Ontario tells hospitals to stop non-urgent surgeries, procedures to preserve critical-care capacity

The Ontario government has instructed hospitals and health-care professionals to stop all non-urgent surgeries and procedures to preserve critical-care capacity and human resources.

The directive took effect on Wednesday.

Alexandra Hilkene, spokesperson for the Ontario health ministry, said in an email on Wednesday that the province was reinstating what it calls "Directive #2" in response to the growing spread of the Omicron variant of COVID-19.

"While this was not an easy decision, this time-limited measure will help preserve and increase hospital-bed capacity by making between 1,200 to 1,500 acute/post-acute beds available as needed," Hilkene said.

"This decision will be closely monitored on an ongoing basis with the intention of bringing on surgical capacity as soon as safely possible."

Response to Omicron spread

The directive signed by Dr. Kieran Moore, Ontario's chief medical officer of health, says action is needed because of the spread of the highly transmissible Omicron variant.

"Specifically, cases are at the highest level since the start of the pandemic (>18,000 per day) and a continued acceleration in cases, and increased hospitalizations are expected throughout January 2022," he says in the directive.

"New data demonstrates two doses of a COVID-19 vaccine provide only some protection against severe Omicron infection, and three doses are needed for better protection.... COVID-19 threatens health system ability to deal with hospital admissions and the ability to care for all patients."

Emergency surgeries to continue

In the directive — issued to "regulated health professionals or persons who operate a group practice of regulated health professionals" — Moore says the following steps are required immediately:

• "All non-emergent or non-urgent surgeries and procedures should be ceased. Emergent and urgent surgeries should continue, in an effort to reduce and prevent patient morbidity and mortality.
• All non-emergent or non-urgent diagnostic imaging and ambulatory clinical activity should be ceased, unless directly related to the provision of emergent or urgent surgeries and procedures or to pain management services."

Moore says health professionals are "in the best position" to determine what is urgent or an emergency in terms of surgeries, procedures, diagnostic imaging and ambulatory clinical activity in their specific fields.

However, when making decisions about what to cease or postpone, health-care professionals should be guided by their regulatory colleges and such principles as proportionality, minimizing harm to patients, equity and reciprocity, he says.

"As this outbreak evolves, there will be continual review of emerging evidence to understand the most appropriate measures to take to protect health care providers and patients," Moore says.

"This will continue to be done in collaboration with health system partners and technical experts from Public Health Ontario and with the health system."

The directive comes as the number of people in hospital with the virus in Ontario reached 2,081 — 288 of them in intensive care units being treated for COVID-19-related illnesses. The province also reported at least 11,582 new cases.