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Between March 2020 and June 2021, hospitals admitted 11% fewer inpatients, compared with the pre-pandemic period. Following the disruption experienced early on in the pandemic (Wave 1), hospitals gradually resumed routine care, while keeping resources in reserve in the event of a surge of COVID-19 hospitalizations. By the start of Wave 2, admissions had rebounded to within 6% of pre-pandemic levels and many surgical restart programs had been implemented. In Wave 3, hospitals were again pushed to adapt to the changing pandemic and some care was delayed again. 

Note: For this analysis, 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.

Maximizing the hospital sector’s finite capacity and resources during the COVID-19 pandemic unfortunately resulted in the disruption of thousands of surgical procedures and diagnostic imaging services, which compromised timely access to care and tested the resilience of the hospital sector. The significant toll of the pandemic from COVID- and non-COVID-related delays in care has made it clear that Ontario can’t afford to maintain the status quo when it comes to health care. Hospitals are committed to working closely with Government and our health system partners to urgently address the growing demand for health care services, eliminate the backlog of care and enhance capacity across the continuum of care to alleviate the additional pressure that’s been placed on hospitals and health care workers. – Anthony Dale, President and CEO, Ontario Hospital Association

Change in hospital inpatient occupancy during the pandemic, March 2020 to June 2021

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Compared with 2019, inpatient occupancy dropped by about 30% in April 2020 as the first wave of the COVID-19 pandemic took hold in Canada. As community cases slowly declined in late spring and throughout the summer, inpatient occupancy rebounded to about 6% below pre-pandemic levels. After the start of Wave 2, inpatient occupancy again declined, to about 10% below pre-pandemic levels. With Wave 3 in spring 2021, inpatient occupancy continued trending steadily downward.

Notes
Excludes Quebec data.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data. 

Sources
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. . Accessed September 24, 2021.  

The data shows that during the pandemic, some scheduled surgical care (such as hip and knee replacements) was delayed, while events like births remained relatively unchanged. For cardiac care that involved diagnostic procedures to determine urgency, the data indicates that a moderate approach was taken in balancing the risk of delaying care with the risk of COVID-19 infection and resource availability. 

Change in hospital admissions during the pandemic by reason for admission, March 2020 to June 2021

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Month	Pregnancy with delivery	Major cardiac diagnosis	Hip and knee replacement non-traumatic	Monthly COVID-19 community cases
March 2020	-2%	-14%	-35%	8,533
April 2020	-2%	-35%	96%	44,688
May 2020	0%	-21%	-87%	37,711
June 2020	-6%	-8%	-50%	13,257
July 2020	-3%	-5%	-5%	12,108
August 2020	-5%	-8%	-3%	12,636
September 2020	-4%	-3%	0%	29,810
October 2020	-3%	-6%	1%	76,686
November 2020	-5%	-11%	-8%	142,695
December 2020	-6%	-11%	-7%	203,288
January 2021	-6%	-17%	-16%	198,426
February 2021	-1%	-9%	-19%	87,841
March 2021	1%	-5%	-7%	114,416
April 2021	2%	-13%	-31%	237,308
May 2021	-1%	-19%	-60%	162,155
June 2021	-13%	-14%	-40%	33,711

Notes
Excludes Quebec data.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data. 

Sources
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. . Accessed September 24, 2021.  

Early analysis at the national level shows that quality of care was maintained during the first 2 waves of the pandemic. While there were longer wait times for joint replacement surgeries, in-hospital mortality, hip fracture surgery timeliness and wait times for radiation therapy remained stable. 

More information on health system performance indicators (2020–2021) is available in the Your ������ϱ� System interactive web tool. This includes information on surgical wait times, obstetric care, readmissions and deaths, as well as use of acute care services for specific conditions, at the hospital, region, province/territory and national levels.

From March 2020 to June 2021, almost 560,000 fewer surgeries were performed due to cancellations and delays, compared with the pre-pandemic period (excluding Quebec). The largest drop occurred in Wave 1, with approximately 370,000 fewer surgeries. By the summer of 2020, most jurisdictions had resumed the delayed surgeries, with some even exceeding pre-pandemic surgical volumes in an effort to clear backlogs. Overall, in Wave 2 the number of surgeries was within 4% of pre-pandemic levels. During Wave 3, with rising numbers of COVID-19 infections and hospitalizations, some regions (Ontario, Manitoba, Saskatchewan and British Columbia) delayed surgeries again.

Change in surgical volumes during the pandemic, March 2020 to June 2021

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Compared with 2019, daily surgical volumes saw a sharp drop by about 80% in early April 2020 as the first wave of the COVID-19 pandemic took hold in Canada. By the end of July 2020, surgical volumes had recovered to pre-pandemic levels and remained there until early September 2020. During Wave 2, overall surgical volumes were similar to those seen in the pre-pandemic year. However, there were large spikes in percentage change, reflecting a lack of seasonal slowdowns during the pandemic period rather than an increase in activity. During Wave 3, surgical volumes showed a general downward trend, dropping 20% to 40% below pre-pandemic levels.

