Canada's ERs are under intense pressure — and winter is coming

With rising COVID-19 cases and staff shortages, hospital emergency departments are jammed up in much of the country even before the traditional flu season begins, raising concerns about the winter months ahead.

Several provinces are already struggling with patient load ahead of flu season

A paramedic stands beside an ambulance outside a hospital
A paramedic is pictured near ambulances outside St. Michael's Hospital in Toronto on Friday. A recent Ontario Health report outlined the immense pressure on the province's emergency rooms. (Evan Mitsui/CBC)

Hospital emergency departments are jammed up in much of the country even before the traditional flu season begins, raising concerns about the winter months ahead.

In Montreal, for instance, ERs hovered at about 150 per cent capacity for much of the past week — and some surpassed 200 per cent.

Dr. Judy Morris, head of the Quebec Association of Emergency Physicians, said the sustained pressure on the system from the COVID-19 pandemic and subsequent staffing shortages has taken a toll.

"It's kind of unseen to have that over such a long period," said Morris, an emergency physician at Sacré-Coeur hospital in Montreal.

"Certainly the lack of personnel — all types of personnel, but mostly nursing personnel — is hurting us across the health-care network."

The situation is also troubling in other parts of Canada, including Alberta, British Columbia and Ontario.

"I've been in emergency medicine for almost 19 years now, and I have never seen the waits that our patients have to endure at all," said Dr. Carolyn Snider, the head of emergency medicine at St. Michael's Hospital in downtown Toronto.

"I think what's most concerning about it is that it doesn't feel like there's an end in sight for so many of us."

Dr. Supriya Sharma, Health Canada's chief medical adviser, noted that another COVID-19 wave is beginning in Europe.

"There's concerns that we might see a worse flu season than we've seen from the last couple of years and as well as keeping an eye on COVID cases," she said.

"It's a matter of really being watchful and putting in place as many of our multi layers of our multi-layer public health approach as we possibly can."

Wait times up, rural ERs scaled back

An Ontario Health report leaked by the Liberal opposition last week illustrates the extent of the problem in that province.

Patients in an emergency room waited more than 33 hours for an inpatient bed in August, a 54 per cent increase compared with the same month a year earlier. Ambulance offload times also rose, with patients waiting up to 83 minutes before entering the hospital.

At the local level, authorities are warning the public of a challenging fall and winter ahead and urging residents to get their influenza and COVID-19 booster shots.

In eastern Ontario, Hastings Prince Edward Public Health, which is based in Belleville, issued a statement on Friday pointing to the continued prevalence of COVID-19, along with an expected resurgence of influenza and a health-care system already under strain.

"This year, residents are encouraged to get the influenza vaccine when it becomes available, and to stay up-to-date with COVID-19 vaccines, to reduce their risk of severe illness and to reduce the risk of spreading illness to others," said Dr. Ethan Toumishey, medical officer of health at the unit.

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Emergency rooms in British Columbia are also under strain, said Aman Grewal, head of the B.C. Nurses' Union.

She said many hospitals in rural areas have, at times, scaled back services or closed on the weekends due to a staffing shortage — putting more pressure on larger hospitals.

"Those patients that would have gone to that hospital are now having to travel an hour and a half to two hours to a more tertiary site," Grewal said. The staffing shortage will only get worse, she said, if governments don't put money into education programs for young nurses, as well as provide better salaries and working conditions to retain those on the job.

In Quebec, more than 4,000 health-care workers were off the job on Friday due to COVID-19, the highest number in nearly two months.

Morris, head of the province's emergency physicians' association, said the lack of staff, a resurgence in COVID-19 patients and backlogs elsewhere in the system are all contributing to overloaded ERs.

"When patients have nowhere to go, they come to the emergency room, and that's why our numbers are high. But mostly we need personnel in order to open up more beds so that they can be in the right place to get the care they need," she said.

"We're feeling this way going into what is traditionally one of the busiest seasons with flu and another wave in front of us or upon us with COVID as well, and it's pretty worrisome."

The number of Quebec patients in hospital with COVID-19 climbed beyond 2,000 last week for the first time since August, prompting the province's health minister, Christian Dubé, to once again encourage people to get their booster shots.

'Patients have gotten more complex'

Snider of St. Michael's Hospital in Toronto said the problem isn't likely to be solved any time soon. Put simply, the number of patients coming into the hospital is greater than the number going out, she said.

"I think everybody can sort of grasp that, and there's only so many beds in the end," she said.

"As our patients have gotten more complex, as our patients are getting older, we need more and improved care for them when they leave."

WATCH | Doctor warns of difficult months ahead

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With an increase in COVID-19 cases, the possibility of new variants emerging and the upcoming flu season, the next six months could be challenging for health-care systems across the country, says cardiologist Dr. Christopher Labos.

In an attempt to free up hospital beds, the Ontario government made the controversial decision to allow seniors to be sent up to 150 kilometres away for long-term care.

Snider said authorities will need to move quickly to free up space in the winter months and should think creatively in doing so.

"Do we need to take over hotels, do we need to take over apartment buildings and ensure that good care is being provided in different spaces than we're used to, because we're at such a crisis state in our health-care system," she said.

"The other very important piece of this is: Who are the humans that are going to take care of our patients and our loved ones — and that continues to be a problem across Canada? I would say that most of our nurses, if not all, are really not paid for the hard work that they do."


Benjamin Shingler is a senior writer based in Montreal, covering climate change, health and social issues. He previously worked at The Canadian Press and the New Brunswick Telegraph-Journal.

With files from Sean Henry, host of CBC Montreal's Daybreak