As a cancer surgeon at Toronto General Hospital, Dr. Fayez Quereshy regularly speaks with patients anxious to know when.

When they can finally get surgeries that have been delayed by COVID-19.

“It’s totally the big question for me, too,” said Quereshy, who’s also the interim VP at the hospital.

In mid-March, the province made the unprecedented decision to cancel elective surgeries and procedures, from hernia operations to hip replacements, to conserve beds and supplies amid the pandemic.

According to a report from the Financial Accountability Office of Ontario, 52,700 surgeries have been cancelled since March 15, and 12,200 are delayed each week the outbreak continues. Health Minister Christine Elliott told reporters Tuesday about 35 people may have passed away because their heart surgeries were not performed, according to a report from University Health Network (UHN), which includes both Toronto General and Toronto Western Hospital.

Now, seven weeks in, hospitals are already making plans for when they can start back up again. Just like the economy, they will get back to a new normal gradually. And unfortunately there are no dates.

“It won’t be a light switch,” said Quereshy. “It will be a slow trickle increase in activity as we go along.”

Premier Doug Ford announced Monday this is part of Phase 1 of the province’s plan to loosen restrictions, but did not provide a date for when it will happen.

At UHN, the same team that provided guidance on shifting down has developed a three-phase framework for easing back up again.

“This template is in the hands of those programs to say, how are we recovering and how are we going to return back to a new normal?” Quereshy said.

UHN defined urgent procedures as “patients that needed surgeries within 14 days or there would be irreparable harm or, God forbid, life- or limb-threatening illnesses,” he said. Those are still happening and “quite honestly, in our surgical realm, we’re at about a 70-per-cent-reduction in activity.”

As things become more stable with COVID-19, “we’ll likely expand that definition to 21 days, and then likely expand it further to 28 days,” he said, adding they’ll move in “lockstep” with Ontario Health.

“A planning table of health-system experts is developing recommendations for a measured approach to expanding scheduled care,” wrote a spokesperson for the provincial agency in an email. But that can’t happen yet, as the situation in long-term care and other congregate settings continues to pose a threat to the health system.

“In the meantime, hospitals have been asked to continue doing what they have done so well over the past six weeks, which is to triage on a case-by-case basis to determine cases that need immediate care, and those that can wait.”

William Osler Health System, with sites in Brampton and Etobicoke, is also “beginning to work on initial plans to resume both non-urgent and scheduled surgeries, in line with Ministry of Health guidance and direction,” said spokesperson Cara Francis in an email.

Meanwhile, Richmond Hill’s Mackenzie Health will take the lead from Ontario Health “to determine the parameters and timing for any return to more normal hospital operations,” according to spokesperson Christina Cindric. “We know our community is hoping for a return to normal operations soon, and we are too, however, we’ll only ramp up our operations when our public health partners determine that it’s safe to do so,” she said in an email.

Unfortunately, there’s no “crystal ball” to know when that will be, said Quereshy. It will depend on factors like if there’s enough personal protective equipment (PPE), and the situation in long-term care homes.

There have been second waves of infection in other countries that have pulled back restrictions, he notes, and the COVID-19 crisis in long-term care continues to be a huge concern as it could mean a “spike” in patients.

“I think we have to see, to be honest, things start to stabilize in long-term care, before we’re really going to see major shifts in our ability to service our usual patients,” he added.

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According to the Financial Accountability Office report, cancelling elective surgeries and other measures such as moving patients to other sites, freed up 7,849 acute-care and 585 critical-care beds (583 with ventilators).

“The measures to increase the available capacity of hospital beds and limit the spread of COVID-19 in Ontario have allowed Ontario hospitals to accommodate the surge of COVID-19 patients,” the report states. But “going forward, the spread of the virus and the impact on hospital capacity remains uncertain and will be influenced by the actions taken by the province to lift the containment measures and resume normal operations in the economy and the health sector.”

In the long term, these measures will lead to significant pressure for hospitals, the report adds. “Since most of the delayed procedures are medically required, the longer procedures are postponed, the worse health outcomes Ontarians could have and the harder it will be for hospitals to eventually clear the backlog of delayed procedures.”

Silvia Petrozza, a 36-year-old living with a rare autoimmune condition called scleroderma, is one of those patients waiting.

She had regular infusions to open up blood vessels, but they’ve been cancelled due to COVID. She’s left in incredible pain, and her fingers have started to become infected, she said.

As someone with a chronic rare disease she often feels pushed to the end of the line, but this feels so much worse.

“In the end, once this is all said and done, they’re just going to be overwhelmed with people who are more sick from the things they had from before all of this.”

Quereshy, who is not involved in her case, stresses that “patients may be delayed or deferred but they’re not forgotten.”

“It weighs really heavily on our minds that people are not getting the care that we have a commitment to deliver and as soon as it is safe to do so for their heath, for the public health around us, we will absolutely deliver their care for them.”

A silver lining of all of this, he said is the lightning-fast shift to telemedicine. It’s “not perfect” and can’t replace actually seeing a doctor, but it’s something that can continue even after the worst of the pandemic has passed.

That “new normal” in the last phase of UHN’s plan, the post-pandemic future state, will probably include some permanent changes.

Already in emergency rooms, every other chair is taped out so that people can socially distance, and patients are being asked to wear masks.

“I think it’s clear that until there’s a vaccine, there will be the looming threat of this respiratory illness,” he said.