Canadian ER visits dropped by half during 1st wave of pandemic, national data shows

Emergency and operating rooms across the country were historically empty during the first months of the pandemic, according to national data compiled by the Canadian Institute for Health Information (CIHI).

The biggest dips were seen in Quebec and Ontario. Between March and June, Ontario reported seeing about half the usual number of ER patients on 19 days. In Quebec, that significant drop happened 15 times.

In Quebec, there were 3,100 fewer emergency room visits per day between March and June, compared to the same period in 2019, according to a CBC News analysis of CIHI figures. In Ontario, that's the equivalent of 5,400 fewer daily visits.

Even provinces with few or no cases of COVID-19 reported their emergency departments were emptier than usual around mid-March. 

"The most unexpected finding for us was the consistency," said Tracy Johnson, director of Health System Analysis and Emerging Issues with CIHI. 

"A bit surprising and a bit concerning … there was anecdotal evidence through physicians that said that they felt people weren't showing up with some urgent problems and we do see a 20 per cent decrease in some of those urgent problems."

Sicker patients still not showing up, says ER doctor

These figures depict exactly what Dr. Frederic Dankoff, emergency physician and medical co-ordinator at Montreal's McGill University Health Centre (MUHC), experienced in the first wave.

"It was very abnormal. We have seen a very significant reduction. I would call it too significant," said Dankoff.

"We have all seen a reduction in patients presenting with chest pains. If that patient did visit an emergency department after the first wave, that's fine. But if that person hasn't, they might have had their heart attack and still haven't been examined."

Dankoff, who still works full-time in emergency medicine, said he has seen sicker patients come back to hospital, but not nearly in numbers high enough to make up for what he normally would treat in the four-month period that the first wave lasted.

One Toronto cardiologist also told CBC he was initially worried that some patients were hesitant to come to the hospital after the first wave, but he said that isn't the case now.

"As we restarted, our patients were sicker than what they would be in our steady state a year ago," said Dr. Harindra Wijeysundera, spokesperson for the Canadian Cardiovascular Society and cardiologist at Sunnybrook Health Sciences Centre in Toronto.

That's an experience that now seems to be backed by CIHI's new data: their analysis found that ER visits related to heart disease and trauma have fallen by more than 20 per cent across the country.

Emergency room deaths have also increased by six per cent — more than 5,700 patients have died there this year, compared to 5,400 deaths recorded for the same period last year.

Dramatic drop in ER visits for children

Although Canadians over 65 were the ones told to be more cautious in early months, the biggest drop in ER attendance was actually recorded for newborns, children and teenagers.

Emergency personnel treated up to 74 per cent fewer cases of viral and respiratory infections, including colds and flu, allergic reactions, accidental injury visits and mild trauma, CIHI's new data shows.

This drop is not unusual, according to Dr. Caroline Quach, pediatrician and microbiologist-infectious disease specialist at Montreal's Sainte-Justine Hospital.

"In the vast majority of cities, schools were closed from March to June. If there is no one at school, there is no transmission of viruses," she said. 

"People were also wearing masks, which we know work, and parents were more aware that they can't just give their sick kid some Tylenol and send them to daycare."

Quach also said that many group sports were cancelled, which might have contributed to a drop in ER visits related to accidents, trauma and fractures in children.

Decrease in ER wait times

According to Dankoff, Canada's all-time low in ER attendance had a silver lining for hospital personnel and some patients.

First, he said the drop in attendance gave emergency personnel time to adjust to the new public health measures introduced to prevent the spread of COVID-19.

It also meant that patients who did decide to go to the ER were treated in record time. Between March and June, the median wait time for a first consultation with an ER doctor dropped by 20 minutes in some provinces and territories and by as much as an hour in others.

As a result of these shorter wait times, CIHI figures suggest that the number of people with urgent problems who left ERs before they could be diagnosed by a doctor dropped considerably.

"This is a good thing. It means that fewer people have left without being seen," Dankoff explained. "We think the people who took the time to think about it, but came despite their fear, were determined to wait."

Hundreds of thousands of surgeries cancelled or postponed

In Canada, about 382,000 surgeries were performed between March and June 2020 compared to about 718,000 during the same period in 2019, according to CIHI — that's about 335,000 fewer surgeries, or a 46 per cent decrease.

That number is an estimate that will likely rise sharply in coming months, as Quebec has yet to release its own data on surgeries. The province has said that at least 90,000 surgeries were postponed during the first wave of COVID-19, but it wasn't able to provide comparable data to CIHI at this time.

Again, this downward trend can be observed across the country, even in provinces where COVID-19 cases were very low during the first wave.

According to CIHI, the dramatic decrease in the number of surgeries nationwide may partly explain why hospital admissions fell by 36 per cent and critical care admissions fell by more than 20 per cent in the spring.

CIHI's Johnson said these significant and rapid declines in surgical procedures demonstrate how quickly provinces and hospitals have had to respond to the emergence of COVID-19 and ensure that the health system is not overwhelmed.

"We had no idea what the first wave was going to look like. And if it looked like Wuhan or like Italy, we were going to be in big trouble," Johnson said. "So the reaction was immediately to make sure that we had space in hospitals and space in ICU for anybody who might need it."

Many hospital workers in Canada were dispatched to long-term care homes to help with large outbreaks. As well, a shortage of certain sedatives commonly used during surgery prompted hospitals to cancel some non-urgent surgical procedures, said Quach, the Montreal pediatrician.

However, CIHI's data shows that just before starting these cancellations, hospitals did one last operating blitz. "They tried to be proactive and operate on the most urgent patients," said Johnson.

Surgery drop 'deeply concerning' to cancer care advocates 

When looking at surgeries by type, CIHI's analysis found decreases in 84 per cent of day surgeries, 69 per cent of planned surgeries, 38 per cent of surgeries for heart problems and 29 per cent of cancer surgeries.

"It is deeply concerning to us that there are people with cancer who need surgery, but have had their treatment postponed or delayed due to the pandemic," the Canadian Cancer Society said in a written statement to CBC News.

"We know that the earlier the cancer is treated, the more successful the outcome."

When looking at the drop in surgeries he's seen, Toronto cardiologist Wijeysundera said it is always a concern when patients who need help don't come to the hospital.

"They just got really sick and had adverse events outside a hospital," he said. "And we don't have that information yet. Time will tell if that's the case."

However, he said hospitals have learned many lessons from the first wave and are now better prepared for subsequent waves — and data like this is very helpful to plan for future crises.

"We are very vigilant and we know that at some point it will be necessary to slow down the number of surgeries," Wijeysundera said. "Everyone wonders what's the best time to do it, because you don't want to act too quickly, but you don't want to intervene too late."