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Novel Coronavirus COVID-19 (nCoV-2019)

Richard White

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He’s in denial and that explains so much of their pandemic response.

As far as I am concerned judgement day comes in 2022 at the ballot box. More than likely you will see the province smartening up the closer we get E-365 in order to save their own hide.

They won't do anything stupid within a year of the election to avoid losing. Mind you though, I can see most governments being turned over as a result of Covid.
 

Towered

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Wife and I are booked for tomorrow. She's 48 and I'm 50. Since we're in a "priority neighbourhood" anyone 18 up and get it, but my kids are reluctant - we'll do them later.

Where did you book? When I checked various sites this morning none of them were accepting anyone under 50.
 

Admiral Beez

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W. K. Lis

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Ontario issues emergency orders to bolster hospital capacity as cases soar


From link.

The Ford government has issued two emergency orders to increase critical care capacity in the province after hospitals were ordered to ramp down on elective surgeries amid surging cases of COVID-19.

In a news release issued Friday, the province said the order will allow hospitals to transfer patients without obtaining the consent of the patient during "major surge events."

The orders will also support the redeployment of health-care professionals and other staff working in Ontario Health and Home and Community Care Support Services organizations to hospitals experiencing capacity pressures.
"With Ontario's hospitals facing unprecedented critical care capacity pressures during the third wave of the COVID-19 pandemic, our government is taking immediate action to ensure no capacity nor resource in Ontario's hospitals goes untapped," Ontario Health Minister Christine Elliott said in a statement.

"Together with the provincewide Stay-At-Home Order, these measures will help to ensure that hospitals continue to have the staffing and resources they need to care for patients. We continue to work with our hospital and health care partners to fight this deadly virus, and I want to thank all of Ontario's frontline health care workers for their tireless work each day to protect the health and safety of Ontarians."

The orders came the same day as most Ontario hospitals were instructed to halt all elective surgeries and non-emergent/non-urgent activities in the wake of a record number of COVID-19 patients in intensive care units.

Ontario Health President and CEO Matthew Anderson released a memo on Thursday to hospital CEOs and primary care providers telling most hospitals across the province to scale back elective surgeries as of 12:01 a.m. on Apr. 12.

“Today, given increasing case counts and widespread community transmission across many parts of the province, we are facing mounting and extreme pressure on our critical care capacity,” he said.

Anderson said the ramp down is needed to preserve critical care and human resource capacity as coronavirus cases and hospitalizations are increasing amid a third wave of the pandemic.

On Thursday, there were a staggering 525 people in ICUs across the province, according to the Ministry of Health.

And a new record was set on Friday with 541 people battling the disease in ICUs across the province, according a tweet from critical care physician Dr. Kali Barrett based on the latest data from Critical Care Services Ontario.

Ontario’s latest modelling data released last week said ICU occupancy could hit nearly 800 daily by the end of the month even with the month-long provincewide stay-at-home order that came into effect on Thursday.

Ontario Hospital Association President and CEO Anthony Dale responded to the memo and said a major redeployment of staff and resources is needed to provide care for a large number of COVID-19 patients in hospitals.

“This situation is extraordinarily serious and we ask for patience and support from the people of Ontario as hospitals grapple with this historic crisis. Ensuring equitable access to critical care services is our paramount priority,” Dale tweeted Thursday evening.

Director of Surgery at Humber River Hospital Jhanvi Solanki told CP24 on Friday that the high number of patients needing care in ICUs is concerning, as they don't have enough beds and staff to care for them all.

"We are seeing a lot more sicker patients coming in. Yesterday, our census was 56 out of 46 which is really high. It is 10 patients over what we can staff for and what we can care for. Fortunately, we were able to transfer some patients out and were able to manage with additional staffing. But it is a real concern for us," she said.

Solanki said some patients are being transferred to ICUs as far as London and Kingston, Ont.

With hospitalizations and ICU numbers increasing daily, triaging patients is a worrisome possibility.

Solanki said her hospital set up a triage and screening plan last year if they need to resort to it.

