Updated: Dec 4, 2020
Original author: Amol Verma & Fahad Razak
Published: April 9, 2020
Our hospital ward is only half full. We have not consistently seen, in more than a decade of training and practice, so few patients in hospital as in the last two weeks. And we are not alone – this experience is being shared by our colleagues across the province. Hospital occupancy in Ontario is just 77 per cent, down from 97 per cent a year ago.
We do not expect this situation to last, as the number of patients with COVID-19 is increasing. But this phenomenon of under-capacity hospitals is important to reflect on.
In part, this represents an enormous success of hospitals in creating capacity for the anticipated surge of COVID-19 patients. But we are worried this also means that people who need hospital care are staying home.
Clinicians, administrators, and policymakers have been working furiously to move patients from acute care hospitals to their homes or other care facilities (like rehabilitation hospitals or nursing homes). Primary care and specialist physicians are redoubling their efforts to help people manage chronic and acute illnesses to avoid hospitalization. Our health system is acting with unprecedented urgency, creativity, and cooperation. Two of our colleagues who were waylaid abroad noted that, “health care in Canada changed more during the two weeks we were away than it did during the two decades since we were medical students.”
But the reduction in hospitalizations might not be all good. Although 20 to 30 per cent of hospital admissions might be avoidable, actually reducing hospitalizations has proven to be extremely challenging. Most efforts report no benefit or only modest success at reducing hospitalization. Even if we assume that all preventable hospitalizations are being avoided, this does not account for the entire reduction in hospital volume that we have seen.
Most likely, people who need hospital care are not coming in. Some people may avoid hospitals because they fear contracting COVID-19 or they want to save scarce hospital resources. Others may have unrecognized illnesses because of disruptions in their usual care. For example, nurses who attend to people with chronic wounds sometimes recognize early signs of infection and send them to the hospital for treatment. If such services are disrupted or people are hesitant to come to the emergency department with serious symptoms, illnesses will not be recognized until they are more severe and harder to treat.
Modern healthcare systems in high income countries, like Canada, have not seen the kind of healthcare shock that COVID-19 is creating. SARS killed 44 Canadians and infected fewer than 500. Emergency department visits in Ontario