauchwerger said these hospital strategies may not be enough without more public health measures to curb community spread.
“Last time, the province shut down elective surgeries. That’s not going to be a plausible solution this time because now, what might have been elective in the spring, all this backlog is not elective anymore.”
Michael Garron Hospital in Toronto has prepared for a spike in patients this fall by doubling the physical space and physician staffing levels in its emergency department, said Dr. Kyle Vojdani, chief and medical director of the emergency department. It’s also added an online booking system for patients with musculoskeletal injuries who need urgent but not immediate care, such as those with fractures or sprains, as one way to safely space out patients, he said.
Currently at 91-per-cent capacity, the hospital has ongoing plans to manage spikes in patient volumes. But Vojdani said that while hospitals can create capacity, they can’t create “infinite capacity.”
“We’ve increased pieces as much as we can,” he said. “If community prevalence (of COVID-19) is continuously increasing, what we will inevitably see is an increasing inability to even implement these strategies because our staffing will become inconsistent, because then our nurses and our doctors and our patient attendants and our imaging technicians, they will start to themselves get sick.
“So our ability to respond in a robust way is dependent on robust strategies in the community to curb spread.”
Healey said Osler opened its COVID-19, cold and flu clinic to see people with upper respiratory symptoms and flu-like symptoms who are unable to see a family doctor in the community. Run out of the Peel Memorial Centre for Integrated Health and Wellness, the clinic, which typically sees about 225 patients a day, helps ease stress on emergency departments and ensure people get appropriate care, he said.
Healey said he’s worried more people will now show up in emergency departments now that Ontario has directed hospitals to do appointment-only COVID-19 tests at their assessment centres.
“We are concerned that if people cannot get an appointment, they will arrive on the doorstep of our emergency department,” he said. “I do not think the emergency department system in Ontario can manage that volume.”
Dale of the Ontario Hospital Association told the Star on Friday that hospital leaders do not know what criteria the provincial government will use to implement new public health measures.
“We feel like Dr. (David) Williams (Ontario’s chief medical officer of health) has not been clear or transparent about how he is evaluating the situation,” Dale said.
“The entire hospital sector, which is the anchor of the provincial response, does deserve better than that. We deserve transparency over decision making and a clear explanation as to why decisions are being made in the manner in which they are.”
“Last time, the province shut down elective surgeries. That’s not going to be a plausible solution this time.” DR. DAVID RAUCHWERGER MACKENZIE HEALTH CHIEF OF EMERGENCY MEDICINE