Another day, another record number of COVID-19 cases in Ontario.
The province reported 4,249 new positives on Friday, far surpassing the previous single-day record set on Thursday.
As hospital beds fill up and intensive-care units become overwhelmed, TVO.org speaks to Anthony Dale, CEO of the Ontario Hospital Association, about our struggling health-care system — and how much more it can take.
TVO.org: It’s been a difficult few days. How are you feeling?
Anthony Dale: I am more worried than I've ever been in my life about the ability of our hospitals to meet the needs of the people of Ontario.
TVO.org: The numbers today are pretty grim. We’re approaching 400 patients in ICU, and hospitals are now preparing to move patients into different facilities and different regions. Can you help me understand what that looks like within hospitals?
Dale: There's nothing normal about what's happening in hospitals today. Already, and it's still only early January, we're seeing growing numbers of COVID patients needing hospitalization — historic highs, actually, and historic highs in terms of occupancy in intensive care. So there is already a massive amount of avoidable death and suffering going on in this province. At these trajectories, that is only going to get worse — all from COVID.
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What's also going on, though, is we are now crowding out — very aggressively — many other kinds of necessary health services that people continue to need. Cancer doesn't stop because of COVID; heart disease doesn't stop because of COVID; organ transplants don't stop because of COVID. Based on the forecasts from Ontario Health, by January 24 or so, we'll see more than 500 patients in the ICU and more than 1,700 patients in hospital with COVID. By a month later, February 24, we will absolutely have exceeded our health system’s capability of caring for COVID patients, and all the other people needing other forms of life-saving care.
TVO.org: As an outsider to the health-care system, what does that mean? It sounds very grim, and I'm sure it is very grim, but once we’ve exceeded our capabilities, what happens next?
Dale: Already, because of the crowding-out of elective activities, our society is now making terrible ethical trade-off decisions about who gets access to care they need, and who doesn't. In a situation like I've described — where we are headed for February 24 or so — it’s a situation where the health system is in a state gridlock, with huge amounts of resources devoted to trying to save people's lives from COVID-19 and thousands of people over time being denied access to the other care they need.
I just can't say it any other way: we are heading to that place that no one ever wanted us to go. That's for sure. Maybe people somehow blindly believe that it can't happen in Ontario because of the faith they have in our public health-care system? I don't really know. We do know that we have out-of-control COVID-19 community spread. We know that while many people in Ontario continue to do all the right things in terms of the public health measures that are necessary to keep us all safe, too many people aren't. We know that the virus is spreading, especially over the holidays, in small gatherings of family and friends. What's done is done. There's precious little we can do to avoid that scenario, unfortunately, if these trends keep up — and all evidence suggests they are going to keep up.
Our society is about to pay a terrible price.
TVO.org: You mentioned the gatherings. I think there’s still an idea out there that the virus is spreading in long-term care or in workplaces. Have you noticed a change in the demographics of patients coming into hospitals?
Dale: I'm not a clinician, but I speak to clinicians all the time who are caring for COVID patients, and the leaders of the organizations that are caring for patients. And absolutely, in the past month or six weeks, there's plenty of evidence to suggest that the kinds of patients being hospitalized are much more diverse than people think. There’s a lot more younger people — and by young, I mean people between the ages of 25 and 50, who shouldn't be getting this disease but are. It's just because community spread is literally out of control.
Nobody is safe from COVID-19, I can tell you that. I have a family member in England right now who just spent several days in hospital. You know, he followed the rules for the whole year. In Britain, they have a similar system to Ontario with a series of stages that different regions go under based on their community spread. Where he lives, he was told that it was fine to go into restaurants. So, he went out toward Christmas with his family, for a birthday meal. It was the first time he'd been out in months. Three days later, he tested positive for COVID. Because he has asthma, it has been brutal on him. He's back home now, but he has a blood clot in his lung, and that will be with him for a very long time. He’s 49.
This disease is ruthless. And if it can, it will take advantage of all the things people appear willing to do to allow community spread to continue. The virus exists to spread, there's no other way to put it.
TVO.org: I’m very sorry to hear about your family member; I hope the best for him.
Dale: Thank you.
TVO.org: For the people in Ontario who are following the rules, is there anything that they’re missing that they should know? Any behaviours they should ditch or adopt?
