December 9, 2021 — Since March 2020, Canada’s health care systems have adapted and evolved at an unprecedented rate to respond to COVID-19. CIHI has compiled health system data from the first 3 waves of the pandemic in Canada (March 2020 to June 2021). Our analysis covers 5 distinct topics, looking at health system impacts and changes in the following areas:
- Emergency departments
- Hospital services, including surgeries and intensive care units (ICUs)
- Physician services
- Long-term care
- Unintended consequences on harms caused by substance use, self-harm and accidental falls
Note: The term “wave” refers to significant surges of community cases of COVID-19 infections in Canada overall, although we recognize that the timing and size of the waves may vary by jurisdiction.
The data highlights 3 compelling stories:
Health care systems continually adapted
Health care systems continually adapted their response to COVID-19 during the first 16 months of the pandemic (March 2020 to June 2021) to find the balance between caring for COVID-19 patients and caring for patients with other health issues. Strategies included the following:
- Hospitals prioritized life-saving and more urgent treatments. For example, cardiac procedures such as angioplasty, radiation treatment for cancer patients and surgeries for hip fracture repairs remained at or close to pre-pandemic levels.
- Hospitals retrained and shifted human resources to support areas of greatest need, such as ICUs.
- Surgeries were cancelled or delayed. Almost 560,000 fewer surgeries were performed over the first 16 months of the pandemic compared with 2019.
- Emergency departments triaged people virtually, redirected people who could be treated elsewhere and offered virtual visits to reduce crowding in waiting rooms. Visits dropped by 9,300 per day on average during the pandemic period compared with 2019.
- Virtual care became a key tool for primary care physicians and specialists and may be one of the enduring transformations coming out of the pandemic. Across 5 provinces where data is available, between 27% and 57% of physician services were provided virtually (online or by phone).
It is difficult to know whether the short-term measures used to deliver care through the waves of COVID-19 infections are the right ones or whether they will be sustainable over the long term. Early analyses of hospital performance indicators do not show changes in quality of care during the pandemic period; however, it is difficult to know how to interpret the data given the changes in health system use and access. As well, the data needed to understand the long-term outcomes of the pandemic and public health policies may be different than what is collected today. For example, there are likely unknown impacts on the patients whose care was delayed or whose condition was never diagnosed, on staff given the rise in burnout and on the system as staff leave the health workforce.
Public health measures changed some common illnesses
Our data shows the impact of public health measures such as wearing masks and physical distancing on common infectious illnesses, such as colds and influenza. Physicians and emergency departments saw a big decrease in visits by children and youth, in part due to a decrease in respiratory conditions such as asthma and bronchiolitis, which can be triggered by viral infections. In adults, changes in cold and flu transmission reduced the need for care for conditions such as pneumonia, asthma and chronic obstructive pulmonary disease (COPD). Hospitals were able to accommodate the influx of COVID-19 patients in part because of the decreases in admissions for pneumonia and COPD. The same may not be true as the pandemic evolves, with more people being vaccinated, public health measures loosening and seasonal respiratory viruses returning. Canada could be facing twin pandemics of COVID-19 and influenza this winter.
Public health measures such as lockdowns impacted other common conditions, particularly in children and youth. School closures and restrictions on sporting events led to fewer accidental falls and injuries for children. Restrictions on social gatherings and closures of bars and pubs reduced access to alcohol, resulting in a drop in emergency department visits for alcohol poisoning for youth age 10 to 19 throughout the pandemic period. While fewer injuries and alcohol poisonings are a positive consequence of public health measures, the negative health impacts from a sustained lack of physical activity and social contact will require monitoring.
Canadians experienced effects of the COVID-19 pandemic differently
Although we can’t yet paint the full picture, we know that the pandemic is highlighting pre-existing inequities as Canadians experience the pandemic’s effects differently. Our data shows that those who live in lower-income neighbourhoods were admitted in greater proportions for harms caused by substance use, and young women were hospitalized more for self-harm than any other demographic. However, our picture is incomplete for harms caused by substance use and self-harm, as it does not include care provided in the community (outside of hospital) or deaths that occur outside of hospital (such as opioid and suicide deaths). This analysis provides a high-level indication of whether Canadians are getting access to the mental health care they need during the pandemic, but we don’t know about the long-term impact on Canadians’ general mental health or lack of access to care for those with existing mental health concerns.
Better understood is the pandemic’s impact on older people, like those residing in long-term care homes, who were more likely to have serious outcomes from COVID-19. Long-term care residents were disproportionately affected during the first 2 waves of the pandemic, with more deaths due to COVID-19 than other Canadians and more deaths from other causes compared with pre-pandemic rates. Long-term care resident deaths decreased only when vaccines were available in Wave 3 of the pandemic.
Moving beyond the pandemic
COVID-19 continues to challenge health care systems across Canada — and all Canadians — as we collectively learn about and adapt to the pandemic. CIHI’s data is 1 input into the ongoing exercise of evolving our understanding of COVID-19 and its effects. The numbers tell us that public health measures and innovations in care delivery helped health care systems continue to adapt to COVID-19. These actions ensured that resources were available for the surges of infected patients, but we do not know how sustainable the adaptations will be. We also don’t know what place the various public health measures, such as wearing masks and physical distancing, will have in our public health toolbox going forward.
While we know the changes in service volumes, we don’t yet have the full picture of the impact of delayed or deferred care on health care systems and patients. Given the potential consequences, how do Canada’s health care systems build resilience for the future? The data and learnings from waves 1, 2 and 3 are valuable as health care system leaders seek to adapt their responses to COVID-19 as the pandemic evolves.
Contact us
Have questions or looking for more information? Email us.