Notes
Excludes Quebec data.
Normally, there are surgical slowdowns around statutory holidays, such as during December. During the pandemic, there have been no seasonal slowdowns. The large spikes in percentage change reflect a lack of slowdowns during the pandemic rather than increases in activity.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data. 

Get data on changes in surgical volumes that includes additional months up to September 2022.

Sources
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. . Accessed September 24, 2021.

From March 2020 to June 2021, there was an average increase of about 3,000 additional inpatient admissions a month for respiratory conditions, compared with the pre-pandemic period. This increase was not evenly distributed; each successive wave of COVID-19 saw higher volumes of respiratory conditions and put added pressure on hospitals for beds and specialized resources such as ICU beds and ventilators. While respiratory conditions can include a mix of illnesses, by April 2021, 87% of respiratory admissions to the ICU were for COVID-19 infections. COVID-19 displaced most other common illnesses such as pneumonia and chronic obstructive pulmonary disease (COPD), illnesses that would normally require the same hospital resources. In ICUs, from March 2020 to June 2021, there were almost 14,000 additional respiratory admissions, compared with the pre-pandemic period. In fact, by Wave 3, the need for ICU care and ventilators among respiratory patients had increased by approximately 400%. 

Change in care for respiratory conditions during the pandemic, March 2020 to June 2021

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Month	Inpatient admissions for respiratory conditions	ICU admissions for respiratory conditions	Ventilations for respiratory conditions	Monthly COVID-19 community cases
March 2020	-1%	32%	47%	8,533
April 2020	165%	98%	139%	44,688
May 2020	127%	53%	72%	37,711
June 2020	78%	27%	44%	13,257
July 2020	50%	13%	32%	12,108
August 2020	33%	11%	18%	12,636
September 2020	55%	21%	21%	29,810
October 2020	89%	53%	67%	76,686
November 2020	293%	124%	140%	142,695
December 2020	512%	222%	243%	203,288
January 2021	534%	190%	180%	198,426
February 2021	432%	139%	144%	87,841
March 2021	329%	152%	146%	114,416
April 2021	841%	401%	434%	237,308
May 2021	884%	366%	429%	162,155
June 2021	298%	91%	132%	33,711

Notes
Excludes Quebec data.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data. 

Sources
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. . Accessed September 24, 2021.  

Despite this large increase in ICU stays for respiratory conditions, health care systems were able to manage care because of preparations made in Wave 1, including obtaining more ventilators and reorganizing/retraining staff. 

Some conditions were unexpectedly displaced by COVID-19 — such that the patients who would normally occupy these ICU beds were replaced by COVID-19 patients. Public health measures such as physical distancing and wearing masks reduced transmission of seasonal respiratory viruses, resulting in fewer hospital admissions for patients with chronic and acute respiratory conditions, such as COPD and pneumonia. There were also fewer admissions for cardiac conditions, which is normally 1 of the top 5 reasons for hospitalizations. Those with conditions such as hypertension and obesity are at high risk for both cardiac conditions and COVID-19 infections.Reference1 During times of high COVID-19 hospitalizations, we saw reduced hospitalizations for cardiac conditions. People with cardiac conditions or other frailties who were more at risk for poor COVID-19 outcomes may have been more likely to be admitted for COVID-19 instead of these other chronic diseases. This trend was seen in other sectors such as long-term care. 

Change in hospital admissions for cardiac conditions, March 2020 to June 2021

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Month	Major cardiac diagnosis	Monthly COVID-19 community cases
March 2020	-14%	8,533
April 2020	-35%	44,688
May 2020	-21%	37,711
June 2020	-8%	13,257
July 2020	-5%	12,108
August 2020	-8%	12,636
September 2020	-3%	29,810
October 2020	-6%	76,686
November 2020	-11%	142,695
December 2020	-11%	203,288
January 2021	-17%	198,426
February 2021	-9%	87,841
March 2021	-5%	114,416
April 2021	-13%	237,308
May 2021	-19%	162,155
June 2021	-14%	33,711

Notes
Excludes Quebec data.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data. 

Sources
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. . Accessed September 24, 2021.  

For more information on changes in health status and health care utilization patterns, please see the 80+ indicators available through the ������ϱ� Indicators e-Publication.

• Were delays and cancellations experienced by all patients, or were they felt by certain groups more than others? 
• What were the physical and mental health consequences for patients who have had procedures delayed?
• What are the long-term health needs of those infected with COVID-19 and how will this impact health care systems? 

• ������ϱ� Indicators e-Publication
• COVID-19 Intervention Timeline in Canada
• COVID-19 resources web page

• Overview: COVID-19’s impact on health care systems
• COVID-19’s impact on emergency departments
• COVID-19’s impact on physician services
• COVID-19’s impact on long-term care
• Unintended consequences of COVID-19
• COVID-19’s impact on home care
• Surgeries impacted by COVID-19: An update on volumes and wait times