For Anthony Dale, president and CEO of the Ontario Hospital Association, all the complexity and details of health-care policy in the middle of COVID-19 boil down to something pretty simple.
“You can’t have hallway medicine in a pandemic,” he says. “We can’t go back to the way it was before COVID hit, with some hospitals at 140 per cent occupancy.”
Dale has been ringing the alarm bells for weeks now about the capacity of Ontario’s hospitals to handle a potential second wave of COVID-19 in the fall. At first, this may seem confusing: as of Thursday, the number of patients hospitalized with the coronavirus had fallen consistently for days. It’s now nearly half what it was at the peak of the pandemic: 530 today versus 1,043 in early May.
But these numbers don’t tell the whole story.
“It’s amazing to see those numbers coming down rapidly … that’s where we want to be, and even lower,” Dale says. “But I think, as a province, we’re so obsessed with today and tomorrow, and we’re not yet looking at the next big wave of COVID-19 that many experts say is inevitable with a pandemic like this.”
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With many long-term-care homes still battling COVID-19 outbreaks and others trying to reduce the number of beds to prevent a resurgence of the virus, many patients are piling up in hospital beds with nowhere to go.
The number of “alternate level of care” patients — people who are in hospital beds but don’t need hospital-level care and should probably be in an LTC or being served by home care — keeps growing, and the number of available beds is shrinking.
Data provided by the OHA tell the story of Ontario’s battle with COVID-19 so far. In March, as the province was bracing for the virus to start exploding, there were 5,200 ALC patients, and some hospitals were at more than 100 per cent of their bed capacity. In the early days of the disease, hospitals shut down elective procedures and freed up as many beds as they could; by April 9, there were only 4,000 ALC patients, and occupancy in hospitals provincewide was at record lows (even as some hospitals had occupancy that stayed above 80 per cent).
As of early June, however, the number of ALC patients is back to 5,200, and some of the province’s largest hospitals are back above 90 per cent occupancy.
“That’s a trend that should catch everyone’s attention,” says Dale. “We still have a rescue operation underway in several long-term-care homes, there are a lot of to-dos on the hospital to-do list, and we don’t want to be unprepared for the next wave … Let’s start planning quick, while the situation is a lot more stable that it has been lately.”
Dale says that, as LTC homes will likely not be able to resume full normal intake for the foreseeable future, the province needs to plan for an expansion of home care and virtual care to get patients out of hospital beds while still meeting their needs. And the province should probably still be ready to make even more substantial moves, if necessary: “I do think the reality is we’re going to need to have, at the ready, alternative facilities like field hospitals, using large spaces like hockey arenas, and decommissioned hotels are all going to have to be under serious consideration as part of the contingency plan.”
Minister of Health Christine Elliott has discussed this problem with Dale, and the government has committed funds for the expansion of bed capacity, including $124 million to create more than 1,000 spaces in retirement homes and other congregate-care settings.
“Collectively, these project will help to move more than 20,000 patients designated ALC, out of hospital to a more appropriate transitional care setting, freeing up critical hospital beds for persons requiring acute level care,” Elliott spokesperson Hayley Chazan told TVO.org in an email. “We are continuing to explore alternative opportunities to further enhance efforts already under way.”
Not every region of Ontario faces the same pressures. Even in the GTA, not every hospital is dealing with the same challenges.
Mark Fam, vice-president of clinical programs at Michael Garron Hospital, in Toronto, agrees with Dale’s assessment of the systemic issues — although he says Michael Garron is prepared for a possible second wave: “We’re seeing about double the number of ALC patients we’d normally expect this time of year, which really reflects what’s been happening with COVID-19. Something like a third of our acute beds are filled with ALC patients.”
In order to try to preserve beds, doctors and nurses from Michael Garron have been working in LTC homes to help contain COVID-19 outbreaks. And, like other hospitals, they’ve also created programs to help COVID-19 patients who might still be ill — but don’t need continuous care —recover outside of hospital.
Fam says they’re trying to figure out how they can adapt and prepare such that they wouldn’t have to shut down elective procedures (as all Ontario hospitals had to this spring) in the event of a second wave.
“We’ve got a lot of work underway right now to plan for exactly that,” Fam says. “But I’m confident we’ll be able to respond should another wave come.”