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A woman walks away from the emergency department at Mackenzie Health hospital in Richmond Hill, Ont., on June 8, 2020.Galit Rodan/The Globe and Mail

Ontario’s hardest-hit hospitals have transferred more than 550 patients by helicopter and ambulance in the past two weeks as the third wave threatens to overwhelm intensive-care resources in COVID-19 hot spots.

But even with a record number of transfers easing the burden, some hospitals in coronavirus-battered communities in the Greater Toronto Area are preparing new protocols in case they run out of beds as severely ill patients flow in at unprecedented rates.

“We are dangerously close to not being able to provide typical care to these patients,” said Andrew Healey, chief of emergency medicine and a critical care doctor at William Osler Health System.

The patients who’ve been shipped out in the past two weeks alone represent more than a quarter of the 2,059 pandemic-related transfers that have taken place since the provincial government activated its GTA Hospital Incident Management System (IMS) to co-ordinate the movement of COVID-19 patients in mid-November.

The overwhelming majority of transfers have come from just a handful of hospital networks in communities ravaged by COVID-19, including William Osler, whose Brampton and Etobicoke sites were the source of a third of all the pandemic-related transfers in Ontario last week.

“We are hardly keeping anyone because we know the volume through our front door is so enormous,” Dr. Healey said. “There was a night this week [when] with each bed that was being emptied by transport, there was another patient waiting for that bed.”

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The dramatic recent spike in transfers underscores both the severity of the third wave and the uneven way it has crashed across the GTA. As in previous waves, the coronavirus is wreaking the most havoc in neighbourhoods full of people who can’t work from home, many of them poorly paid, racialized and living in crowded housing with multigenerational families.

The hospitals that serve these communities – including Osler, Scarborough Health Network, Trillium Health Partners in Mississauga and Humber River Regional Hospital in northwest Toronto – have been using the relief valve provided by the GTA IMS transfer system for months.

Osler has transferred out 565 patients since mid-November, according to data provided by Ontario Health as of April 18. Scarborough has transferred 363, Trillium 298 and Humber 236. The hospital networks that have received the most patients are Sinai Health System in Toronto (185), Halton Healthcare Services (265) and Mackenzie Health (335), which includes the new Cortellucci Vaughan hospital, designated exclusively for COVID-19 patients.

Most of the transferred patients have COVID-19; those who don’t are moved to make way for those that do.

Without the GTA IMS command centre and its operational partner, the Ontario critical care COVID-19 command centre, Dr. Healey said his hospitals “would be far underwater.”

Dr. Healey represents a cluster of hospitals on the western side of greater Toronto at the GTA Hospital IMS, which meets over Zoom at noon, seven days a week.

The meetings are “my favourite hour of the day,” he said, describing the co-operative spirit of his colleagues from other hospitals as a balm for the tragedies he’s witnessing on the front line.

Both the GTA hospital IMS and the Ontario critical care command table are led by incident commander Andrew Baker, the director of critical care at St. Michael’s Hospital, part of Unity Health Toronto. From his vantage point leading both daily gatherings – the critical care group meets virtually at 8 a.m. every day – Dr. Baker is able to stay on top of which hospitals need rescue transfers and which have the beds and staff to squeeze in more of the infected.

Dozens of independent Ontario hospital networks are now functioning, effectively, as one big hospital, Dr. Baker said. “This is not just a small departure or scaling up in a small way,” he added. “This is an orders of magnitude difference. This has never been seen before.”

Along with co-ordinating last-minute “rescue” transfers, the GTA Hospital IMS issues weekly directives to hospitals for a certain number of pro-active transfers intended to clear as much space as possible for hot-spot hospitals without putting other hospitals at risk.

Patients have been pro-actively dispatched as far away as Peterborough, Kingston, London and Ottawa, transported by critical care provider Ornge’s aircraft and land ambulances if they require critical care, and by local paramedic services if they don’t.

“My heart goes out to those poor families whose loved one is being cared for in a place that’s a few hours away. It’s very difficult for those patients,” said Michael Fitzpatrick, chief of staff at Kingston Health Sciences Centre, which was caring for 31 COVID-19 patients in the ICU Monday and 14 on its medicine ward. Only one was a local.

At the daily GTA IMS meeting, representatives lay out the challenges each location is facing. Are emergency departments backed up? Are a slew of COVID-19 patients in the medicine wards deteriorating to the point they’ll need critical care soon? Is the ICU itself reaching capacity?

At last Wednesday’s meeting, Ru Taggar, a Sunnybrook Health Sciences executive who represents a group of hospitals in north and east Toronto, said her hospitals were mostly in a “steady state.” The focus that day, she said in an interview after the meeting, was on Osler’s Brampton Civic Hospital. “We basically, as a team, talked about, ‘Okay, who can help William Osler? Who can take patients?’”

Other hospitals were able to step up that day, but Dr. Healey of Osler wonders how much longer such rescues will be possible if COVID-19 patients keep pouring in. Last week, a record 331 patients were transferred out through the GTA IMS and critical care tables, 200 more than the worst week of the second wave.

William Osler is now scouting out non-traditional spaces in common rooms and lobbies where patients waiting for beds can be given oxygen, a chair and warm blanket, Dr. Healey said. Hospital leaders have drawn up a “Code Zero” protocol that would kick in when every ICU bed and every resuscitation space in the emergency department is full. The protocol would see an anesthesiology team care for COVID-19 patients temporarily in operating rooms, preparing them to be transferred to another hospital as soon as possible.

However, transportation resources are also strained.

Local ambulance services and Ornge have stepped up. Ornge recently put out a provincewide callout for staff to come work in the GTA, putting land ambulances that used to be in service 12 hours a day on the road 24 hours a day, said Michael Lewell, Ornge’s associate medical officer. The organization has nearly doubled its land transport capacity in the GTA in the past 10 days.

“In my 14 years at Ornge,” Dr. Lewell said, “we’ve never had a sustained operational surge, systemwide, like we’ve had over the last 10 days.”

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