Front-line healthcare workers prepare for “surge” of COVID-19 patients, which could hit Ontario hospitals in weeks – although timing, experts warn, is hard to predict .
The emergency comes as the number of laboratory-confirmed cases in the province continues to climb, reaching more than 850 Thursday afternoon and fueling ongoing questions about hospital readiness and equipment levels.
“It is almost inevitable that we will see an increase,” said Dr. Andrew Morris, infectious disease specialist at the Sinai Health System and University Health Network in Toronto.
“When that happens, it is not precisely known, but I think our best estimate is that we will start to see an increase over the next week and continue to increase for weeks thereafter, if not months. “
According to the latest survey, almost 60 percent of Canadians who have tested positive for COVID-19 so far have likely acquired it in their community. data available from the federal government. Travel-related transmission is also a concern, given the recent wave of residents returning from abroad amid a wave of government warnings to return home.
“It looks like we’re all holding our collective breath because we feel like something can happen – but we don’t know when,” said epidemiologist Ashleigh Tuite, assistant professor at the Dalla Lana School at the University. from Toronto. of public health.
Although the cases agreed by Tuite may appear to be increasing in the coming weeks, she pointed out that this may be partly due to the fact that public health agencies have slowly increased their screening capacity, revealing carriers in the community who could eliminate the virus without knowing it.
Approximately 11,000 Ontario residents who have been tested for COVID-19 are still waiting for their results in the middle of a backlog at the province’s public health laboratory, when countless potentially positive cases have not been tested.
The number of new daily laboratory-confirmed cases, however, has increased significantly since the beginning of March, providing a glimpse of the progression of the epidemic.
At the beginning of the month, public health officials identified only a handful of new cases known per day at most, and sometimes not at all. At the end of the month, new daily counts were systematically double-digit – reaching 85 in one day on March 24, 100 on March 25 and 170 on March 26.
Dozens of people have been hospitalized to date in Ontario, and at least 29 patients remain in intensive care units, including 20 who are on ventilators to help them breathe, provincial officials said Thursday. .
Fifteen people have also died to date, with six deaths reported between Wednesday and Thursday alone.
“In the current context of the epidemic, having better figures in terms of the number of cases requiring hospitalization – and in particular, the number of cases admitted to the ICU – will be better parameters over the two coming weeks, “noted Tuite.
In an ideal scenario, she said that the number of new cases would stabilize rather than increase, increasing the health system from being overwhelmed.
“We know it’s a marathon to come”
This is the main reason why public health officials across the country have spent weeks urging residents to stay away from each other, in the hope that voluntary physical distancing measures could reduce the spread of the virus.
The federal government also mandatory for all travelers returning to Canada to isolate for 14 days and authorities have suggested that more restrictions may be necessary.
Because the impact of these measures is not yet clear, clinicians are preparing for the “absolute worst scenario,” said Dr. Chris Mackie, medical officer of health for Middlesex-London.
He pointed out that the number of patients could prove difficult if the number of cases quadruples or more each day, slightly bringing local hospitals closer to the overwhelming workload observed in countries like Italy and Spain.
“We know very clearly that we must be ready at all times to manage a large increase in the number of patients affected by COVID-19,” said Dr. Carolyn Snider, chief of emergency medicine at St Michael’s Hospital in Toronto. New.
Downtown Toronto Hospital performed simulations with staff while developing changes in the way people pass through the emergency department – by ensuring that patients arrive, they are quickly identified as potentially COVID-19 carriers and transferred to a separate area.
“We know it’s a marathon ahead of us,” said Snider. “We would love to be able to delay this time when the pistol fires, but if it goes out, we already have plans in place.”
Concerns about equipment shortages, rationing
Despite best efforts from hospitals, system-wide concerns remain about equipment shortages, mathematical modeling reports suggesting that Ontario could quickly run out of intensive care beds and ventilators, and memos obtained by CBC News revealing that major hospitals in Toronto are urging frontline workers to ration surgical masks.
Provincial officials have worked to allay fears, noting that the government has obtained millions of masks and gloves to date, and plans to deploy some of the 55 million outdated N95 masks that the province stockpiled during the SARS epidemic in 2003.
The province also announced major investments Wednesday aimed to add 1,000 acute care beds and 500 intensive care beds, increase peak capacity in long-term care facilities, and purchase essential medical supplies and protective equipment.
Amidst all the concerns and precautions, Morris said it was still “very difficult” to predict how far Ontario will sail in the future.
“What will really determine our success, and being able to manage the outbreak, is just the total number of people (with COVID-19),” added Morris. “And it’s really related to social or physical estrangement.”
Mackie said that while Ontario is experiencing a spike in the number of daily cases, it still leaves another half of the case wave, which could force residents to stay apart longer.
And, he added, this new coronavirus may someday reappear on a seasonal basis, which means it could decrease every spring and come back again in winter when temperatures drop and indoor air becomes drier. .
“Everything is possible to prepare,” said Mackie. “Having said that, it’s an unpredictable disease.”