Ontario’s failure to control the third wave of the pandemic has led to a massive surge in COVID-19 cases in hospitals with devastating consequences on the delivery of health care to millions of Canadians.
“Our hospital system is literally buckling,” said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003.
“There is no way out of the next three weeks, because it takes that long to see an impact on serious illness and death after you start public health measures. That’s awful.”
Ontario extended its stay-at-home order to at least six weeks in an attempt to stem the exponential rise in COVID-19 cases, in addition to lowering capacity at essential retailers to 25 per cent, restricting outdoor gatherings, and setting up checkpoints at provincial borders with Quebec and Manitoba as of Saturday.
McGeer says unless Ontarians can limit their contacts as much as possible and flatten the curve by following the stricter public health measures, the level of care inside hospitals will continue to suffer.
“If we don’t move now, we literally will be facing what New York City and Italy faced in the first wave, and that is much more severe,” she said.
“That is the circumstance in which we’re going to have to say we cannot deliver the care that Canadian health-care workers expect to deliver or that Canadians expect to get.”
McGeer says that while she can sympathize with people who are tired, angry and completely worn down by the pandemic more than a year after it began, “we will not have our health-care system” if we don’t do everything possible to stop the third wave.
“There’s no doubt this is the worst crisis we’ve seen in hospitals in Ontario in our lifetimes,” said Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at the Unity Health Toronto hospital network. “This is totally unprecedented.”
More than 700 patients with COVID-19 are currently fighting for their lives in Ontario ICUs and that number is projected to rise to more than 1,000 by the end of April.
“If you get in a car accident, and you end up needing surgery and that surgery goes awry, there may not be any more ICU beds for you,” said Dr. Noah Ivers, a family physician and associate professor in the department of family medicine at the University of Toronto.
“This is me and you and your kids and your mom. This is at the point where it’s affecting all of us. So even if you’re not afraid of COVID, you should be afraid of this.”
Dhalla says ICUs typically have one nurse on hand for every patient, but there are many hospitals in Ontario where that is currently not possible because of the surging third wave.
“We know that even with the best possible care, somewhere between 20 and 30 per cent of people who end up in an intensive care unit with COVID are going to die,” he said.
“Hundreds of Ontarians will die during Wave 3, and in my view, every single one of those deaths was preventable.”
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Field hospitals are being set up to ease the burden of overflowing ICUs in Toronto, hospital staff are being redirected to the front lines and health-care workers could be forced to make devastating decisions about who lives and who dies in the brutal weeks ahead.
“We’re planning for the worst,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto.
“The worst-case scenario is we’re doing things that are just awful, like triage of patients. All of that’s a reality and it’s all being dusted off again.”
‘Scar’ across Ontario’s health-care system
Health-care workers are bearing the brunt of the pandemic on the front lines, with burnout a clear and present danger that further threatens hospitals.
“There is a scar that’s going to be put across the health-care system with all of what’s happened and it’s really sad to see,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton.
“I see it in the eyes of a lot of people there that are just stretched beyond belief and just kind of bewildered by the next few months and what the last 14 months have been.”
Hota says she is now used to having a “sick feeling” in her stomach all the time, but she and her colleagues carry on with their work inside the hospital regardless.
“It’s not like it’s coming without a toll. We all feel it. We aren’t robots. We’re going through this like everybody else,” she said. “It’s a lot for people to manage.”
Dhalla says the fatigue health-care workers are dealing with now is not the typical burnout they face on a regular basis.
WATCH | Inside some of Canada’s hardest-hit hospitals in the 3rd wave of COVID-19:
“This is a different kind of burnout, that I think some experts call moral injury, and a big contributor to the burnout is the feeling that we have been let down,” he said.
“That’s very different than in the first wave. In the first wave, I don’t think anybody felt that the government could have prevented it.”
Pleas for help, but few resources to spare
Ontario Premier Doug Ford has requested additional health-care workers from other provinces to help staff ICUs, but so far only Newfoundland and Labrador has committed to sending additional personnel.
The Canadian Medical Association also made a desperate plea Friday for “province-to-province collaboration” and “national leadership” to address the “scale and severity” of the pandemic and redeploy resources to hard-hit areas to “save the most lives.”
“Any measures taken now will take time to have an impact given the lag from exposure to disease,” the statement says. “We must act now.”
But Alberta, Saskatchewan, Quebec, Nova Scotia and Prince Edward Island rejected the notion of redeploying health-care workers, as they’re already short of resources and the spread of coronavirus variants across the country could spark outbreaks at any time.
Dhalla says it’s hard to imagine that any other provinces would actually have a sufficient number of staff that could be deployed to Ontario to stop the worsening crisis in hospitals.
“The fact that we are even talking about that more than a year later is really just a sign of how badly we failed,” he said.
Ontario Health Minister Christine Elliott said this week the province is trying to open up hundreds of additional ICU beds in the coming days and weeks.
Ontario is expected to make a formal request to the federal government for more than 600 critical care staff to help support the province’s hospitals, CBC News has learned.
But Chagla says sending more vaccines to Ontario may make more of an impact than sending health-care workers from other provinces.
“As bad as it sounds, especially in places where the pandemic is raging, the federal government needs to think about redeploying vaccines,” he said.
McGeer said that while Ontario would be grateful for any additional resources, pulling staff from other parts of the country doesn’t seem like a viable solution.
“In terms of the health-care system, this is unquestionably far worse than it’s ever been. I think it was scarier in March of 2020 when we knew much less about what we were facing,” she said.
“I don’t know how we’re going to respond and how we’re going to get through this.”
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