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Hamilton hospitals worry uptick of COVID-19 will disrupt elective cases again

Posted: September 17, 2020

(September 16, 2020)

By: Joanna Frketich, The Hamilton Spectator

A sign sits on a corner near Hamilton General Hospital at the height of first wave back in April.

Hamilton’s hospitals are watching Ontario’s uptick in COVID-19 cases with worry as they try to get through a massive backlog of postponed care.

“We’re seeing increased cases in the community but we’re not seeing increased hospitalizations so far,” said Dr. Wes Stephen, chief operating officer of Hamilton Health Sciences (HHS). “But it’s only a matter of time.”

Over the weekend, the Ontario Hospital Association and Kevin Smith, CEO of Toronto’s University Health Network (UHN), warned the province is losing ground in the fight against COVID-19.

“I’m worried,” Smith, who was previously CEO of St. Joseph’s Healthcare, tweeted on Sept. 12. He said UHN has gone from zero cases for several weeks to seven, with the majority in the intensive care unit.

“It’s time to act,” he tweeted. “We know how to turn the tide on increasing cases of COVID. Mask. Physically distance. Hand wash. Limit gatherings. Test. Trace. Isolate. Get serious.”

The second wave of COVID-19 is coming sooner than expected, said current CEO of St. Joseph’s Healthcare, Dr. Tom Stewart.

“There is a growing concern,” he said. “Really the numbers we are seeing now on a daily basis are not dissimilar to numbers that would be typical during the spring (in the first wave).”

The uptick — with 251 new infections reported by the province Tuesday — comes as hospitals are gradually reintroducing elective surgery and other postponed care. While there are no numbers locally, research published in the Canadian Medical Association Journal on Sept. 1 estimates 148,364 surgeries were postponed provincewide from March 15 to June 13. The Toronto researchers estimate it will take 84 weeks to clear the backlog.

“We’ve got one eye on the uptick of COVID cases,” said Stephen. “It is worrisome. We’re all wondering how big is the next wave and how much of an impact it’s going to have on health care.”

There is wide agreement that hospitals can not postpone care again but they also need to make sure they have beds available for a potential surge of COVID-19 patients.

“Our goal is not to add to the wait list and we are actively working toward getting back to our pre-COVID surgical volumes,” said Stephen. “I do want to emphasize that we do recognize the impact on the patients waiting for their surgery and we continue to plan in hopes to get the backlog addressed.”

Originally, the province directed hospitals to leave 15 per cent of their acute care beds open for COVID-19 patients but Stephen says HHS is working to keep 10 per cent free.

It’s a big task considering Ontario’s hospitals normally have more patients than funded beds. As a result they open beds not paid for by the Ministry of Health and often have to put them in unconventional spaces like sunrooms, family rooms and hallways which has been coined hallway medicine.

“From what we’re hearing — all across Ontario — the hospitals are back up toward 100 per cent capacity,” Natalie Mehra, executive director of the Ontario Health Coalition, said about hospitals having all funded beds full.

“Now we are heading into a second wave and it does not appear that there’s any more of a plan than there was in the first wave to provide enough care to meet the population need — so we are extremely concerned.”

A long-standing issue that fills hospital beds is patients who can’t be discharged because they are waiting for other types of care such as home care and long-term care. For the first time in more than a decade, hospitals were able to get the majority of these patients care in other settings at the beginning of the pandemic. But the problem is creeping back again.

“We haven’t been able to move patients in the usual way into long-term care, so a lot of patients are backed up into hospital,” said Stewart. “As we try to ramp up and catch up on our backlog, as we maybe get hit by another surge of COVID and then do our usual hospital operations, something has got to give.”

Hospitals in Hamilton, Burlington, Brant, Niagara, Haldimand and Norfolk released a joint plan for the second wave which mostly focuses on working together to make sure none of them are overcome.

“We have worked together to develop a strategy that allows us to balance the demand across the region and make sure that our health-care system — no one part of it becomes overwhelmed,” said Dr. Cheryl Williams, vice-president of adult regional care at HHS.

The plan keeps things much as they are with Hamilton General Hospital, the Charlton campus of St. Joseph’s, Joseph Brant Hospital, Niagara Health’s St. Catharines site, Norfolk General Hospital and Brant Community Healthcare System as the main providers of care to COVID patients.

“Hospitals have always had the ability to work together if one is completely overwhelmed,” said Mehra. “I think they’re making much of what really isn’t much of a plan.”

She said the lack of a robust plan is a problem across the province

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