"We set up a triage and screening process in wave one and we are going to be using the same kind of screening process right now. So we have an ethical framework that we use and principles of medical management and basically that determines the acuity to delay care and we determine if for example a cancer case would trump all other cases that might be a little bit delayable by a day or two, by a couple weeks, by four weeks et cetera.

The ramp down will not apply to hospitals in the Northern Ontario Health Region yet but Anderson said that they should be prepared to do so in the near future if requested.

Meanwhile, speciality hospitals for children and youth are being told not to scale back any capacity.

“Paediatric speciality hospitals are advised not to ramp down any capacity and continue with plans to care for children, youth, recognizing that we may ask you to do more, if required, to support other hospitals in your region,” Anderson said.

He added that limited ambulatory services may continue for some hospitals in low COVID-19 areas “recognizing that immediate ramp down may be required.”

Going forward, Ontario Health may also ask available healthcare workers and teams to support care in other parts of the system.

Anderson said Ontario Health will continuously monitor the ramp down in an effort to stabilize surgical capacity as soon as possible.

“These are very difficult and challenging times for all Ontarians, and we understand that deferring scheduled care will have an impact on patients and their families and caregivers.”

In March, the Ministry of Health instructed hospitals to put elective procedures on hold in order to preserve capacity for potential COVID-19 patients. The order then remained in effect until late May.

A study published by the Canadian Medical Association Journal in September estimated that the move to delay elective care amid the first wave resulted in a backlog of more than 184,000 surgeries. It said at the time that it could take upwards of 84 weeks to clear.
 

W. K. Lis

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Too bad her government didn't take immediate action to ensure we didn't have to get to this point.

AopD
Why? The Conservatives are in the habit of closing hospital beds. See this link from 1995.

You can't spend much time in Toronto these days without realizing that it is a battleground. This being Canada, the weapons are restricted to lawn signs, huge posters, newspapers columns and editorials, and fierce arguments at the water cooler. Still, the proposal to close about 25% of the hospitals in Metropolitan Toronto, and cut 2800 jobs in the process, has galvanized this metropolis in a way few other issues could.

Politicians and health care planners in cities that have already started restructuring their hospital sectors -- Calgary, Halifax, Montreal and Vancouver are examples -- might be forgiven for raising a sceptical eyebrow at the furore, for they already know that such cuts always trigger outrage. They also know that hospital cuts in Canada's largest city are way overdue.
Although Ontario has pruned the number of hospital beds by 20% over the past 5 years, it scarcely touched the bricks and mortar of the hospitals themselves. During the New Democrats' 5-year regime, it would have been more than Premier Bob Rae's political life was worth to chop jobs in the hospital sector, where 61% of employees belong to unions. And Conservative Premier Mike Harris, mindful of the electorate's love affair with medicare, steered well clear of any talk about health care cuts during the 1995 provincial election.
During that campaign, he specifically promised that his government would not cut the province's $17.4-billion health care budget, which accounts for about one-third of all provincial spending. Now that he is premier he faces a provincial deficit of $9 billion and impending cuts in transfer payments from Ottawa. No wonder he is taking a serious look at a report that would see $1.3 billion in spending cut from Toronto-area health care facilities in the 5 years it would take to implement the plan.

But if observers outside Ontario are muttering "it's about time," health care providers within the province are watching nervously. The Toronto report, Directions for change: toward a coordinated hospital system for Metro Toronto, is one of many such examinations under way in Toronto. Communities like Ottawa want to know how sharp the Harris axe will be -- and whether community protests will blunt it -- before embarking on their own hospital reorganizations.

The 239-page report was issued in September by the Metro Toronto District Health Council. It was commissioned by the Rae government and took 2 years and $5 million to complete. The provincial government is expected to respond early in 1996.

The authors say the term "hospital system" is an oxymoron when applied to the city's hospitals. "Each hospital currently operates independently with respect to planning, setting priorities and delivering services," points out Edward Crawford, chair of the Canada Life Assurance Committee and chair of the committee that produced the report.

