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Altaf Stationwala, CEO of Mackenzie Health hospital in Richmond Hill, Ont., stands outside the hospital's emergency department, on June 8, 2020. 'People are starting to come back to the hospital,' he says, 'but the patients who are coming are pretty sick. So our admission rates have gone up.'

Galit Rodan/The Globe and Mail

At least five hospitals in the Greater Toronto Area can’t resume elective surgery because they’re nearly as full today as they were before the pandemic – primarily because of seniors who can’t be transferred to unsafe nursing homes, and patients who put off essential care for fear of COVID-19.

Hospitals in Mississauga, Brampton, Richmond Hill and the Etobicoke area of Toronto are among those that have seen their acute-care beds fill up again in recent weeks.

“People are starting to come back to the hospital,” said Altaf Stationwala, chief executive officer of Mackenzie Health, a 437-bed hospital in Richmond Hill, north of Toronto. “But the patients who are coming are pretty sick. So our admission rates have gone up.”

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On Friday, 96 per cent of Mackenzie Health’s acute-care beds were full, Mr. Stationwala said, even though the hospital is not yet offering non-urgent operations that require an overnight stay, and won’t be any time soon. In April and May, at the height of the coronavirus crisis, the hospital’s average occupancy rates were 71 per cent and 77 per cent, respectively.

The equivalent of one-and-a-half units at Mackenzie Health are now occupied by patients waiting for a spot in long-term care, Mr. Stationwala added.

Anthony Dale, the president of the Ontario Hospital Association (OHA), called it an “alarming trend,” that the province’s hospitals are once again filling up with alternate-level-of care (ALC) patients, which is how the health care system describes those who no longer need acute care but have nowhere else to go.

The OHA said Ontario hospitals now have about 5,200 ALC patients, about the same number as before the pandemic, when overcrowding was a chronic problem.

The increase in ALC rates has generally been overshadowed by the good news that the total number of COVID-19 patients in Ontario hospitals has been declining steadily from more than 1,000 in mid-May to just 603 as of Saturday.

ALC patients are usually transferred to nursing and retirement homes in a steady flow, but those transfers have slowed because of the number of seniors’ facilities grappling with devastating coronavirus outbreaks, Mr. Dale added.

In May, for example, 571 ALC patients were transferred to long-term care or retirement homes, significantly less than the 962 ALC patients sent to such homes in the same month last year, according to Ontario’s Ministry of Health.

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In Ontario, hospitals that are filled near to the brim can’t get government permission to resume offering the elective procedures that were cancelled or postponed at the beginning of pandemic measures, when the health care system was clearing space for a surge of critically ill COVID-19 patients that never came.

In a “framework” document released on May 7, the provincial government said hospitals looking to resume scheduled operations would have to satisfy a readiness checklist that includes having 30 days of personal-protective equipment available and 15 per cent of acute-care capacity available to handle a spike in coronavirus cases.

So far, 85 Ontario hospitals have begun gradually resuming scheduled procedures, while 19 have submitted plans and are either waiting for approval or preparing to restart, according to Jennifer Schipper, a spokeswoman for Ontario Health, the agency that oversees delivery of health care.

Another 42 have not yet submitted plans, she added.

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Among those holding off are William Osler Health System, which operates hospitals in Brampton and Etobicoke, and Trillium Health Partners, which operates two acute-care hospitals in Mississauga.

As of June 1, Brampton Civic Hospital’s acute-care section was at 93-per-cent occupancy and Etobicoke General’s was at 89 per cent, while Trillium’s Credit Valley Hospital was at 91-per-cent capacity and its Mississauga Hospital was at 84 per cent.

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Their communities are also among the hardest-hit by the coronavirus in Canada, which is another factor in deciding where elective care can resume. William Osler’s sites are an outlier in that the number of COVID-19 patients they are treating has continued to rise.

In British Columbia and Alberta, where the number of new coronavirus cases reported daily has dropped to single and double digits, operating rooms began humming with elective surgery again last month.

In Quebec, the province hit hardest by the pandemic, the government officially announced on May 18 that it would gradually resume non-emergency surgical activities. About 68,000 operations had been postponed, Quebec Health Minister Danielle McCann said.

Elsewhere in Toronto, some major hospitals have already restarted elective surgery or received a green light to do so, including St. Michael’s Hospital, St. Joseph’s Health Centre, Sunnybrook Health Sciences Centre and the University Health Network (UHN), which oversees Toronto General and Toronto Western hospitals.

Capacity at Toronto General and Toronto Western was at 79 per cent and 70 per cent, respectively, last week.

Overall, the number of patients being treated at UHN hospitals for COVID-19 fell from 79 on May 1 to 44 on June 1.

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Fayez Quereshy, a surgical oncologist and clinical vice-president of Toronto General Hospital, said that, like all hospitals, UHN’s sites have continued to provide surgery to people whose diseases were progressing quickly.

He checks in weekly with his cancer patients who are trapped in limbo because of the virus. “Every patient has been very gracious,” he said. “It’s incredibly humbling to hear people say, ‘Doc, I understand, and I know other people need the resource. When the time comes, I’ll have my surgery.'"

Mr. Stationwala of Mackenzie Health said he hopes the time will soon come for his hospital to restart all surgery.

In the meantime, with his hospital nearly full, Mackenzie is only asking for permission to resume day operations.

With a report from Tu Thanh Ha

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