Tag Archives: Ontario Canada

‘Unnecessary sadness’: Inside Ontario’s strained intensive care units

By Anna Mehler Paperny

TORONTO (Reuters) – Over the course of a single shift last week, critical care physician Laveena Munshi saw her intensive care unit (ICU) at Toronto’s Mount Sinai Hospital fill with pregnant and post-partum COVID-19 patients.

During that week, the ICU doubled the total number of pregnant COVID-19 patients it had previously seen throughout the entire pandemic. Swamped with patients with complex medical needs, one day Munshi ended up pulling a 36-hour shift.

“You do what you have to do,” she said.

Ontario’s hospitals and ICUs have been crushed by a punishing third coronavirus wave, as depleted resources and overworked staff push Canada’s healthcare system – often held up as a model for the rest of the world – to the brink.

Last week, Munshi and her colleagues spent agonizing hours discussing what to do if a pregnant woman needed an artificial lung to help her get enough oxygen.

“Having delivery equipment outside an ICU room is never a thing you want to be walking into at the beginning of your shift,” she said. “It just adds an added layer of unnecessary sadness to this whole pandemic.”

By Thursday, ICUs in Ontario, Canada’s most populous province, had 800 COVID-19 patients, with such admissions at the highest point since the pandemic began.

Patients are coming in younger and sicker, driven by more highly transmissible virus variants. Hospital staff say they are seeing whole families infected due to transmission at front-line workplaces that have remained open through lockdowns and stay-at-home orders.

Mount Sinai Hospital just added a third ICU. It has seconded non-ICU nurses to help deliver critical care to the most seriously ill patients as it braces for the worst.

“The next couple of weeks are going to be extremely busy, there’s no question,” Munshi said, adding that people most affected by the current wave do not come from privileged backgrounds that would allow them to protect themselves, for example by working from home.

The provincial government has promised more ICU beds and requested medical staff from other provinces.

‘HOW MUCH MORE CAN WE STRETCH?’

Ramping up vaccinations targeting high-risk communities will help bring the third wave under control, experts said. But that will not relieve the immediate pressure on hospitals.

Exhausted staff are pulling overtime shifts and doctors are bracing for the tipping point no one wants to talk about: The activation of a “triage protocol” that will dictate who gets critical care when there isn’t enough for everyone who needs it.

Ontario’s Ministry of Health did not respond when Reuters asked what criteria would activate that protocol.

The protocol provides a standardized way to predict who is more likely to survive the subsequent 12 months, “trying to prioritize so that the most lives could be saved,” explained Dr. James Downar, one of its authors.

It does not include a provision for withdrawing life-sustaining measures, he said.

Raman Rai, manager of the ICU at Toronto’s Humber River Hospital, said she has never seen such a volume of critical care patients.

The hospital has redeployed staff, is treating people in “unconventional spaces,” and is stretching resources so a nurse who might have been responsible for one or two patients now has three, Rai said.

“We have already gone over capacity,” she said. “How much more can we stretch?”

Hospitals have been conducting drills and exercises in preparation for the triage scenario, said Ontario Hospital Association Chief Executive Anthony Dale.

“If it is used, it means we’ve failed as a province,” he said. “This did not have to happen. But are we preparing with everything we’ve got? Yes.”

In Toronto’s Sunnybrook Hospital on Wednesday morning, the ICU was buzzing with health workers having bedside discussions, punctuated by alarms from pumps and various equipment monitoring patients’ vital signs.

“It’s particularly distressing when we see someone who is 30 years old and healthy who comes in unable to breathe,” said intensivist doctor Hannah Wunsch. She is also seeing younger patients, pregnant patients and whole families with COVID-19.

From a medical perspective much of the work is the same, Wunsch said – save for ubiquitous masks.

“I haven’t seen anyone smile in a long time.”

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Bill Berkrot)

Ontario hospitals may have to withhold care as COVID-19 fills ICUs

By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada’s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

(Reporting by Allison Martell and Anna Mehler Paperny; Editing by Denny Thomas and Grant McCool)

Ontario issues stay-at-home order, closes most stores as COVID cases rise

(Reuters) -Ontario will begin a four week-long stay-at-home order and close in-store shopping for non-essential retailers as of Thursday, Premier Doug Ford said on Wednesday, as the Canadian province battles a surge of COVID-19 cases.