Dale: I do think it's confusing for people, 100 per cent. We get different messages federally, provincially, and locally from public-health officials. But the foundational things that people need to be doing, we can all agree on. Unfortunately, you can't see in-person someone who's not within your household. Period. I know the City of Toronto, the medical officer of health feels that, outside, people should be wearing masks out of an abundance of caution. Personally, I've advised my siblings that, if they do have to go into a grocery store, or if they're inside the LCBO, or some place like that, in addition to a mask, I personally wear a face shield. But again, we really should only be going out for the most essential of things. I can't put it more simply than that.
TVO.org: Is the face shield for the eyes?
Dale: Yeah, exactly. It’s protective. Masks largely protect others from you; I choose to wear a face shield to protect myself — especially my eyes.
TVO.org: Many have spoken about the mental-health burden carried by workers in hospitals. What is the mood inside today? Has the presence of vaccines helped?
Dale: Well, people who work in health care are resilient, and they got into this work because they want to make a difference and care for people and use their skills to make people better if they if they can. So, for people who are on the vaccination program — and keep in mind, it's concentrated right now primarily in Toronto and the GTA, spreading soon to other communities — yeah, sure. There is a huge psychological lift to be part of that program. And if they're getting the vaccine themselves, you can see the lift that it gives them right away.
But I would have to say that the mood in the field right now is a combination of trepidation, a kind of angry anxiety over what's about to happen, and the realization that we have horror looming here. It's already very difficult, but we have a horrible situation about to unfold. What Ontario Health has done, with our strong support, is implement measures that are required to respond to this heightened state of emergency. Those are mitigating efforts, though. They are not preventative efforts any longer.
I sometimes wonder if the province shouldn't, for the power of simply stating the words, re-declare the state of emergency. The province has maintained its emergency powers needed to respond to the pandemic, but the state of emergency was rescinded some time ago. I think that is a powerful kind of statement, because that's where we are. We are effectively in a state of emergency in the hospital sector, and I don't know that the rest of the province fully appreciates that. I simply don't think that many people in the general public really understand what is about to happen here.
TVO.org: My last question was going to be, moving forward, what have hospitals learned from this crisis point? But now I wonder whether that question is even worth asking, given that there's still so much to come, and the focus should be on that.
Dale: No, it's a very good question. The hospital sector has been through a lot over the past 20 years. What Ontario has, that I am so proud to be a part of as CEO of the OHA, are some incredibly resilient and courageous and durable organizations that have responded valiantly so far to this pandemic. They are really the anchor of the provincial response. That commitment will be unceasing over the next two months.
What they've learned is that they're capable of remarkable things, but they've also increasingly learned that they need help from their provider colleagues. Whether it's working with primary care to get assessment centres up and running and all the testing in place for the past 10 months; working so closely with the long-term-care homes that have needed help from hospitals; of course, vaccines — another example where they've been asked to start the vaccination program, but the vaccination program will only succeed over the next year if it's done with public health, with the strong involvement of family medicine and nurse practitioners. That's the only way a mass-vaccination program will succeed.
It's those two things that I think they've come to fully appreciate: how resilient they are, and the importance of integrated services and an integrated approach to caring for people. If anything, that will be the legacy of COVID-19. Ontario’s health-care system cannot go back to the siloed, splintered thinking has characterized it for so many years. We really have to learn from this and make the changes that are needed, not just to prepare for some future pandemic, but also to meet the ongoing needs of the people of Ontario — especially our vulnerable seniors.
TVO.org: It strikes me that that is very similar to the lessons we were meant to learn from SARS. How optimistic are you that we will learn these lessons properly?
Dale: Within acute-care hospitals especially, the lessons of SARS were profound. It has been a major factor in why acute care has been so prepared for the pandemic. Especially our infection prevention and control professionals in leadership positions were working for months before March hit, to prepare. In general, I think the sector has done as best as it possibly can under the circumstances. The lessons about infection prevention and control for long-term care are profound. It's the the absence of that capability in too many long-term-care homes that has led to unnecessary death and harm to those residents.
So certainly, I would hope and believe that a legacy of this will be a complete rethink of how we provide care and support for our frail seniors. That, to me, is what we will need to concentrate on when this pandemic is finally under control and behind us. Do we have the right models of care for our frail seniors? And there's much work to do to make sure that, into the future, they are protected, not only from infection and disease like COVID-19, but that we have the right to models of care to give them a good quality of life — a happy life and a safe life in the autumn of their years.
This interview has been condensed and edited for length and clarity.
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