Why Ontario hospitals are full to bursting, despite few COVID-19 patients

Some of Ontario's largest hospitals are nearing or exceeding full capacity even before flu season and the second wave of COVID-19 bring an expected surge in new patients. 

Data obtained by CBC News shows that the acute care wards of a dozen major hospitals were filled above 95 per cent of their funded capacity for more than half the days in September and early October. 

Those rates significantly exceed the province's maximum occupancy target of 85 per cent. That was set earlier this year for hospitals to get the green light to resume scheduled surgeries, such as organ transplants, cancer operations and cardiac surgeries, basically halted during the pandemic's first wave. 

Many of the hospitals running at or over capacity are in Ottawa and the Greater Toronto Area, the regions hit hardest by COVID-19 cases this fall. However some hospitals outside those regions are also full to bursting, including in Sudbury, Hamilton, the Niagara region, and Peterborough. 

The data suggests many hospitals have returned to the overcrowding levels seen before the pandemic, when CBC News revealed hospitals filled beyond capacity nearly every single day, with patients housed in hallways, conference rooms and cafeterias not as exceptional cases, but as a matter of routine. 

Most of Ontario's large community hospitals are effectively full, said Anthony Dale, CEO of the Ontario Hospital Association.

"Hospitals are walking across a tightrope right now," said Dale in an interview.

"We're back to where we were pre-COVID with the risk of hallway health care. And you can't have hallway health care in a pandemic because of the need for infection prevention and control." 

Hospital occupancy levels typically peak in winter, a key reason behind the province's push to keep the number of COVID-19 cases down this fall. 

"The real fear here is that we see those (COVID) numbers really get sky high and start to overwhelm hospitals through the fall and in winter," Dale said. "It's January and February especially where hospitals are just rammed with patients because of flu season." 

Health Minister Christine Elliott says the government is providing hospitals with enough new funding to allow them to deal with the expected growth in patients from the combined effects of flu season, COVID-19, and clearing the surgical backlog from spring. 

"We're always concerned when hospitals get over 100 per cent [occupancy], particularly now with the second wave of COVID and with flu season approaching." Elliott told reporters at Queen's Park.

"We know that we need to create capacity and we are doing that now."  

Elliott referred to recent announcements by the government, pledging a total of $351 million for 2,250 new beds in 57 hospital facilities around the province. 

CBC News asked for a list of the hospitals getting additional funding and the number of beds for each, but a spokesperson for Elliott declined, saying more details will be communicated in the coming days and weeks. 

The increased funding to add bed capacity does not necessarily mean hospitals will hire more nursing staff to care for the additional patients, said Vicki McKenna, a registered nurse and president of the Ontario Nurses Association. 

"Nurses are working beyond their normal hours and being requested on a regular basis to cover for vacancies," said McKenna in an interview. 

"I've got to tell you, they're weary, they're tired," she said.

"How long can they continue to work at this pace and deliver the care that they need to and that they want to? That's what they're worried about when they're stretched so thin." 

McKenna said she has heard from nurses in hospitals that are currently running over capacity who are concerned about what the coming winter will bring.  

CBC News has obtained daily occupancy data for Ontario's hospitals through freedom of information requests, as the detailed numbers are not made public. 

The figures show that last winter, despite the government's promise to end so-called "hallway health care," acute care occupancy rates hit unprecedented levels, with many hospitals filled beyond capacity for weeks. 

Other publicly available information shows that patients admitted to hospital through the emergency room faced record-long waits to get a bed in the acute care wards last winter, averaging more than 18 hours at the peak in January. 

That wait time figure is considered a rough barometer of hospital overcrowding. 

It dropped sharply this spring after the pandemic was declared, as hospitals cancelled scheduled surgeries and saw a steep decline in emergency room visits. Since bottoming out in April, however, the wait time has steadily risen, reaching 14.2 hours in August, the latest month for which the statistic is available.  

More recent data suggests a range of hospitals around Ontario have been at or near capacity since early September. 

• Acute care wards in hospitals in Ottawa are at 101 per cent of capacity, according to Ottawa Public Health's COVID-19 dashboard. 
• Peterborough Regional Health Centre was above 100 per cent of its funded capacity in acute care nearly every day in September and early October.
• Hamilton General has exceeded 95 per cent capacity almost daily since Sept. 1. 
• Health Sciences North, in Sudbury, exceeded the 100 per cent capacity mark in acute care on all but five days in September.   

Patients sick with COVID-19 are not the biggest driver of hospital occupancy in Ontario right now. Modelling released Thursday by the province shows the increase in patients admitted to hospital with the novel coronavirus is actually slower than what was anticipated for the second wave of the pandemic. 

Province-wide figures published Sunday showed 350 patients in hospital with confirmed cases of COVID-19, including 72 in intensive care. 

Although those numbers remain well below the spring peaks, Dale is frustrated by social media commenters who use Ontario's hospitalization statistics to cast doubt on the severity of the pandemic and the need for public health restrictions. 

The hospitals are already so full that any significant increase in patients with COVID-19 "completely destabilizes all the other activity that hospitals need to be doing," Dale said. 

"Our staff are stretched," said Sonya Canzian, executive vice-president of clinical programs for Unity Health, which includes St. Michael's and St. Joseph's hospitals in Toronto. St. Michael's averaged 95 per cent of funded capacity in acute care through September and early October. 

"Everybody in every corner of the institution is working very hard to accommodate the demand that's at our doorstep," Canzian said in an interview.

"It does take its toll over time, and people are tired, but people are committed to delivering excellent care to our patients." 

The Unity Health hospitals have not had to accommodate patients in hallways so far this fall, said Canzian. She said staff are trying their best to move patients out of the emergency rooms as quickly as possible to prevent any overcrowding, and said the hospitals have contingency plans to reduce some services if faced with a high influx of COVID or flu patients. 

One of the first hospitals to be approved to resume scheduled surgeries after the first wave of the pandemic subsided was Peterborough Regional 

"Because cases of COVID-19 in our community have remained low, we have been able to continue providing non-urgent care over the last five months, which has contributed to our higher patient volumes," said the hospital's vice president and chief medical executive Dr. Lynn Mikula in a statement.

"We have surge strategies in place to address patient volumes when they exceed our capacity."  

Hospitals around Ontario are trying to free up beds through a range of methods, including creating temporary overflow wards in parking lots, a solution employed by both Ottawa's Civic Hospital and Barrie's Royal Victoria Hospital  

Increased expenses and decreased revenues from April through June have left hospitals with a funding shortfall of $850 million, according to the Ontario Hospital Association's estimates.

Dale says this results from the costs of running assessment centres, expanding labs, and assisting long-term care homes, combined with lower revenues from such sources as performing fewer provincially-funded procedures and less use of hospital parking. 

The OHA is hoping the provincial budget on Thursday will cover that deficit.