“The situation is extremely serious. We need to hunker down right now,” Ford said at a briefing in Toronto.

“What we do until we start achieving mass immunization will be the difference between life and death for thousands of people.”

The order requires people in Canada’s most populous province to stay in their residences except for essential reasons, including exercise, vaccination appointments or grocery trips.

Last week, Ontario shuttered all indoor and outdoor dining, a move that fell short of what the government’s expert advisory panel said was necessary to avoid catastrophically high case numbers.

All retailers except those selling grocery, pharmacy and gardening goods will close for four weeks, except for curbside pickup. Big box stores can remain open, but with capacity limits and only certain products including groceries, pharmacy and gardening materials available for in-store purchase.

Industry groups had criticized Ford for allowing big box stores to remain open during past lockdowns while shutting small businesses.

Retailers considered essential can open for in-store shopping by appointment only. These include medical device supply and repair shops, optical stores and auto mechanics.

On Tuesday, Canada reported 6,520 cases, the most recent data publicly available. Prime Minister Justin Trudeau warned of a “very serious” third wave of the virus, with more young people going into hospital and on ventilators due to more lethal variants.

Hospitals in Ontario are becoming more stretched. Provincial data showed more COVID-19 patients in intensive care units than at any point since the pandemic began.

ICU admissions are rising faster than the worst-case scenario modelled by experts, Ford said.

The province also announced that all teachers and education staff in Toronto and the suburb of Peel would be eligible for vaccination beginning during the school districts’ April break.

On Tuesday Toronto Public Health shuttered the city’s schools for in-person learning, sending the country’s largest school district of around 247,000 students back to remote learning from Wednesday until April 18.

Hours earlier Ford had told reporters that schools were safe and closures would be unnecessary.

Ontario reported 3,215 new cases on Wednesday, according to government data.

(Reporting by Moira Warburton in Vancouver Editing by Chris Reese and David Gregorio)

Ontario ‘pulling the emergency brake’ with third COVID-19 lockdown as cases rise, ICU beds fill

By Allison Martell and Moira Warburton

TORONTO (Reuters) – The Canadian province of Ontario will enter a limited lockdown for 28 days on Saturday, as COVID-19 cases and hospitalizations rise and more dangerous virus variants take hold, the premier said on Thursday.

The lockdown for Canada’s most populous province will fall short of enacting a stay-at-home order, which new government modeling released earlier on Thursday suggested would be necessary to avoid a doubling to some 6,000 new COVID-19 cases per day by late April.

Ontario’s third lockdown since the pandemic began will shutter all indoor and outdoor dining, although retailers will remain open with capacity limits, Premier Doug Ford said, calling the measures “pulling the emergency brake” on the entire province.

“We’re now fighting a new enemy,” Ford said. “The new variants are far more dangerous than before. They spread faster and they do more harm than the virus we were fighting last year… That means we need to take action now.”

Schools would remain open, Ontario’s education minister said on Twitter.

The Canadian Federation of Independent Businesses (CFIB) panned the lockdown measures, calling it “unconscionable” for the government to “continue to rely almost exclusively on blanket lockdowns” for controlling cases. It said the new measures were making small businesses “a scapegoat for the Ontario government’s lack of planning or foresight.”

Earlier on Thursday, new modeling released by an expert panel advising the provincial government predicted that new cases of COVID-19 would double unless the government imposes a stay at home order.

The report suggested a two- or four-week stay at home order imposed on April 5 could reverse the rise in new infections.

The new model came as more than 150 critical care doctors published a letter urging Ontario to act to halt a wave of infections there.

“We are seeing younger patients on ventilators – many are parents of school-aged children,” the letter said. “We are seeing entire families end up in our ICUs. We are caring for people who have contracted COVID-19 at work, or who have followed all the rules and only gone out for groceries.”

As new, more contagious and deadly coronavirus variants spread across the province, the number of COVID-19 patients in intensive care units has reached 464, higher than at the peak of the last wave, said Ontario Chief Medical Officer David Williams at a media briefing.

