The Impact of COVID-19 on Elective Procedures in Ontario

“…the cancellation of elective procedures and preservation of essential materials, as a result of the pandemic, will have a lasting impact on Ontario’s healthcare system for several years to come…”

Author: Grace Gillis

On March 15, 2020, Ontario’s Ministry of Health released a memorandum for hospitals to begin “ramping down elective surgeries and other non-emergent clinical activities” [1]. As COVID-19 cases continued to climb in the province, this approach was intended to preserve a hospital’s capacity to handle these cases, as well as protect access to urgent and emergent care [1]. Hospitals were also instructed to minimize the use of “essential items” for patient care, such as personal protective equipment, sanitization supplies, and ventilators [1].

The mass cancellation of procedures quickly followed, leaving only 10-20% of regular surgical activity in Ontario hospitals [2]. Here are some statistics showing the decrease in elective procedures between March 16 and April 16, 2020, in comparison to 2019 figures [2]:

62,614 fewer adult non-oncological surgeries (-93%)
6,097 fewer pediatric surgeries (-93%)
2,039 fewer adult cancer surgeries (-34%)
609 fewer cardiac surgeries (-44%)
1,033 fewer adult vascular surgeries (-73%)

Diagnostic imaging procedures were also greatly impacted [2]:

8,697 fewer CT scans for cancer staging and diagnosis (-25%)
61,896 fewer CT scans for other indicators (-52%)
2,051 fewer MRIs for cancer staging and diagnosis (-25%)
1,317 fewer MRIs for breast cancer screening (-89%)
60,390 fewer MRIs for other indicators (-64%).

As Ontario moved into phases 1 and 2 of gradual reopening, hospitals began rescheduling cancelled procedures [3]. Physicians were faced with the challenge of prioritizing patients to ensure that the most urgent cases received immediate care. While some medical specialties have systematic methods for triaging patients, others employed questionnaires and telemedicine conversations to measure the status of a patient’s condition and their quality of life [4]. While elective surgeries may not be considered emergent or urgent, these procedures often prevent the worsening of underlying conditions and greatly improve the patient’s quality of life [4].

As elective procedures are postponed, physicians including Clinical Vice-Dean of the School of Medicine at Queen’s University, Dr. Chris Simpson, express a collective concern: “a patient’s status could change. Their condition might worsen and that would bump them up into the urgent and emergent category,” ultimately further overwhelming Ontario’s strained hospital’s [4]. As described by Dr. Simpson, “the prospect of operating at 120 percent or 140 percent of normal volumes for weeks or months, just to catch up with backlog, is highly problematic from a feasibility point of view” [4].

To safely meet the demand for surgeries during a pandemic, hospitals have implemented policies in mandating masks/face coverings, conducting pre-operation appointments virtually, ensuring only necessary people (i.e. only the patient and medical professionals) are present at the hospital, and extending operating room hours [3]. Needless to say, the cancellation of elective procedures and preservation of essential materials, as a result of the pandemic, will have a lasting impact on Ontario’s healthcare system for several years to come [2].