Ontario hospitals to ‘ramp down’ on elective procedures starting Monday amidst spike in hospitalizations

A memo released on Thursday by Ontario Health President and CEO Matthew Anderson told hospital CEOs and primary care providers to "ramp down" elective procedures beginning Monday, April 12 and 12:01 am. He said the need to scale back would "preserve critical care and human resource capacity" as the third wave of the COVID-19 pandemic takes its toll on hospitals.

"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,” Anderson wrote.

There were a record-setting 525 people with COVID-19 in ICUs across Ontario Thursday, a little more than 100 higher than the province's wave two peak.

That record was broken again Friday, with 541, with 356 of those on ventilators, according to a tweet from Dr. Kali Barrett with data from Critical care Services Ontario.

If current trends continue, even with the province-wide lockdown now in effect, ICU occupancy could be nearing 800 people daily, according to new modeling data.

In a response to Anderson's memo, Ontario Hospital Association President and CEO Anthony Dale said in order to provide proper care for the influx of COVID-19 patients, a redeployment of staff and resources would be necessary.

"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 wrote in a tweet Thursday.

Jhanvi Solanki, Director of Surgery at Humber River Hospital told CP24 about the overwhelming amount of patients coming in, and the lack of beds and staff for those patients. Some had to be transferred as far as London and Kingston, Ontario.

"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," said Solanki.

Many experts are worried that in the face of increasing hospitalizations, triaging patients may be on the horizon.

On Thursday, Ontario Health Minister Christine Elliott said that the province is finalizing its protocols do deal with a life-saving treatment hierarchy is ICUs get overwhelmed.

Solanki said that last year, her hospital created a plan for setting up triage and screening if the situation should ever arise.

"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," she said.

Anderson said that Northern Ontario Health Region hospitals, as well as pediatric hospitals should not ramp down, but be ready if requested in the near future.

"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," he said.

Anderson said that they will be monitoring ramp downs to in an effort to stabilize surgical capacity and allow staff and resources to recover.

"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," said Anderson.