Is it already too late for Ontario’s fall COVID-19 plan?

Hospitals, long-term-care homes, and others in the health-care sector have been waiting months for the government’s fall plan — now they’re starting to sound the alarm
By John Michael McGrath - Published on Sep 18, 2020
Premier Doug Ford speaks to the media in Guelph on September 15. (Stephen C. Host/CP)

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Premier Doug Ford reassured the people of Ontario, in response to a reporter’s question, that a plan for the fall, and a likely resurgence of COVID-19, was coming soon.

“I just got off a call with our health team and some of the best medical minds in the entire country, and that will be rolling out very shortly over the next little while,” Ford said. “So we have a plan that will be rolling out, and we’re prepared.”

The problem is, that was on July 14, during a press conference in Cambridge. More than two months later, representatives in the health-care sector say that the government has kept them waiting long enough.

“Speed really does matter,” says Anthony Dale, president and CEO of the Ontario Hospital Association. “I really can’t emphasize how important it is for that plan to get released — and released immediately.”

Dale’s core concern is that the government can’t just announce a plan and expect it to fall into place: it will need to be implemented by doctors, nurses, and other people in the hospitals he represents, and they will need time and resources to actually get things moving. The long lineups for COVID-19 testing this week are an example of how quickly the system can be overwhelmed.

“We’ve seen the lineups at different assessment centres over the last few days, and I think it’s a sign that we really need to be moving much faster,” Dale says. “Our sector is walking a very fine line at the moment. We can’t easily absorb another wave of COVID-19 patients.”

Dale acknowledges that, as any fall plan will certainly involve continuing or modifying measures that the government and hospitals already have in place, implementing those parts will be reasonably straightforward. But anything new — including, potentially, additional costs that hospitals may have to bear — will require time.

Hospitals have had to juggle not just the direct medical response to the pandemic, but also their role in the province’s testing and long-term-care interventions, when necessary. While some hospitals have been able to resume elective procedures since cases came down in the summer, the margins may be thinner than the public realizes: in Sudbury, Health Sciences North had to postpone surgeries for two days last week due to an inability to move “alternative level of care” patients out of the hospital and into long-term-care homes.

While HSN’s experience is partly the result of long-standing issues with hospital capacity in Sudbury, it’s an example of the kind of thing Ontario could see more of in the coming weeks. Hospitals haven’t worked through the backlog of procedures they incurred from the shutdown in the spring, and, while hospitalizations from COVID-19 are down across the province, not all recovered patients have been able to move on to other forms of care.

It is unlikely that Health Sciences North will be the last hospital that needs to postpone procedures as Ontario heads into the fall. And another round of outbreaks in long-term care could also cause the system to freeze up again: that makes news of a major outbreak in Ottawa (47 resident cases, at least 11 staff cases, and six deaths at the West End Villa home as of Thursday) another cause for concern.

But more than any one outbreak, it’s the overall rapid increase in cases across the province — 401 were reported on Friday morning, the highest since early June — that’s alarming.

Indeed, the LTC sector is suffering from a major staffing shortage, another element of the health-care system that predated COVID-19 but was made substantially worse because of it.

“We have a far more critical staffing shortage than we had in the spring. That’s the thing that’s really keeping us up at night,” says Donna Duncan, CEO of the Ontario Long Term Care Association, which represents about 70 per cent of LTC homes in Ontario.

“We know what worked in the spring: we got staffing help,” Duncan says. “We had the benefit of hospital employees helping, hospital infection-control specialists coming in and supporting us … the stabilizing workforce, and all of the assistance, is no longer available to us in a second wave, because hospitals are getting back to business as usual.”

Duncan says that there are beds in Ontario right now that could accept patients from hospitals — and ease the crunch in that part of the system — but that they can’t be filled, because there just aren’t enough workers. Getting those beds back into use would mean addressing the staffing shortage, and that would require a more robust system of supports for LTC workers.

“They need to feel supported; they need to feel safe,” Duncan says. “They need to know there’s going to be sufficient infection prevention and control, so we’re asking for the means to build that into every home in long-term care.”

Dale says that any fall strategy must properly account for LTC : “We cannot afford for the sector to be left vulnerable again in a second wave.”

Barry Rubin — one of the doctors leading the clinical-activity recovery team at the University Health Network in Toronto, which was responsible for coordinating the winding down of hospital activity when COVID-19 first struck — has praise for the government’s cautious approach so far in the pandemic.

“I’m just so impressed with the way they’ve paid attention to the numbers and are willing to react to those numbers,” Rubin says. “And, unlike some other jurisdictions, they’ve really been proactive about these things.”

Any fall plan, he says, will need to ensure that hospitals have sufficient staff and PPE and that they’re able to coordinate care across multiple institutions to maximize the use of existing resources.

If one or more hospitals do need to shut their doors, even temporarily, the situation likely won’t be as chaotic as it was in the spring, Rubin says, adding that he saw first-hand how hospitals were able to ramp down their procedures then — and how quickly they pivoted to such things as virtual health care, after decades of debates over how to do it.

“I have actually not seen a patient in-person since March,” Rubin says. “The patients uniformly love it … If they have X-rays, CAT scans, or so on, I can put it on the screen. There’s no risk of COVID — they don’t have to wait for me in a waiting room, and they don’t have to pay for parking.”

Rubin does, though, have two concerns about the hospital system heading into the fall: the long wait-lists that have been generated from the shutdowns in the spring and the physical and mental well-being of hospital staff. Hospital administrators have needed to be realistic about what staff can do in the midst of a pandemic.

“If you can’t make a meeting in the morning because you’re getting a child ready for school, nobody’s admonishing you for that. It’s all good: we’ll catch you up later,” Rubin says.

It’s never too late,” says Dale. “The good news is that hospitals are very resilient organizations. They’re well-positioned to adapt quickly. The point is, we know this pandemic doesn’t slow down. It only accelerates. Time is of the essence, and the perfect is the enemy of the good.”

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