Ontario appears to be once again in pandemic crisis as the Omicron variant causes cases to soar. On December 1st, 2020 daily reported cases were 780 and by the 15th they had soared to 2,421 and on December 31st the reported number of cases was 18,445. The first chart presents the daily number of cases since the start of the pandemic with a LOWESS smooth and indeed the figure is quite astounding showing a near vertical soaring of daily case numbers to heights heretofore unseen as has been occurring in other parts of the world. Indeed, there are now so many cases that Ontario has restricted access to testing meaning that we have now lost track of the pandemic. The result is a new set of restrictions and lock down measures for January designed to slow down and blunt the wave given the surge and the confused and chaotic rolling out of vaccine boosters.
Figure 1
At the same time, the evidence has been mounting that Omicron is not as severe as the previous variants and the disease is generally milder. Yet, the concern is that while the disease is generally milder, there are so many cases that hospitals still risk being overwhelmed. While hospitalizations have been rising over the last few weeks it remains that relative to the total number of active cases, hospitalizations remain at levels well below those of previous waves as shown in the next figure taken directly off of the government web site. Indeed, as the next figure shows, there are now so many cases relative to hospitalizations that the chart shows a hospitalization line that looks practically flat at the horizontal axis.
Figure 2
This obscures the reality that it is still possible that this current wave of the pandemic will see hospital and in particular ICU capacity overwhelmed. So we proceed to the third and final chart which presents since May 2020 the total number of adult ICU beds available at Ontario hospitals (lightest green), the total number of occupied ICU beds (intermediate shade of green) and the number of adults in ICU due to COVID-19 (the darkest green). This is perhaps the most curious piece of the puzzle. While ICU hospitalizations due to COVID-19 have been rising in Ontario, they are nowhere yet near the peak reached in May of 2021.
Figure 3
Yet, the concern is about overwhelming the hospital system which has been the concern all along. Indeed, despite a pandemic that has lasted nearly two years now we still seem to be having the exact same issues with each new wave - worries about capacity whether it is hospital beds or health professionals. Indeed, it is this capacity issue that has been a key driver behind some of the longest lock downs in the developed world. It remains that Ontario, like Canada, has some of the lowest per capita hospital bed numbers in the developed world as this chart put together by yours truly for the 2022 Maclean's chart fest illustrates.
And, what chart three also shows is that after the ramping up of ICU bed capacity in the wake of the first wave - ICU capacity was reduced rather dramatically in Ontario after the summer of 2020. It was ramped up a bit in spring of 2021 but then came down again where it has remained since August of 2021. And this is during a pandemic that has been occurring in successive waves and continually generated concerns about capacity of the health system.
If there is one thing that this pandemic has revealed about Canada's heath care system and the pandemic response is that we have spent a lot of money - indeed health spending to GDP soared to over 13 percent in 2021 - and yet we seem to always be chronically short of resources. Indeed in the case of ICU bed capacity in Ontario - we have been winding things down only to panic once again when the pandemic reignites. It is fortunate that the Omicron variant appears to be relatively mild and likely the last stage before becoming an endemic virus as it infects virtually everyone.
Will we have learned anything from it when it comes to our health care system? Likely not. Once it subsides it will be back to business as usual - a high spending system that is apparently resource starved at the same time, operates with just-in-time capacity and with little resilience to meet unforeseen demands. After all, recall that even before the pandemic, the Christmas holidays were always a source of concern about hospitals capacity as flu season hit and health professionals took holidays thereby reducing services. The pandemic has simply aggravated a long standing trend.
Given the general lack of outrage by Canadians or Ontarians about this state of affairs, it is obvious that they are quite happy with a bumbling mediocrity that spends more and gets less every time. I guess that as long as business and individuals get deficit fueled federal and provincial government support payments, they are not too concerned about value for money in their health care system - until they suddenly have to use it. If that is not the sign of a declining civilization, I don't know what is.
