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Ontario hospitals gear up for growing pressure from Omicron wave

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TORONTO — Ontario's health system is preparing for widespread measures including patient and staff transfers to deal with a growing wave of COVID-19 that's infecting people at an unprecedented rate.

There were 1,290 people in hospital with COVID-19 as of Tuesday, and 266 patients in intensive care. The government announced a series of measures Monday including business and school closures to beat back the Omicron variant spread that's expected to infect more people.

Hospitals across the province were preparing to pause all surgeries deemed non-urgent on Wednesday to free up bed space and hospital workers, and some had already declared themselves strapped for resources, requiring patient transfers and an early ramp-down of surgeries. 

"I don't think any of us want to candy-coat any of this. This is not a good situation," said Chris Simpson of Ontario Health, the agency overseeing the health system. 

"It's a different disease. It's putting pressures in different places, and the magnitude of it is just eclipsing everything else. So that's the challenge." 

Public Health Ontario has said that daily infections, ranging in official reports from 10,000 to 18,000 in recent days, are likely higher due to policy changes making tests less accessible. But the daily percentage of tests that were positive — considered another indicator of COVID-19 prevalence — was at 30.9 per cent on Tuesday.

During the height of the third wave, the positivity rate topped out at 10.9 per cent.

Pressure on hospitals is coming from the sheer number of patients requiring care, from staff absences due to COVID-19 infections and exposures, and from burnout and turnover nearly two years into the pandemic.

A specialized children's hospital in Toronto on Tuesday reported more active staff cases than during the previous 20 months of the pandemic. 

"It has really been in the past two weeks, really with the surge of Omicron, that we've seen a dramatic change," said Julia Hanigsberg, CEO of Holland Bloorview Kids Rehabilitation Hospital.

Front-line and administrative staff have been affected at the hospital with a workforce of about 1,000 people, Hanigsberg said, either sick with the virus themselves or isolating from exposures. More were preparing to potentially miss work due to child-care obligations, with schools moving to remote learning on Wednesday.

Hanigsberg said staffing ratios have been changed and workers are being redeployed. Some scheduled in-person appointments have been carried out virtually and she anticipates some cancellations will be necessary.

"We'll do that on a case-by-case basis and we'll be triaging for the urgency of the needs of the individual patients to make sure that we reduce risk of harm to any children," she said.

Across the province, hospitals will try to place workers like nurses in areas where they have experience, but that might become challenging as the health human resources become more strained, Simpson said.

So far, he said fewer people are experiencing COVID pneumonia during the Omicron wave, but many are being hospitalized for short stays or have chronic illnesses worsened by a COVID-19 infection. 

He said staff need to be redeployed to hospital wards dealing with shortages or to help admit people who are sick with COVID-19. 

The surgery ramp-down directive from the province's top doctor, issued earlier in the pandemic to contend with intensive care challenges, is this time being used to free up staff, Simpson said. 

One Toronto-area hospital network declared a Code Orange on Sunday due to a lack of resources, requiring patient transfers and other measures like halting scheduled surgeries to free up capacity. 

Simpson said the situation at William Osler Health System will likely be seen elsewhere as Omicron spreads. But he noted that the transfer process will get complicated as more hospitals deal with capacity crunches, and assessments will need to be made about what facilities can take on more risk at a given time.

"We need to be prepared for a period of time where the care that's being delivered is not the kind of care we would we would want to deliver. It's just simply a fact, because of the way that Omicron is growing," he said. "But I think if we if we do this in a measured way, and in a very system approach kind of way we can mitigate that risk."

The CEO of the Registered Nurses' Association said current government plans like transferring nurses between departments and adding more beds won't be enough to adequately address the staffing challenge during Omicron. 

"A bed without a nurse is just a bed," Doris Grinspun said in an interview. 

She said absenteeism is already a "huge" issue, with nurses off work dealing with COVID-19 infections in their families or leaving work due to burnout and stress. 

A Progressive Conservative government bill that caps public sector wage increases at one per cent annually is also causing widespread anger among nurses, Grinspun said, and contributing to the shortage. 

She said Premier Doug Ford should repeal the bill and immediately raise nurses' wages to keep more people from leaving the field during the crisis. Grinspun also called for even stricter public health measures to keep the Omicron situation from escalating, such as closing retail stores and houses of worship to in-person attendance.

This report by The Canadian Press was first published Jan. 4, 2022.

Holly McKenzie-Sutter, The Canadian Press