Data confirms that current seriously ill patients are younger with 46% of ICU admissions between March 15 and March 21 under age 60, up from 30% during a December surge, according to the expert panel.

And vaccination rates are lower in neighborhoods hit hardest by COVID-19. In areas with the highest incidence of infection, about 8% of residents have received the vaccine, compared with 13% in areas with the lowest incidence.

Howard Njoo, Canada’s deputy chief medical officer, said he was particularly concerned about the potential for COVID-19 to spread as people gather for Easter this weekend.

“We have seen in the past a spike in cases following a long weekend,” he told a briefing in Ottawa on Thursday. “We’re very worried and really I would implore all Canadians … to stay home.”

(Reporting by Allison Martell in Toronto and Moira Warburton in Vancouver; additional reporting by David Ljunggren in Ottawa; Editing by Franklin Paul and Bill Berkrot)

Ontario declares emergency amid surging COVID-19 cases as Canada buys more vaccines

By Moira Warburton and David Ljunggren

TORONTO/OTTAWA (Reuters) – Ontario declared an emergency on Tuesday after latest modelling put Canada’s most populous province on track to have more than 20,000 new COVID-19 cases per day by the middle of February, a nearly ten-fold increase from the current count.

Ontario, which is battling a coronavirus surge that has swamped its hospitals and triggered a province-wide lockdown, could also see roughly 1,500 more deaths in its long-term care homes through mid-February under a worst-case scenario, according to modeling from experts advising the government.

New restrictions that take effect on Jan. 14 mandate that residents must stay at home except for essential activity, while outdoor gatherings will be limited to five people, and non-essential construction work will be restricted.

“I know the stay at home order is a drastic measure, one we don’t take lightly. Everyone must stay home to stay lives,” said Ontario Premier Doug Ford at a media briefing. “Enforcement and inspections will increase.”

Canada began targeted vaccinations in December, with current efforts focused on healthcare workers and residents of long-term care homes.

The federal government ordered an additional 20 million doses of the coronavirus vaccine from Pfizer Inc and BioNTech, Prime Minister Justin Trudeau told reporters on Tuesday. That would take the total number of doses to be delivered this year in Canada to 80 million.

Ontario, the country’s economic engine, has been under lockdown since Dec. 26, with non-essential businesses shuttered and schools closed for in-person learning.

Yet the daily number of COVID-19 cases has spiked above 3,500 on average over the past seven days, government data showed. On Tuesday, Ontario reported 2,903 new COVID-19 cases.

Under the worst-case scenario with 7% case growth, there would be 40,000 new cases daily by mid-February, while the best-case scenario with 1% growth would result in 5,000 new cases every day, Ontario’s data showed. Case growth has recently been over 7% on the worst days, the data showed.

In five of the hardest hit areas of Ontario – including the Toronto area, nearby Hamilton, and Windsor-Essex across the border from Detroit – schools will remain closed until at least Feb. 10. Childcare for children who are too young for school will remain open, along with emergency childcare for some school-age children.

“We will have to confront choices that no doctor ever wants to make and no family ever wants to hear,” Dr. Steini Brown, head of Ontario’s case modeling, said at a briefing on Tuesday. “People will die from the virus itself and from the overloaded health system that is unable to respond to their needs.”

Brown warned that the new COVID-19 variant from Britain was already in Ontario and could decrease the doubling time of cases – or how long it takes for case counts to double, currently 30 to 40 days – to 10 days.

Last week Quebec, Canada’s worst-affected province from COVID-19, became the first in the country to introduce a curfew to limit the spread.

(Reporting by Moira Warburton in Toronto and David Ljunggren in Ottawa; Additional reporting by Allison Martell in Toronto; Editing by Denny Thomas, Paul Simao and Rosalba O’Brien)

Canada’s most populous province makes clear ‘hard lockdown’ needed to fight COVID-19

TORONTO (Reuters) – Health officials in Ontario, Canada’s most populous province, on Monday said their ability to control a second wave of COVID-19 was precarious and made clear a “hard lockdown” of four to six weeks was needed.

