Ottawa Citizen

Why hospital capacity in Canada was so easily overwhelme­d by COVID

According to a new poll by Maru Public Opinion, more than 42 per cent of Canadians believe their local hospital is so overwhelme­d that they don't trust it to take care of them if they suddenly needed medical care. One third of Canadians, meanwhile, have someone in their inner circle for whom that is the case: They had treatment for a “serious medical issue” postponed because hospitals were too busy with COVID-19.

Canadian hospitals, particular­ly in Quebec and Ontario, are being pushed to the breaking point by the effects of the Omicron variant. One of the most surprising things about the crisis, however, is how little it took to get here. Ontario is a province of 14.5 million people, and as of last Thursday it only took 3,630 people hospitaliz­ed with COVID-19 to plunge the province into one of the world's strictest lockdowns.

For two years, COVID-19 has been highlighti­ng a crisis of Canadian hospital capacity that has been limping along for decades. Below, some numbers on why Canada was so easily overwhelme­d.

Canada has fewer intensive care beds than almost anyone else in the developed world

The Organizati­on for Economic Co-operation and Developmen­t (OECD) is an internatio­nal body roughly comprising all the world's developed liberal democracie­s. When ranked against its OECD contempora­ries, Canada comes fourth last in terms of intensive care beds available per capita (only Chile, Sweden and Colombia ranked lower). Canada had just 1.97 ICU beds for every 100,000 residents. The top-ranked country, Japan, had 7.74 beds per 100,000.

A 2017 OECD ranking also found that Canada was one of the countries least likely to have an acute care bed available for use. Even before COVID-19, 91.6 per cent of Canadian acute care beds already had someone in them, a rate that was worse only in Israel and Ireland. In the U.S., average occupancy rate on acute care beds was just 64 per cent. In the U.K. it was 84.3 per cent.

Our rate of overall hospital beds is also one of the worst in the OECD

Canada also ranks near the back of the pack in overall hospital beds. The latest numbers from the OECD show Canada with just one hospital bed for every 400 citizens, a ratio that put us in the bottom tier of OECD countries. In France, there's a hospital bed for every 172 citizens, and in Japan (the first place contender) there's a bed for every 78 people.

The United States also lags behind much of the developed world in terms of relative hospital beds. At one bed for every 357 people, the Americans are only two spots ahead of Canada in the OECD ranking. Tellingly, the Omicron surge is yielding many of the same scenes of overstretc­hed hospitals in the U.S. as in Canada. Michigan, for instance, called in military help for its overwhelme­d emergency rooms just before Christmas.

And yet, there are few COVID-battered jurisdicti­ons in Canada that wouldn't envy the hospital capacity of their U.S. neighbours. Alberta, Canada's richest province, has roughly the same population as the poorest state, Alabama (4.4 million vs. 4.9 million, respective­ly). And yet, in the Delta wave that swept both jurisdicti­ons in October, Alabama had 1,531 ICU beds to 370 in Alberta.

As of last Wednesday, Ontario was reporting 2,343 staffed ICU beds, of which 489 contained a patient with COVID-19. Just across the border in New York State, there were 34,869 ICU beds. Even accounting for New York's larger population (19 million vs. 14 million in Ontario), that's more than 10 times as many ICU beds.

It’s extraordin­arily easy for the system to become overwhelme­d

Even before the first case of COVID-19 was confirmed in North America, Brampton, Ont., Mayor Patrick Brown was declaring a “health-care emergency” due to excessive wait times at the city's hospitals. “We were consistent­ly over 100% capacity and this was before the pandemic even started,” he wrote in a recent tweet.

Quebec, too, is no stranger to hospitals being strained to the breaking point under conditions that most non-Canadian jurisdicti­ons would consider normal. In 2011, it only took an unusually busy night to send the Montreal-area Hôpital du Lakeshore into 232 per cent capacity. A bad flu season in 2015 sent emergency rooms throughout Quebec City into capacity overages of more than 150 per cent.

Throughout the pandemic, provincial health systems became critically overwhelme­d by levels of hospitaliz­ation that wouldn't even faze the average British or American hospital. In September, economists for CIBC calculated that hospitals in both the U.K. and the U.S. didn't reach their “peak” until hospitaliz­ations were as much as five times higher than what it took to max-out a Canadian hospital. “Simply put, we reached capacity at levels that many other countries consider to be acceptable,” wrote the authors.

Even pre-pandemic, Canada had some of the longest wait times in the world

If you're a Canadian who wakes up a with a fever or a sore throat, the odds are that you won't be able to get in front of a doctor for at least 24 hours. In a report published just before the onset of COVID-19, the Fraser Institute found that only 43 per cent of Canadians could reasonably expect to secure a same-day appointmen­t when sick — a ratio that placed Canada in last place among 17 comparable countries.

A 2016 OECD ranking also put Canada in last place when tallying up the share of patients who have to wait one month or more for a specialist appointmen­t. More than 60 per cent of Canadians found themselves in that category, compared with 41 per cent in the U.K. and just 25 per cent in Germany. Although, when it came to wait times for emergency surgeries, Canada didn't fare all that bad at all; Canadians wait just six days for a coronary bypass against an OECD average of 24 days.

But Canada is pushed right back into last place when it comes to emergency room wait times. A 2014 report by the Commonweal­th Fund found that upwards of 26 per cent of Canadian hospital patients needed to wait at least four hours in the emergency room. In Norway, the first-place contender for wait times, the experience was so rare that only one per cent of Norwegians had ever encountere­d it.

Despite everything, Canada’s system is still one of the world’s priciest

Every year, the New York City-based Commonweal­th Fund ranks the world's major health-care systems to figure out which country is getting the best bang for their buck. The U.S. always ranks last place, thanks to an extraordin­arily expensive system that still remains inaccessib­le for many without private insurance. But in 2021, the second-tolast place went to Canada in the category of “health care performanc­e compared to spending.”

The OECD's raw numbers on health spending aren't quite so dire, but they do still show Canada as one of the world's leading spenders on health care. According to 2014 data, Canada spent 26 per cent more than the OECD average on hospital services.