‘People are stranded:’ A downtown hospital is seeing a rise in cold-related injuries as shelters struggle to find spots

Physicians and outreach workers at St. Michael’s Hospital are seeing an alarming rise in the number of homeless individuals coming to the emergency department seeking shelter and suffering from severe cold-related injuries, including frostbite, painful foot infections and life-threatening hypothermia.

Hospital staff say the crisis has escalated in the last two weeks due to a critical lack of space in the city’s shelter system, hit hard by the Omicron variant.

The extreme winter temperatures gripping the city, combined with at-capacity shelters, mean more homeless people need emergency care after prolonged exposure outdoors. And more in the unhoused population are seeking shelter in the ER as a place of last resort, hospital staff report.

“They quite literally have no place else to go,” said LP Pavey, an outreach worker in St. Louis. Michael’s emergency department.

On a recent night, when the temperature plummeted to almost -20 C, 12 people were in the ER – not for medical care but to get warm and ask for help finding shelter, she said.

“People are stranded out there,” Pavey said. “The conditions for the last couple of weeks have been pretty brutal. That comes with a lot of risks and a lot of poor health outcomes for people. ”

In recent weeks, at least two underhoused patients were treated in the emergency department for life-threatening hypothermia. One of those patients died, said Nicole Champagne, an emergency department social worker. “It’s been devastating.”

Earlier this month, housing advocates warned the shelter system was “in near collapse” amid the Omicron wave.

The fast-moving variant has triggered dozens of outbreaks in shelters and caused staffing shortages. Housing advocates and outreach workers say this has led to fewer staff monitoring intake phone lines and fewer available spots in the system already struggling to keep up with demand.

As of Jan. 27, there were 368 COVID cases and 35 active outbreaks in Toronto’s shelter system. When asked about the number of staff off work in the last week due to COVID, the city’s Shelter, Support and Housing Administration (SSHA) said on average “there were approximately 17 per cent staff absences.”

SSHA said due to mitigation measures announced this month, including redeploying city staff to “meet high-priority needs,” the absences in the shelter system were “minimized to approximately 10 per cent and these absences have been decreasing over the past week.”

On Thursday afternoon, while in conversation with the Star, Champagne was trying to find shelter spots for four patients discharged from the emergency department but with no safe place to go.

She said the hospital’s outreach staff had been calling the shelter intake lines since 7am, faced long waits to speak with a shelter worker and multiple dropped calls.

“I have another cellphone in my pocket right now on hold with the intake line while we’re talking,” Champagne said, noting the discharged underhoused patients were taking up needed acute care beds.

“Even the warming centers… they are at capacity as well. So we can not even get them into a basic warm building to stay, let alone a bed. ”

On Jan. 14, the city announced it was opening two community centers as additional 24-hour respite centers that provide 89 additional physically distanced spaces. SSHA told the Star the respite centers will continue to operate and that its four designated warming centers currently have capacity for 166 people.

SSHA also said the city will continue to supply N95 masks to shelters “on a 14-day schedule until the need subsides.” The city announced on Jan. 13 it was providing 310,000 N95 masks to shelter clients.

At St. Michael’s Hospital’s emergency department, about 20 percent of its patient visits are by patients experiencing homelessness, said Dr. Carolyn Snider, chief of emergency medicine at the hospital, a part of Unity Health Toronto.

And while the ER does see an increase in the number of underhoused individuals seeking care in the winter, the recent spike caused by Omicron hitting the shelter system alongside frigid temperatures is different, she said.

“We’re seeing more patients. They’re staying longer because there is nowhere else to send them. And they’re coming in sicker, with more cold-related injuries. ”

Hospital staff are seeing cases of “trench foot” in underhoused patients. The serious condition is caused when feet are cold and wet for too long.

“Their socks are wet, their feet have been in the cold and snow, and their skin is macerated from that,” Snider said, adding that if left untreated patients can get serious infections.

On a recent shift, Snider spoke to three patients experiencing homelessness who needed medical care but had no stable or safe housing options. One was sleeping on a warm grate behind a building, another was seeing shelter at Union Station, she said, noting people are struggling to find places to stay warm.

Staff have also this month seen more cases of frostbite. Snider said the extremely painful injury is different from frostnip, a less serious injury more likely to be experienced by the general public.

Dr. Stephen Hwang, director of the MAP Center for Urban Health Solutions, said the recent experiences of St. Mike’s staff offer a window into what is happening in the shelter system and points to the immediate need for more warming centers and more shelter beds.

He noted that some city shelters experiencing a COVID outbreak are directed to not accept new clients for public health reasons, a decision that may be causing additional harm. According to SSHA, some locations can continue accepting clients with appropriate protections and under guidance from Toronto Public Health. And while in some cases shelters may need to close for a short time, “all efforts are being dedicated to ensure access to safe indoor spaces for people in need,” SSHA said.

Hwang, a physician at the hospital and a researcher who studies homelessness and health, said given the current shelter pressures and extreme cold, he hoped city staff would see the importance of offering a person shelter from the cold.

“The need for more shelter beds right now in the city, we are seeing it from a health-care perspective. But we know people in the community are seeing it every day as well. We are all very concerned. ”


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