Ontario is telling hospitals to prepare for transferring dozens and potentially hundreds of patients across and even out of regions, as unprecedented numbers of people sick with COVID-19 fill the province's beds.
In a memo dated Thursday and obtained by CBC News, the president and CEO of Ontario Health, Matthew Anderson, lists "actions that hospitals must take immediately … to provide the necessary care for COVID-19 and non-COVID-19 patients."
"We need to work as a provincial system at a level never required before," Anderson wrote.
"All hospitals must be ready to accept patient transfers when directed by their regional COVID-19 response structure," he continues.
"This includes accepting patients from other hospitals in and outside your regions."
Hospitals that have intensive care space available are told they must reserve one-third of those beds for transfers from hospitals that have maxed out their ICU capacity.
Ontario has created a COVID-19 critical-care command centre that will manage the transfers of ICU patients between hospitals.
Even in the areas where COVID-19 transmission is at its highest, hospitals are told to continue "time-sensitive" surgeries and procedures, including cancer treatments, transplants as well as cardiac and neurological care.
"This is really going to be quite an unprecedented effort, to do what they call 'load-sharing' to help some of the hospitals that have been really disproportionately impacted by COVID-19," said Dr. Chris Simpson, executive VP medical of Ontario Health.
Simpson said this is a result of the "extreme asymmetry" of COVID-19 in Ontario.
"The fact that some of the Toronto hospitals are right at the brink of being at the edge now, some places like where I am, in Kingston, we've been lucky with relatively low numbers, our hospital has been able to continue, not as affected."
The hospitals are told in the memo to "have a plan in place to appropriately defer non-time-sensitive care, if required."
Ontario's hospitals are projected to have more than 500 patients with COVID-19 in intensive care units and more than 1,700 COVID-19 hospitalizations in total by Jan. 24, according to the memo.
"No hospitals should feel they are on their own," Anderson wrote.
Dr. Brooks Fallis, division head and medical director of critical care at William Osler Health System, a hospital network in Peel Region, said central and Toronto regions are "nearly full," with some hospitals already overflowing.
"Many hot spot areas have been dependent on transfer strategies for weeks," Fallis told CBC News.
"The local transfer options are drying up at the same time that case numbers are skyrocketing — this is a disastrous combination for the integrity of the health system as a whole."
Transporting patients will be challenging, particularly due to the limited trucks and staff, Fallis said.
"If you move an ICU patient from Brampton to Kingston, that's an entire shift for a critical care crew and you've only moved [one] patient," he said.
"The health-care system has done an amazing job to this point at creating additional capacity — truly impressive. But there is a limit, and it feels like the limit is arriving as cases are growing exponentially."
Hospital prepares to accept patients from hard-hit regions
Dr. Wil Smith, chief of staff for West Parry Sound Health Centre, said his hospital is preparing its surge plans to accommodate for the transfer of patients from hard-hit regions in the province.
"Unless we see a major turnaround in the numbers over the next week or so, I think the entire province is going to struggle over the next month or two," Smith said.
"We, of course, hope that it'll never happen, but we need to be ready and to be able to help our colleagues in the South and that would be a real turnaround."
He said the hospital in Parry Sound, a town that is more than 200 kilometres north of Toronto, is used to needing to send patients to the big city, not vice versa.
"We're normally sending patients to tertiary care centres in the south and now we're being asked to receive patients from the south to the north," Smith said. "If that's the way the hand is dealt, that's the hand that we will play and we'll do our part to help everyone out."