In effect, this means that Toronto's hospitals compete for scarce resources in Darwinian fashion, with victory resulting more often because of sharp elbows, not proven need. There is duplication in administration and support services. In 1994, the 44 hospitals in Metro Toronto cost $3 billion to operate; 25% to 30% of that money, depending on the hospital, went to administrative, overhead and infrastructure costs.

The committee has therefore tried to create a "big picture" of Toronto's hospital services. It predicts a shift away from acute care provided in inner-city buildings and toward ambulatory care provided in the suburbs. The shift would include:

  • Reduction in the number of emergency departments from 21 to 14. At the same time, patients who use the emergency system inappropriately would be steered to a strengthened primary care system.
  • Reduction in the number of teaching, community and chronic care hospitals.
The bottom line is that 12 hospitals would close and the number of hospital beds would be cut by 13%. Most of the 2800 jobs that would be lost would be on the administrative and managerial side. The report says that none of the 5400 physicians with privileges in Toronto hospitals should be out of work because of the realignment of services.
All the proposals reflect current thinking in health care policy -- similar proposals have recently been implemented with great success in Melbourne, Australia. However, when the debate gets down to naming hospitals scheduled for closure, the fights begin. Some of the suggested closures include the Western Division of the Toronto Hospital and the Wellesley and Salvation Army Toronto Grace hospitals. Several mergers are also suggested -- one would see Women's College Hospital integrated with the Sunnybrook Health Science Centre.

As soon as the report was published, hospitals scheduled to disappear started churning out press releases, vowing to fight for survival. If he decides to accept the report's recommendations, the biggest fight facing Health Minister Jim Wilson will come from supporters of the 220-bed Women's College Hospital, where 50% of the medical staff are women. Toronto Star columnist Michele Landsberg trashed the report for treating hospitals like dots on a map. "The authors did not stop to consider that Women's College Hospital now runs in the black, is highly cost effective, is a leader in obstetrics, and is not a dot but a breathing institution with a deeply loyal constituency."

The hospital fought, and won, a bitter battle for survival 6 years ago, and Landsberg said its name came up again because "they weren't thinking about humans, only about numbers, [and] because they didn't think about women as a special medical clientele, or even admit that women's health interests aren't always well served in male-dominated institutions."

Her passionate defence of the hospital is bound to give politicians goosebumps, simply because the fact that her arguments don't begin to address the wider pressures facing planners is irrelevant. Women's College can call upon a huge army of supporters that includes Dr. Bette Stephenson, a CMA past president, a member of the hospital board and a past minister of health in a Tory government. The hospital lobby comprises people who are expert in marshalling support for causes and reaching the ears of the powerful. Will the Harris government be able to stand its ground before Toronto's feminist establishment?

Jim Wilson has not committed himself to full implementation of the Toronto report -- he has simply said that the government is willing to close hospitals if this would eliminate "duplication, waste and administrative inefficiencies."

But if the government allows Women's College to survive, what sort of message will it be sending to other Ontario cities, where closures are also bound to be proposed?

In the end, the battle over closures will likely obscure another important recommendation: the provision of alternative forms of care in the community. The report called for $75 million in annual spending to improve community-based services, such as visiting nurses and 24-hour clinics.

Toronto physicians are concerned that the Harris government may be tempted to use the savings from hospital cuts to pay for its promised tax cut, and not to reinvest in the health care system. For instance, when the city of Windsor asked for $68 million to help downsize its hospital sector, Wilson's first reaction was to balk at the cost.

Some Ontario hospitals have already reacted in response to what they predict will be massive cuts in hospital spending. In September, the University and Victoria hospitals in London announced they would create Canada's second-largest teaching hospital by merging -- and in the process would save $40 million annually by reducing duplication, particularly on the administrative side.

Whatever the government does, it knows there will be opposition. At its November convention, the Ontario Hospital Association released a survey showing that most Ontarians oppose any health care cuts. Only 10% of respondents in the Environics survey thought there were too many hospitals in their region.

However, it is also true that the longer Mike Harris and his government wait, the more difficult hospital closures will be. Keep this in mind: whatever happens to Toronto hospitals early in 1996 will set the pattern for the rest of the province to the turn of the century.
 

lenaitch

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