Health and well-being

Transition to virtual care 

The shift from in-office to virtual health care delivery has been drastic.  In March 2021, Hamilton’s primary care physicians reported that over 70% of their visits are now carried out online.1 Provincial research showed total primary care visits dropped by 28% between March and July 2020 compared to 2019, with in-office visits dropping by 80%, and virtual visits comprising 71% of all appointments.2

Mental health

National research from Statistics Canada found that the percentage of Canadians who reported excellent or very good mental health declined significantly, to 55% in July 2020 compared with 68% pre-pandemic. The drop was most pronounced for people aged 16 to 34.  Additional research during the pandemic showed health care workers, racialized groups and people who are Two-Spirited and LGBTQIA+ were less likely than the general population to report excellent or good mental health.3

In Hamilton, there has been a drastic increase in hospitalizations for youth experiencing mental health crises, including suicide attempts and eating disorders.4 McMaster Children’s Hospital reported that the number of youth admitted for medical support after a suicide attempt tripled over a four-month period in 2020 compared with 2019, and that these patients are staying in hospital longer due to more serious attempts. Referrals to McMaster’s Eating Disorders Clinic increased by 90% over the same four-month period compared to 2019, while projections for hospital admissions are expected to increase by 33% over pre-pandemic levels.

Children’s health experts pointed out several contributing factors:5

Opioid overdoses and deaths

Overdoses and deaths caused by opioid use continued at high levels throughout the pandemic.  For the first 11 months of 2020, there were 113 deaths in Hamilton.  There were 105 deaths in 2019 and 123 in 2018.6 These deaths are drastically higher than historical numbers: the average number of deaths between 2008 and 2016 was fewer than 40 annually.

Paramedic incidents related to opioid overdoses or deaths have been increasing throughout 2020 into 2021.  While the paramedic response to suspected opioid-related incidents has not reached the levels seen in the first and second quarters of 2019, there have been steady increases throughout the year. The monthly average number of suspected opioid overdose paramedic calls in the first quarter of 2020 was 38, rising to 55 by the end of the year.  During the first three months of 2021, the average has risen to 58 incidents.7

Delays in cancer screening and treatment

Responding to the pandemic forced some elective and non-urgent surgeries, including cancer screening programs, to be delayed.  These delays in diagnosis and intervention could lead to an increase in the number of cancer cases and the severity of those cases when they are detected.  National projections showed that a six-month delay in colorectal and breast cancer screening could lead to 3,000 additional cases and up to 1,200 additional deaths over the next eight years.8

In Hamilton, there were 666 (17%) fewer cancer surgeries between March-November 2020 than for the same period in 2019.  The number of patients being checked for symptoms of colorectal cancer dropped to 321 in May 2020 from 1,231 in January 2020.  Patients were also reluctant to go to hospitals for appointments:   Hamilton Health Sciences reported over 5,000 missed appointments related to cancer followups.9

[1] McMaster Department of Family Medicine.  Weekly report to Hamilton Covid Response Table, March 2021.  Unpublished.  Author’s personal communication. 
[2] Glazier, R., Green, M., Wu, F., Frymire, E., Kopp, A., Kiran, T.  (2021). Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario.  Canadian Medical Association Journal, February 2021.
[3] Government of Canada, 2021.  COVID-19:  A Year in Review.
[4] CBC Hamilton:  Number of youth in hospital after suicide attempt tripled over 4-month period under COVID-19.  Published March 18, 2021.  Accessed May 2021. 
[5] Ibid.
[6] City of Hamilton 2021.  Hamilton opioid information system.  Accessed May 2021. 
[7] City of Hamilton 2021.  Hamilton opioid information system.  Accessed May 2021. 
[8] Government of Canada, 2021.  COVID-19:  A Year in Review.
[9] Hamilton Spectator, December 21, 2020.  Hamilton missing hundreds of cancer patients as COVID postpones screenings.