Ontario emergency rooms fill up again as COVID-19 fears ebb, patients with other illnesses return

Ontario's emergency rooms are getting busier as most of the province prepares to enter Stage 3 of the recovery from COVID-19, and some doctors are warning patients are coming in with more serious illness after avoiding seeking care at the height of the pandemic.

The most recent data from Health Quality Ontario shows there's an average wait time of 11.2 hours before patients are admitted to hospital. That's a steep drop from a record average wait of 18.3 hours in January of this year, but still an increase from an average wait time of nine hours recorded at the height of the pandemic. 

Dr. Erin O'Connor, deputy medical director for the University Health Network's emergency departments at Toronto General and Toronto Western hospitals, said at the peak of the pandemic her facilities were dealing with just 50 per cent of their normal volume. Now she's worried about what the results of that "drastic" decrease will be.

"People stopped presenting to emergency departments for things that they really should have been presenting to the departments for," she told CBC Toronto.

"We saw a decrease in [heart attack and stroke] presentations and the thought was that likely people were still having these events but were staying home."

When patients did finally go to the emergency department, some did so late and with deteriorating health conditions.

"We know that delayed presentations for these things really result in poor outcomes. I think what's most heartbreaking for all of us is knowing that decisions needed to be made," O'Connor said.

Doctors and hospital officials are bracing for a surge in people flooding back to emergency rooms to seek medical help that's unrelated to the novel coronavirus, especially as flu season approaches and even as COVID-19 is still infecting more than 100 people per day across the province.

Meanwhile, the Ontario Ministry of Health said it's creating a plan that will optimize capacity across all sectors and help treat patients who have been waiting for elective surgeries that were postponed or cancelled due to the pandemic. 

Hallway medicine isn't safe, doctor says

In a statement to CBC Toronto, the ministry addressed the growing concern felt by doctors like O'Connor about the increase in patient volume, given Ontario hospitals' history with overcapacity and the use of hallway medicine. 

"In 2020-21, the ministry will invest an additional $594 million in the hospital sector to accelerate progress on the government's commitment to address capacity issues," the statement read, referencing their March announcement on funding.

The province intends to use the money to help publicly funded hospitals continue providing high-quality care to their patients and "support the ending of hallway health care in hospitals."

O'Connor said her facilities are looking at extending the COVID-19 protocols put in place to prepare for a second wave of cases: making use of and maximizing existing spaces; erecting tents in parking lots to help with physical distancing; and installing Plexiglas to make shared rooms more isolated and safe. 

"But what we are not willing to do is to go back to the situation where we had patients in hallways. It is not safe, particularly when you have a certain amount of virus circulating in the community," she said.

Ontario must prepare for second surge: OHA

"A contingency plan is needed to ensure the health-care system is equipped for a potential second surge, including the creation of regional health service and staffing plans that must be in place at the earliest opportunity," said Anthony Dale, president and CEO of the Ontario Hospital Association (OHA), in a statement Monday evening. 

Dale said the OHA recommends that the government support the "widespread expansion" of home care and community services, virtual care, and maintenance or construction of new, temporary infrastructures to use to fight overcapacity issues, such as field hospitals and decommissioned buildings. 

At a Tuesday news conference, Premier Doug Ford touted his government's forthcoming plan to deal with a potential second wave of COVID-19, saying Ontario is now "100 times better and more prepared now with health care and PPE."

The province is also launching a long-term care pilot project Tuesday morning, which the government says is another step toward ending hallway healthcare — something Ford promised to do during the 2018 election campaign. 

The project, in partnership with North York General Hospital, would give alternate level of care (ALC) hospital patients priority access to a long-term care home, a government statement read. 

Dale said the number of patients currently waiting in Ontario hospitals for an ALC, like home care or a long-term care home, is "well over 5,000."

Ontarians have to play their part

But O'Connor said the province isn't the only body responsible for the public's health, saying citizens of Ontario have to do their part as well. 

"We need to think about how to protect each other so that things don't become overwhelming," she said.

"We have to remember that still keeping physically distanced, making sure your bubble is not too large, washing your hands, wearing masks ... [is] what's going to keep this big second wave surge from happening."