Ontario hospitals told to activate surge plans as number of COVID-19 patients spikes

RVH CEO says hospital has been preparing for this announcement for some time

As new COVID-19 cases in the province topped 2,000 for a second straight day on Wednesday, hospitals in Ontario have been told to be ready to activate their surge capacity plans within 48 hours.

For hospitals in grey lockdown and red control zones that means 15 per cent of their beds must be for COVID-19 patients.

Ontario Health President Matt Anderson issued a memo to hospital CEO’s on Tuesday that said the province has entered a “critical phase” of the pandemic where there is widespread community transmission.

The alert did not catch Royal Victoria Regional Health Centre (RVH) off guard.

“Given the spread of COVID through the second wave, RVH has been preparing for this announcement for some time,” according to Janice Skot, RVH President and CEO.

The hospital has developed a critical care capacity plan.

“This is where if more than the 16 beds available in our intensive care unit were to be needed, we actually have an ability to go up to 37 intensive care unit beds,” explains Skot. “We also have all the equipment we need for those extra patients. For example, we have more than enough ventilators on site.”

RVH also built a pandemic response unit (PRU) or field hospital. The PRU has the capacity for up to 70 beds for non-COVID patients. As of Tuesday, there were six patients in the PRU, and since it opened in late November, there have been over 50 discharges from the unit.

“This extra capacity has actually allowed us to be of assistance to the Greater Toronto Area, which is in far worse shape in terms of the number of COVID-positive patients, and those requiring hospitalization and intensive care unit,” says Skot.

Patients who might have anywhere from a three to five day stay in hospital can be transferred to the PRU, which then allows the hospital to free up those beds within the building.

“We’ve created a bed opportunity either for ourselves or our partners in the north, or the GTA patients who have been coming north,” says Skot.

Anthony Dale, President and CEO of the Ontario Hospital Association(OHA), says clearing 15 per cent of beds means shutting down some “elective activity” such as cancer and cardiac care and organ transplantation.

Dale said he has worked at the OHA in different roles for 16 years and he has never been as concerned as he is now about the capacity of the hospital system to care for the needs of the people of Ontario.

Skot says they have completely ramped up all of their 11 operating rooms and endoscopy suites at RVH.

“At this point in time, given where we are at, we are not in need of cancelling any of those scheduled procedures.”

Skot says the caution would be if the numbers continue to rise, the hospital does have a ramp down plan.

RVH was able to keep four operating rooms functioning for emergency surgeries, as well as many cancer surgeries, during wave one of the pandemic.

Everything that was a scheduled procedure during wave one had to be shut down, which did create a significant backlog. The hospital was back to full operation by the fall.

“If there was a requirement for us to create even more capacity in our building, we do know that scheduled procedures would be an area where you’d be looking at.”

Skot acknowledges that everyone is suffering from COVID fatigue.

“This is no time to let off on our practices. We really underscore the importance of the entire region to ensure they are following all public health practices such as wearing a mask, washing hands frequently and keep that two metre distance, and ensuring the bubble is small for your household, particularly as we are in the red zone.”

RVH is in daily contact with hospitals in Simcoe Muskoka, as well as Parry Sound, which Skot says gives the facility “a better understanding of what the northern regions needs are, let alone participate in what’s required from southern Ontario.”

The province logged 2,143 new cases of the virus on Wednesday and there were 43 more deaths, bringing the number of fatalities in the province from COVID-19 to more than 4,000.

Ontario reported 2,043 more recoveries from the illness and there were just over 17,000 active cases.

Most of the new cases continue to be in the Greater Toronto Area.