TORONTO -- The Ontario government has issued two emergency orders to help increase critical care capacity in the province after hospitals were ordered to ramp down on elective surgeries as surging COVID-19 cases continue to threaten the health-care system.
In a news release issued Friday evening, the province said the orders will allow hospitals to transfer patients to another hospital without obtaining their consent during "major surge events."
The orders, which came into effect Friday, will also grant Home and Community Care Support Services organizations and Ontario Health the authority to redeploy health-care professionals and other staff to hospitals inundated with COVID-19 patients.
"With Ontario's hospitals facing unprecedented critical care capacity pressures during the third wave of the COVID-19 pandemic, our government is taking immediate action to ensure no capacity nor resource in Ontario's hospitals goes untapped," Ontario Health Minister Christine Elliott said in a statement.
"Together with the provincewide stay-at-home order, these measures will help to ensure that hospitals continue to have the staffing and resources they need to care for patients. We continue to work with our hospital and health care partners to fight this deadly virus, and I want to thank all of Ontario's frontline health care workers for their tireless work each day to protect the health and safety of Ontarians."
The province said the measures are expected to increase ICU capacity by up to 1,000 beds. The orders will remain valid for 14 days unless it's revoked or extended.
The emergency orders were introduced a day after most Ontario hospitals were instructed to halt all elective surgeries and non-emergent/non-urgent activities in the wake of a record number of COVID-19 patients in intensive care units.
Ontario Health President and CEO Matthew Anderson released a memo on Thursday to hospital CEOs and primary care providers telling most hospitals across the province to scale back elective surgeries as of 12:01 a.m. on Apr. 12.
“Today, given increasing case counts and widespread community transmission across many parts of the province, we are facing mounting and extreme pressure on our critical care capacity,” he said.
Anderson said the ramp down is needed to preserve critical care and human resource capacity as coronavirus cases and hospitalizations are increasing amid a third wave of the pandemic.
On Thursday, there were a staggering 525 people in ICUs across the province, according to the Ministry of Health.
And a new record was set on Friday with 541 people battling the disease in ICUs across the province, according a tweet from critical care physician Dr. Kali Barrett based on the latest data from Critical Care Services Ontario.
Ontario’s latest modelling data released last week said ICU occupancy could hit nearly 800 daily by the end of the month even with the month-long provincewide stay-at-home order that came into effect on Thursday.
Ontario Hospital Association President and CEO Anthony Dale responded to the memo and said a major redeployment of staff and resources is needed to provide care for a large number of COVID-19 patients in hospitals.
“This situation is extraordinarily serious and we ask for patience and support from the people of Ontario as hospitals grapple with this historic crisis. Ensuring equitable access to critical care services is our paramount priority,” Dale tweeted Thursday evening.
Director of Surgery at Humber River Hospital Jhanvi Solanki told CP24 on Friday that the high number of patients needing care in ICUs is concerning, as they don't have enough beds and staff to care for them all.
"We are seeing a lot more sicker patients coming in. Yesterday, our census was 56 out of 46 which is really high. It is 10 patients over what we can staff for and what we can care for. Fortunately, we were able to transfer some patients out and were able to manage with additional staffing. But it is a real concern for us," she said.
Solanki said some patients are being transferred to ICUs as far as London and Kingston, Ont.
With hospitalizations and ICU numbers increasing daily, triaging patients is a worrisome possibility.
Solanki said her hospital set up a triage and screening plan last year if they need to resort to it.
"We set up a triage and screening process in wave one and we are going to be using the same kind of screening process right now. So we have an ethical framework that we use and principles of medical management and basically that determines the acuity to delay care and we determine if for example a cancer case would trump all other cases that might be a little bit delayable by a day or two, by a couple weeks, by four weeks et cetera.
The ramp down will not apply to hospitals in the Northern Ontario Health Region yet but Anderson said that they should be prepared to do so in the near future if requested.
Meanwhile, speciality hospitals for children and youth are being told not to scale back any capacity.
“Paediatric speciality hospitals are advised not to ramp down any capacity and continue with plans to care for children, youth, recognizing that we may ask you to do more, if required, to support other hospitals in your region,” Anderson said.
He added that limited ambulatory services may continue for some hospitals in low COVID-19 areas “recognizing that immediate ramp down may be required.”
Going forward, Ontario Health may also ask available healthcare workers and teams to support care in other parts of the system.
Anderson said Ontario Health will continuously monitor the ramp down in an effort to stabilize surgical capacity as soon as possible.
“These are very difficult and challenging times for all Ontarians, and we understand that deferring scheduled care will have an impact on patients and their families and caregivers.”
In March, the Ministry of Health instructed hospitals to put elective procedures on hold in order to preserve capacity for potential COVID-19 patients. The order then remained in effect until late May.
A study published by the Canadian Medical Association Journal in September estimated that the move to delay elective care amid the first wave resulted in a backlog of more than 184,000 surgeries. It said at the time that it could take upwards of 84 weeks to clear.
