Article written for Carleton University’s J-School in the spring of 2021

[Unpublished]

Postponed, non-emergent surgeries continue to stack up after Ontario’s Feb. 10 announcement to lift the halt on these procedures.

On Jan. 5, the province called for a pause on Directive 2 in an effort to make room in hospitals for the rising number of COVID cases. Dr. Kieran Moore, Ontario’s chief medical officer of health, in response to the decline in COVID-19 hospitalizations, made the statement saying that these surgeries would begin to gradually resume.

“Resumption of these services will follow a planned, phased approach across the province in alignment with guidance provided by Ontario Health and oversight by regional officers working with local hospitals,” Dr. Moore said.

Directive 2 can be issued by the chief medical officer if they, at their judgement, have assessed that there exists an immediate health risk without it, according to the Health Protection and Promotion Act. The Ontario Ministry of Health dictated that any non-urgent surgery that “requires surgical nursing support, requires general anesthesia health human resource support, or carries a risk of resulting in the use of emergency medical services or other hospital services due to serious … complications,” cannot be performed.

Surgeries targeting a wide range of medical conditions and injuries have fallen under this directive, as long as holding off on them wouldn’t be fatal. Many patients expecting the relief that surgery could bring them have been left frustrated. Ottawa resident Amal El-Tahan, 76, is one of them.

El-Tahan, who has suffered from multiple forms of cancer for two-and-a-half years, has been waiting on cataract surgery for more than a year. After its first postponement due to her cancer treatments at the time, the heightened number of COVID cases continued leading to delays, two more for the same surgery. Her granddaughter, Maram Basiri, spoke about the experience on El-Tahan’s behalf, translating from Arabic.

“I mean, it's vision, so she hasn't been able to do much. She hasn't been able to walk,” said Basiri. “I mean, she's an old lady, so she sits at home by herself most of the time … the fact that she can't look at her iPad or play cards or anything because she can’t see anything—she was getting kind of upset and frustrated, and a little more jittery.”

El-Tahan continues to wait for a rescheduled surgery appointment from Montfort Hospital. “They told her they would get back to her,” said Basiri. “They told her they’ll call her back when they have a closer date, and they'd have to check her eyes again and the cancer levels. Then they'd let her know, but they haven't even called to set an appointment.”

According to data from the Canadian Institute for Health Information, recorded on Dec. 9, 2021, the number of surgeries declined by around 35,000 a month. Notably, cataract surgeries were most largely affected, decreasing by 5,900 per month.

With information collected by the Toronto Star, Ontario Health data shows that around 883,815 scheduled surgeries took place between March 15, 2020, and Jan. 23, 2022. 1,219,800 scheduled surgeries were performed in the province during a comparable period before the pandemic, suggesting that approximately 336,000 scheduled surgeries didn’t happen.

This long-term delay has also critically affected surgeries as treatment for conditions relating to heart and brain disease. A spokesperson for the Heart and Stroke Foundation was unable to comment at the time but provided data from their Health Professionals COVID Impact Survey, which was conducted between Aug. 16 and Sept. 7, 2021, and reflects the ongoing difficulties of Canadian healthcare throughout the pandemic.

“90% of health professionals and researchers who responded to the survey are worried that the health of people living with heart disease or stroke has gotten worse because they were not always able to access the care they needed during the pandemic,” the report states. Moreover, “54% of health professionals and researchers are worried about a decrease in cardiovascular health in people who did not have existing conditions prior to the pandemic.”

The possibility of an increase in diagnoses and developing conditions due to long wait times could make the backlog of non-urgent surgeries in Ontario, well, quite urgent. The Ontario Medical Association (OMA) “estimated the pandemic had caused a backlog of 20 million patient services” before Directive 2 was issued in early January.

In a report published on Feb. 16, OMA illustrates a “three-stage approach” to advance through the extensive backlog of surgeries. By establishing new “integrated ambulatory car centres,” the association says this could make room for surgical care, both emergent and not. The ambulatory model, however, could take an estimated five to eight years to achieve.