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Paramedics and ambulances spill out of the emergency ramp at Michael Garron Hospital in Toronto on April 12, 2021.Frank Gunn/The Canadian Press

Ontario hospitals are seeing a decline in COVID-19 hospitalizations as caseloads drop, but now say they are facing new challenges: an increase in emergency cases unrelated to the virus and a backlog of non-urgent surgeries.

Toronto’s Sunnybrook Health Sciences Centre said there’s been a “steady decline” in the number of COVID-19 cases requiring hospitalization, and as of Thursday, the hospital had no COVID-19 patients in its ICU.

“We are not ready to declare victory on the pandemic yet but we can say confidently we are through the most acute part of wave three,” Sunnybrook president and CEO Andrew Smith said in a staff e-mail. “Our mission now is twofold: avoid a fourth wave and focus on helping those who have had their surgeries and other care delayed as a result of the provincial restrictions that were in place.”

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At the University Health Network, the number of COVID-19 patients has “dramatically decreased” over all, said Barry Rubin, medical director of the Peter Munk Cardiac Centre and co-lead of the University Health Network’s clinical activity recovery team. There used to be more than 100 cases, but now that number is fluctuating between 20 and 35.

But some hospitals are now reporting an increase in emergency cases unrelated to COVID-19. Humber River Hospital, for instance, typically has a 7-per-cent emergency admission rate, but as of Thursday, that has increased to between 10 and 14 per cent, said Jhanvi Solanki, program director of the hospital’s surgical services and endoscopy.

The number of emergency patients at Sunnybrook has also increased to numbers not seen since before the pandemic, said Aikta Verma, chief of the hospital’s department of emergency services. On average, the emergency department would see about 170 patients a day before the pandemic, and it’s now seeing between 165 to 200 patients a day. Only now, patients are showing up sicker than before.

Dr. Rubin said this trend could be because people weren’t going to the hospital as frequently as they did before the pandemic, and so went longer without being properly treated until their illness progressed to “a more advanced stage.”

“As the health care system ramps back up, we’re going to identify a lot of people that need care,” Dr. Rubin said.

On Thursday the Ontario government said hospitals would now be permitted to resume non-urgent surgeries and procedures that require inpatient and critical-care services. But health officials cautioned that hospitals need to meet certain criteria in order to resume non-urgent surgeries, and not all will be able to do so immediately. The province had previously enabled hospitals to perform non-urgent surgeries that didn’t require inpatient services.

The government also released two memos that revoked some emergency measures that would have both allowed the province to transfer hospital patients to long-term care facilities without their consent, and to redeploy homecare staff to long-term care and retirement homes, although the government said no transfers occurred. The government said other emergency measures that allow the province to transfer hospital patients to other hospitals and redeploy healthcare staff to hospitals will remain in place until June 16.

Now that non-urgent procedures are resuming, the University Health Network is looking at a surgery waitlist with about 4,300 people on it, Dr. Rubin said. Of those, 2,100 have been scheduled.

Humber River Hospital also started resuming non-urgent surgeries, and decided Thursday that by June 14, the hospital will return to 60 per cent of its surgical capacity, Ms. Solanki said.

The hospital is planning to “ramp up quite significantly” in August and September, reaching 120 per cent of its capacity to catch up on backlogged surgeries, she said. But staff meet weekly to evaluate the hospital’s COVID-19 burden and surgery backlogs.

“It is a balancing act for us,” Ms. Solanki said.

As hospitals continue ramping up activity, an added challenge will be maintaining COVID-19 precautions – for instance, maintaining physical distancing in a busy emergency room. But Dr. Verma said hospital staff are “grateful” that COVID-19 hospitalization numbers are down, and that they can continue treating other urgent cases.

“It’s as busy now as ever,” Dr. Verma said. “Although it’s been difficult with the COVID precautions, it’s much better to be on this side of it.”

With a file from Laura Stone

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