ER visits soared for cyclists during the pandemic even as they dropped for drivers and pedestrians. What that says about our streets — and what we can do about it
Ontario hospital emergency rooms saw a surge of bicycle-related visits during the first year of the pandemic, even as injuries to other road users sharply declined.
Data obtained by the Star for select Ontario cities and regions showed bike-related emergency room visits rose by 35 per cent across the province during the fiscal year from April 2020 to March 2021.
At the same time, ER visits for drivers, car passengers and pedestrians all fell - by 46 per cent, 53 per cent and 45 per cent respectively.
The simplest explanation for the numbers is that car traffic dropped when COVID-19 hit and workplaces, businesses and schools closed, while at the same time more people took up cycling as their regular forms of exercise became inaccessible. That many pandemic cyclists were inexperienced riders may also have played a role in the data, which doesn't indicate whether an ER visit was due to a collision with a motor vehicle or the result of a wipeout.
But experts say the surge in bike-related hospital visits points to a problem that was evident before the pandemic: Ontario lacks adequate infrastructure to protect riders and its streets aren't safe for cyclists.
It speaks to a real systemic problem in street design," said Amanda O'Rourke, executive director of 8 80 Cities, a group that advocates for healthy and equitable communities.
She said the province-wide jump in hospitalizations indicates the problem isn't isolated to any one city. This is an alarming trend of increased injuries and traumas on our streets," she said.
Of 13 cities and regions covered by the data, which was provided to the Star by the non-profit Canadian Institute for Health Information, all but two - London and Thunder Bay - saw increases in ER visits where a bicycle was involved, compared to 2019-2020 (the organization tracks statistics by fiscal rather than calendar year). The increases ranged from 21 per cent in Windsor to 81 per cent in Sudbury. Toronto bike-related ER visits jumped 28 per cent.
Younger riders bore the brunt of the problem. Although ER visits rose for all age groups, ER visits for those aged 17 and younger rose in 2020-2021, overall, by 67 per cent, while visits for those aged 18 to 64 rose 23 per cent, and were up 34 per cent for the group aged 65 and up.
These numbers are hard to believe," said Toronto cycling lawyer Dave Shellnutt. With more than 7,400 bike-related ER visits province-wide in the first year of the pandemic, we are dealing with an endemic," he added.
Bikes became as hot an item for some people as toilet paper did for others during the start of the pandemic. When lockdowns hit, people of all ages took to two-wheelers to get socially distanced exercise, or to avoid public transit on their way to work in essential sectors.
When Toronto closed Lake Shore Boulevard West to car traffic on weekends in 2020 as part of its ActiveTO program, as many as 18,000 cyclists a day took part. The numbers rose further in the second year of the program.
It's definitely a bike boom," said Matthew Pioro, editor of Canadian Cycling Magazine, and an avid cyclist and year-round two-wheeled commuter in Toronto.
All the bike shops that I've been in touch with in the city, the common story for the last two years has been that they're busy. They're very, very busy."
Pete Lilly, who owns Toronto's Sweet Pete bicycle shops, said in addition to more people riding, the pandemic changed bike sale trends in ways that might have contributed to the spike in injuries.
Lilly said many people who shopped in his store in the early days of COVID-19 were novice riders, including adults who hadn't been on a bicycle in years and kids whose parents were hoping to get them into cycling as schools and recreation programs closed their doors.
There were a lot of first-time riders" who might have been more vulnerable to injuries, he said.
As demand for bikes soared and supply chain problems slowed deliveries, it also became harder for parents to find bikes that were the right size for their children. Lilly and his staff did their best to pair kids with the right sized bicycle, but the task was made harder when in-store shopping was suspended, forcing parents to buy online. Some parents even bought their kids adult bikes. Lilly suspects the mismatches increased the chances of spills.
You would have somebody just scrambling to say yeah, of course, my kid will learn how to ride it, they'll make do," he said. It's something that during normal times you just wouldn't do."
On a per-capita basis, the cities with the highest pandemic bicycle ER visit rates were Kingston, Barrie, Ottawa and Toronto, with the lowest rates coming in Brampton, Mississauga, York Region and Thunder Bay. This may be in part a reflection of places where more and less people took to cycling.
Jess Spieker, a spokesperson for Friends and Families for Safe Streets, said the fact bike-related ER visits were up across Ontario underscores the need for a province-wide Vision Zero road safety plan.
Pioneered in Europe more than 20 years ago, Vision Zero aims to completely eliminate serious and deadly traffic collisions through road design changes, speed limit reductions and other measures. The idea is that while crashes are inevitable, roads can be configured in a way that minimizes the damage.
Although Toronto, Hamilton and other cities have their own Vision Zero plans, Spieker said a province-wide approach would mean you don't have to rely on each municipality to voluntarily implement safer speed limits" and other life-saving policies.
In response to more people taking up cycling during COVID-19, in 2020 Toronto installed about 30 kilometres of protected cycle tracks and painted bike lanes on city roads, which helped set a one-year record for new on-street cycling infrastructure in Canada's largest city.
But advocates like Spieker say that one year doesn't mean the city is making sustained progress. In the four years prior to 2020, Toronto averaged just 5.2 km of new protected or painted lanes per year, and last year the number fell back to less than 18 km.
By contrast, London, England installed 260 km of high-quality cycling infrastructure between 2016 and 2021, according to that city's mayor's office.
Hakeem Muhammad, spokesperson for Toronto transportation services, said between 2019 and 2021 the department oversaw an unprecedented expansion of bikeways" that included 65 km of new lanes, off-road trails, and signed routes, as well as upgrades to 47 km of existing infrastructure. Between 2022 to 2024 the city plans to add 100 km of new on- and off-street bikeways.
Although cycling infrastructure is considered primarily the responsibility of municipalities, the Ontario PC government says the province is contributing more than $286 million to 44 projects in 21 municipalities that include the advancement of cycling infrastructure.
Road safety experts agree that street design and cycling infrastructure like bike lanes are the most important factors in protecting riders. But education for drivers and cyclists alike can also help.
Scott Marshall, director of training at Young Drivers of Canada with 34 years' experience training drivers and driving instructors, said the most important thing for motorists to recognize is that roads are not theirs alone.
Share the road," said Marshall. Everybody is allowed to be there."
Known in Toronto as The Biking Lawyer," Shellnutt recommends cyclists attend one of his law firm's know your rights" workshops, which are hosted regularly with cycling advocacy groups across Ontario.
Prevention is everything," said Shellnutt. A bike never wins in a fight with a car so we must ride defensively."
Ry Shissler, communications manager for Cycle Toronto, a bike advocacy group, said that, at least anecdotally, many of the people who have taken up riding during the COVID-19 bike boom seem unsure of the rules of the road and how to ride defensively.
There are people who obviously don't know how to navigate the roads safely," Shissler said, stressing that drivers and pedestrians also behave dangerously.
Cycle Toronto offers courses on road rules, safety tips, and all weather biking. According to Shissler, even just a half-hour or an hour class can do wonders."
But while community groups and employers can seek courses from Cycle Toronto and other organizations, most people in Ontario receive little formal cycling education. O'Rourke, of 8 80 Cities, says that's an oversight.
Education and promotion are really important aspects of increasing not only the rates of cycling, but making people feel more comfortable riding a bike and feeling more safe choosing that mode," she said.
She points to the Netherlands, where the non-profit Dutch Traffic Safety Association partners with elementary schools to provide traffic education to students from age 4 to 12, culminating with an on-road cycling test taken by about 200,000 students each year.
Those kinds of programs, along with safe street design, help foster a safe cycling culture. The Organisation of Economic Cooperation and Development reports the Netherlands has among the lowest cycling fatality rates among member countries.
For riders 17 and younger, the hike in ER visits was largest in places like Durham Region, which went from 121 visits in 2019-2020 to 271 during the first year of the pandemic, a 124 per cent increase.
Young riders in Toronto were in ER rooms with bike-related injuries 543 times in 2020-2021, an 80 per cent increase.
Mike Fitzgerald's son Nik was one of the lucky ones. The boy from Thorold, Ont. didn't ride his bike much, but started riding every day when COVID-19 hit, his father says. On June 11, 2021 Nik was crossing an intersection two minutes from the family home when a driver blew through a stop sign and struck the front wheel of his bike.
Astonishing dash cam footage released by the Niagara Region Police Service shows Nik, who was 11 at the time, being thrown from his bicycle and somehow landing on his feet before stumbling to the curve. Remarkably, he escaped with minor injuries to his wrist and knees. The driver hasn't been caught.
He didn't see the car coming until it was already in his face," Fitzgerald said. The incident sent Nik into shock, and for a while he was nervous about riding again. Fitzgerald said he's since got back in the saddle.
Obviously it could have went much, much worse," he said. He got lucky."
Ben Spurr is a Toronto-based reporter covering transportation for the Star. Reach him by email at bspurr@thestar.ca or follow him on Twitter: @BenSpurr
Jim Rankin is a Star reporter based in Toronto. Follow him on Twitter: @Jleerankin
Andrew Bailey is a freelance data analyst for the Star