Coronavirus disease 2019 (COVID-19) first emerged in China in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Clinicians around the world looked to cities that first experienced major surges to inform their preparations to prevent and manage the impact the pandemic would bring to their patients and health care systems. Although this information provided insight into how COVID-19 could affect the Canadian palliative care system, it remained unclear what to expect. Toronto, the largest city in Canada, experienced its first known case of COVID-19 in January 2020, with the first peak in cases occurring in April and its second wave beginning this September. Despite warnings of increased clinical loads, as well as widespread shortages of staff, personal protection equipment, medications, and inpatient beds, the calls to action by international colleagues to support the palliative care needs of patients with COVID-19 were not realized in Toronto. This article explores the effects of the pandemic on Toronto's palliative care planning and reports of clinical load and capacity, beds, staffing and redeployment, and medication and PPE shortages. The Toronto palliative care experience illustrates the international need for strategies to ensure the integration of palliative care into COVID-19 management, and to optimize the use of palliative care systems during the pandemic. J

Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.