Surge at emergency departments in Brampton, Etobicoke leads to transfers of in-patients to other hospitals, for the first time in the pandemic

A crush of patients arriving at emergency departments in Brampton and Etobicoke have forced William Osler Health System to postpone some elective surgeries and — for the first time during the pandemic — transfer in-patients to other Toronto-area hospitals to ease dangerous overcrowding.

The surge of emergency patients — a mix of those with symptoms and those with other urgent health concerns — pushed Osler beyond capacity late Thursday, prompting its president and CEO to warn this could be the “leading edge of more difficult times for our communities.”

Even as Osler struggles to maintain its health-care services in Ontario’s biggest COVID-19 hot spots, the province on Friday eased public health measures for Peel Region, which had been under modified Stage 2 restrictions since mid-October.

The new provincial public health framework puts Peel in the red or “control” zone, which permits bars, restaurants and gyms to open for some indoor service starting Saturday. Soaring COVID-case counts with York Region and Ottawa into the more lenient orange or “restrict” zone.

Peel’s medical officer of health, Dr. Lawrence Loh, asked the province Friday to keep Peel in modified Stage 2 for another week, as was granted to Toronto.

“I certainly advocated for that given our ongoing challenges with contact tracing — — and also the recent developing challenges with capacity at William Osler,” Loh told the Star on Friday, noting the red control zone was not enough in his opinion to subdue the local epidemic.

“I’m working with our local leaders, our mayors, to take a look at what additional local restrictions we can bring into place so we can encourage people as much as possible to limit their close-contact interactions.”

Dr. Naveed Mohammad, Osler’s president and CEO, said he “supports completely” Loh’s efforts for more public health measures across Peel. Osler’s hospital system includes Brampton Civic Hospital, Etobicoke General Hospital and Peel Memorial Centre for Integrated Health and Wellness.

“We can provide our colleagues in the government with our recommendations from a science and epidemiology (perspective) and what we’re seeing in the hospitals’ point of view,” he said. “Once the decisions are made we have to work with them to ensure we keep our communities and patients as safe as we possibly can.

“The province has made its decision and we will provide our feedback … and we will see where things go from there.”

In a statement issued Friday afternoon, the Ontario Hospital Association called the province’s decision to allow Peel to reopen in the new red control zone “reckless,” stating it “must be reversed immediately given the risks it poses to area hospitals, particularly William Osler Health System.”

Anthony Dale, the association’s president, told the Star that Osler faces “punishing pressures” to keep up with the health-care demands of its community at the best of times, but especially so in a pandemic and with Peel a major hot spot.

“The situation is precarious and fragile and a major surge in COVID patients would greatly destabilize William Osler’s operations,” he said, pointing to hospital systems in other regions and countries being overwhelmed during the pandemic’s fall wave.

“We’re in a situation where the circumstances could change very quickly,” Dale said. “And we may have the illusion of control, but all of the jurisdictions in the world that have made that assumption have paid a price.”

Starting Friday and going through to Saturday, Osler plans to transfer 15 to 20 patients from Brampton Civic and Etobicoke General to other GTA hospitals, after which the situation will be reassessed, according to an Osler spokesperson. More than 10 hospitals have offered Osler help, including Sunnybrook Health Sciences Centre, Markham Stouffville Hospital, Mackenzie Health and the University Health Network.

Mohammad said transferring Osler in-patients to other hospitals because of overcrowding typically only happens about once a year. Until this week, Osler had not yet asked for such help during the pandemic, he said, adding that hospitals have offered to take both COVID and non-COVID patients.

As of Friday, Osler was caring for 55 patients with suspected COVID-19 and 57 confirmed COVID-positive patients, 15 of whom are in intensive care, Mohammad said. Each of these patients must isolate in a single room for infection control, he said.

“That really impacts our capacity and our real estate,” he said, adding that Osler has already opened up all possible spaces in its hospitals that can currently be staffed. “Finding staff to care for those patients is where the challenge starts.

“Last night (Thursday) we got to a point that if any more patients came in through the emergency who needed to be admitted, we could not possibly provide them a safe place to be held and be admitted.”

A COVID-19 outbreak on a surgical floor at Etobicoke General has also “compounded the situation,” Mohammad said.

Capacity pressures have also forced Osler to postpone 50 elective surgeries within the last two weeks, according to an Osler spokesperson. The hospitals will “continue to prioritize urgent and time-sensitive surgeries” in the coming weeks, the spokesperson said.

As of Friday, Peel still had the province’s highest COVID-19 infection rate of 120 cases per 100,000 population per week with a seven-day average of 264 new cases a day, according to the Star’s ongoing tally. Peel’s most recent epidemiological summary shows 6.8 per cent of COVID-19 tests in the region came back positive between Oct. 18 and Oct. 24; the same week Brampton reported a 9.6 per cent test positivity rate.

Currently, Osler has a COVID-19 test positivity rate of 11 per cent that includes tests from its assessment centres and hospital patients. A hospital spokesperson said data could not be broken down to individual hospital sites because “analyzing data into smaller subgroups may be misleading because the number tested is small.”

Mohammad said he is worried about the situation at Osler because it’s fuelled by the escalating number of cases in the community

“I’m worried about where things are going. I’m also worried that this may be the leading edge of a wave of patients that may need more hospital care.”

Dale said the Ontario Hospital Association is reviewing the province’s new colour-coded public health measures framework with its partner hospitals and outside experts and plans to submit recommendations to the province next week.

“We do see some significant room for improvement,” he said, noting the definition of hospital capacity in the document is not clear and the threshold levels for the COVID-19 reproduction rate are too high. “As it is right now, it leaves essentially no room for error.”

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: