At the North Bay Regional Health Centre, doctor Jennifer Mihill is preparing to treat patients from more than 300 kilometres to the south. “Any day, we could be asked to ramp down in order to accommodate ICU patients from Toronto,” says the NBRHC’s COVID-19 critical-care-preparedness lead.
On April 12, hospitals in southern Ontario were told to ramp down elective surgeries and non-emergency activities, according to a memo from Ontario Health CEO Matthew Anderson: “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.” While the instructions didn’t apply to northern Ontario, “hospitals in this region should be prepared to ramp down quickly, in the near future, if requested to do so,” the memo says.
Mihill receives notice of patient transfers from the Ontario Critical Care Command Centre: “We receive a complete list of where patients are going from what hospital to what hospital.” As ICU capacity fills in southern Ontario, NBRHC is among the hospitals in the province’s north that are monitoring the situation and getting ready to receive COVID-patient transfers from outside the region. A spokesperson for NBRHC tells TVO.org via email that it is “in discussions on how our Health Centre can support hospitals in southern Ontario facing unprecedented critical care volumes. We are waiting on provincial direction from the Ontario Critical Care COVID-19 Command Centre.”
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So far, Mihill says, patients from the south have been transferred as far north as Orillia. According to Ornge, the air-ambulance service “is working with local paramedic services throughout Southern Ontario who have been transferring stable, less critically ill patients to create capacity. Ornge has been transporting critical care patients.” Between April 1 and 18, Ornge and local paramedic services transported a total of 498 patients — more than the total number of such transports in the previous two months combined. Over the last few days, Ornge says it has had an average of 30 to 40 patient transports per day. “Ornge is transporting ICU COVID patients to create capacity in airplanes, helicopters and our critical care land ambulances,” an Ornge spokesperson tells TVO.org via email. “We started to see an increase in transfers in March with a significant increase in demand into April.”
Ontario Health says that northern Ontario hospitals have not been told to ramp down their activities but that a move to do so would be based on such factors as the community’s rate of transmission and how many patients require transferring. “The situation in the rest of the province will also factor into the decision given that health human resources, and other resources, may need to be shared in unique ways,” an Ontario Health spokesperson says in an email. “A small number of patients might be able to be accommodated without ramp down.” (The Ministry of Health referred TVO.org to Ontario Health when asked for comment.)
A spokesperson for the Sault Area Hospital confirmed to TVO.org in an email that it’s received notice from the OCCC to expect ICU patients from southern Ontario, though no request has been made yet. “We have reviewed our elective and non-elective surgical cases, we are reviewing and updating our surge plans, and we have expanded our critical care capacity,” they say, noting that the ICU has 22 beds. “Our patient volumes in critical care are stable at this time and our health care workers are prepared if or when the landscape changes.”
It’s a common refrain from health-care facilities across the region. A spokesperson for Health Sciences North, in Sudbury, says in a statement that “patient transfers of COVID positive patients to northern Ontario hospitals and specifically to HSN’s ICU are expected, however no request has been made at this time.” A spokesperson for the Thunder Bay Regional Health Sciences Centre says, “TBRHSC is prepared with expansion plans for our intensive care unit if required” but directed further comment to the Ministry of Health.
Patient transfers are nothing new for the West Parry Sound Health Centre, according to Wil Smith, the hospital’s chief of staff — but usually the patients are departing. “Every day at West Parry Sound Health Centre, our patients and care teams benefit from the ability to send patients to hospitals where they will receive a higher level of care,” Smith tells TVO.org via an emailed statement. “We now stand prepared to return that service to our partners in the provincial health-care system.” Smith adds that they have yet to receive patients but that the hospital is “participating with regional and provincial partners as they share information about the movement of patients, and we are paying very close attention to our own capacity.”
The NBRHC has had a surge plan for more than a year, according to Mihill — the hospital’s ICU normally has 16 beds and, in surge capacity, it can accommodate an extra 12. “In a pinch, we do have our operating rooms that are operating on ventilators; that would be a very last-resort situation,” she adds, noting that this would create staffing issues. “We have enough ventilators and physical space, but we then will be running out of trained personnel.” Health Sciences North also has room for additional beds: “When required to do so, HSN can increase its 41-bed ICU by 12 beds,” says an HSN spokesperson. “HSN can also provide care to 35 non-critical care COVID patients in its Respiratory Care Unit.” As of Monday, HSN has 21 confirmed COVID-19 patients, three of whom are in the ICU. According to the North Bay Parry Sound Health Unit, there are two COVID-19 patients hospitalized in Nipissing District.
While the third wave has not led to capacity issues in the northwest, Peter Voros, COVID-19 incident manager for the TBRHSC, notes that there has been a lag between developments in the region and in the south of the province. “We’re in a situation in northern Ontario where our current reality of COVID is not exactly the same as in southern Ontario,” he said on April 9. “We’re not seeing as many of the variants of concern as they are and certainly not seeing as many admissions as they are, but, typically, in the northwest, we’ve been a few weeks behind what’s happening in southern Ontario.”
However, because of previous ramp-downs in non-essential activities, he says, the hospital remains behind on surgeries: “We have about a year and a half backlog of surgery to make up … winding down will increase that backlog and will take us longer to recover.” Both NBRHC and HSN say their wait-lists are near pre-pandemic levels. “We spent a good six months catching up” over the summer, says Mihill. “But now we’re back on track.”
Mihill has the following advice for NBRHC patients worried about the possibility that a surgery or appointment will be postponed: “Assume that your surgery will take place. You will hear from us if anything starts to change here. We do try to give a lot of leeway because we understand that people go through quite a bit to get surgery.” Those whose surgeries have been postponed will be prioritized once the ramp-downs are over, he says.
Given the potential for a ramp-down, Voros says, it’s crucial for Thunder Bay residents to follow public-health advice: “As a community, if we pull together and stay home and only leave our homes when we have to continue to isolate, we hope we can avoid the third wave.”
His staff, he says, are “incredibly dedicated people who have been working incredibly hard for 13 months to do what needs to be done. They’re tired — the entire world is really tired. But they’re professionals, and they’re digging deep and preparing … We’re saying to everybody, ‘Be ready; get rest when you can. Because if wave three comes, we’re going to need everybody on board.”
This is one in a series of stories about issues affecting northeastern Ontario. It's brought to you with the assistance of Laurentian University.
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