They made the remarks to reporters just hours before Ontario premier Doug Ford was due to unveil what local media say will be a range of restrictions lasting for a month. These include a shutdown of many non-essential businesses and gyms and limiting bars and restaurants to take out service.

The province announced 2,123 new cases on Monday, the seventh consecutive day the number has exceeded 2,000.

“Our ability to control case growth is still precarious,” said Adalsteinn Brown, co-chair of Ontario’s COVID-19 science advisory team.

“Based on experience in France and Australia, ‘hard lockdowns’ of 4–6 weeks can reduce case numbers in Ontario to less than 1,000 per day,” he said in a presentation to media.

Other jurisdictions, he added, were six weeks to three months ahead of Ontario and most have used some form of hard lockdown, he added.

The Ontario Hospital Association last week said the health care system could hit breaking point unless people started listening to calls to restrict gatherings.

Around 300 people are in intensive care units but this could jump to 1,500 in mid-January, Brown said.

(Reporting by Moira Warburton, writing by David Ljunggren; Editing by Alistair Bell)

What you need to know about the coronavirus right now

(Reuters) – Here’s what you need to know about the coronavirus right now:

Biden rejects Trump claim that vaccine is imminent

U.S. Democratic presidential candidate Joe Biden on Thursday bluntly contradicted President Donald Trump’s suggestion that a coronavirus vaccine may be only weeks away, warning Americans they cannot trust the president’s word.

“The idea that there’s going to be a vaccine and everything’s gonna be fine tomorrow – it’s just not rational,” Biden said during a CNN town hall in Moosic, Pennsylvania.

Trump again said on Wednesday that a vaccine for COVID-19 could be ready for distribution ahead of the Nov. 3 election.

Most health experts, including Robert Redfield, the director of the Centers for Disease Control and Prevention, have said a vaccine will likely not be widely available until mid-2021.

Israel imposes second lockdown

Israel will enter a second nationwide lockdown on Friday at the onset of the Jewish high-holiday season, forcing residents to stay mostly at home amid a resurgence in new coronavirus cases.

The country’s initial lockdown was imposed in late March and eased in May as new cases tapered off, reaching lows in the single digits.

But in the past week, new cases have reached daily highs of over 5,000, and Israeli leaders now acknowledge they lifted measures too soon.

The new lockdown will last three weeks and coincides with the start of the Jewish New Year, Rosh Hashana, traditionally a time for large family gatherings and group prayer.

UK COVID hospital admissions double every eight days

Britain’s health minister said that the novel coronavirus was accelerating across the country, with hospital admissions doubling every eight days, but he refused to say if another national lockdown would be imposed next month.

The United Kingdom has reported the fifth-highest number of deaths from COVID-19 in the world after the United States, Brazil, India and Mexico, according to data collected by Johns Hopkins University of Medicine.

COVID-19 cases started to rise again in Britain in September, with between 3,000 and 4,000 positive tests recorded daily in the last week. More than 10 million people are already in local lockdowns.

China reports highest new cases since Aug. 10

Mainland China reported 32 new COVID-19 cases on Thursday, marking the highest daily increase in more than a month and up sharply from nine cases reported a day earlier.

Although the latest increase still remains well below the peaks seen at the height of the outbreak in China early this year, it is the biggest since Aug. 10 and suggests continued COVID-19 risks stemming from overseas travelers coming into the country as the pandemic rages on in other parts of the world.

The National Health Commission said that all new cases were imported infections. Mainland China has not reported any local COVID-19 infections since mid-August.

Canada’s Ontario clamps down on parties

Canada’s most populous province will clamp down on social gatherings to prevent “reckless careless people” from spreading the coronavirus at illegal parties, Ontario Premier Doug Ford said on Thursday.

His warning came as the nation’s top medical officer said authorities could potentially lose the ability to manage the pandemic.

Indoor social events in Toronto, Canada’s biggest city – along with Ontario’s Peel and Ottawa regions – would be authorized to include no more than 10 people, down from a previous limit of 50, Ford said.

“This is a serious situation, folks. We will throw the book at you if you break the rules,” he told a news conference.

(Compiled by Linda Noakes; Editing by Hugh Lawson)