As the novel coronavirus spreads to dozens of countries, sparking concerns of a looming pandemic, the tone from some health officials has changed from an assuring “we got this” to a more anxiety-inducing “we might get this.”
Earlier this week Canada’s chief medical officer, Dr. Theresa Tam, admitted that the global spread of the virus, officially named COVID-19, is concerning and conceded that “the window of opportunity for containment … is closing.”
“It also tells countries like Canada, who have been able to detect and manage imported cases thus far, that we have to prepare,” she said.
And on Wednesday federal Health Minister Patty Hajdu advised Canadians to start stockpiling food and medications in their homes as a precaution.
While most of the messaging from public health officials in Ontario so far has stressed the low risk to citizens, WHO executive director Dr. Michael J. Ryan advised against adopting a false sense of security.
“We believe that all countries are vulnerable,” Ryan said on Monday. “It is time to do everything you would do in preparing for a pandemic.”
But what does that mean?
Canadian epidemiologist, Dr. Bruce Aylward says hospitals should be increasing bed capacity, assuring enough ventilators and oxygen tanks are available in the event of severe illnesses, and be prepared to isolate entire hospital wings.
Aylward, who recently returned from China where he was part of a team studying coronavirus for the World Health Organization, was adamant during a briefing Tuesday morning that aggressive preparedness is crucial.
“This is going to come soon potentially, you’ve got to be shifting to a readiness, rapid response thinking,” he said. “There has to be the mindset shift, number one, then there has to be the readiness planning and capacity building and it has to be done fast.”
“Have you got 100 beds where you could isolate people if you have to?” he asked. “Have you got a wing of a hospital that you are going to close off? Have you got 30 ventilators?”
Toronto hospitals already at capacity: University Health Network
Dealing with an influx of ill patients could prove challenging in Ontario, and especially in Toronto, where a hospital bed shortage is well documented.
“There is no question that all hospitals are operating at or over capacity on most days,” a University Health Network (UHN) spokesperson told CityNews on Thursday.
“From the information we have from other countries, it is fortunate that most patients with COVID-19 have mild symptoms and will be able to manage at home. For those who require admission we will be working through protocols to care for the sickest patients.”
UHN said in some cases, elective procedures could be “put on a temporary hold” to accommodate patients who develop severe cases of coronavirus.
“We are not contemplating that at this time – but planning would incorporate such an approach.”
CityNews reached out to the Ministry of Health to ask if more beds and ventilators would be available in the event of a widespread outbreak, but hasn’t yet received a response.
“There is a provincial supply of additional ventilators which would be distributed if it became necessary,” UHN added. “Our oxygen is supplied to us and there is no indication at this point that there would be a shortage.”
“Our capacity for caring for patients who require hospital admission is fixed as we cannot erect a hospital wing in (a) matter of weeks and this is not currently the guidance we have received from the Ministry of Health,” the network added.
Pandemic inevitable, infectious disease doctor says
Dr. Isaac Bogoch, an infectious disease physician at UHN’s Toronto General Hospital said if there’s a silver lining to the situation, it’s that a coronavirus outbreak locally wouldn’t clash with the flu season, which is winding down.
“This coronavirus … is not going to overlap with our influenza season so our capacity has improved to hopefully accommodate a greater number of patients who might require hospital needs and intensive care level needs,” he said. “In the same breath we have to think beyond the hospital too. We know that many people infected with this virus have mild symptoms or symptoms that might not require hospitalization.”
“We have to think about issues with capacity at primary health care centres, at pharmacies, anywhere that people seek health care.”
When asked if he believes the coronavirus will soon reach pandemic levels, Bogoch replied: “100 per cent.”
“If we are not using the word pandemic now we will be using it in a day or two from now, because that’s what this is. We have widespread, global transmission of an infection, that’s a pandemic.”
“There’s a lot of work that’s been going on behind the scenes to prepare for this scenario,” he added.
Despite the challenges an imminent pandemic would present, Bogoch believes the health care system in Ontario can handle it.
“I’m not saying it isn’t challenging, obviously we could all use more resources, of course we could. What I’m saying is the job still gets done. We make due with the resources we have available to us during our routine influenza season and in virtue of that winding down I think that buys us a little bit more wiggle room than if this was superimposed with our influenza season.”
‘We want to make sure we are ready’: Dr. David Williams
While announcing details of a new case of novel coronavirus in Toronto on Wednesday afternoon, Ontario’s chief medical officer of health, Dr. David Williams said the province is taking steps to prepare for a pandemic.
“We want to make sure we are ready and prepared,” he said. “You don’t want to go ahead too fast because you use up your resources that you need and you burn (out) your staff … you want to make sure you’re planning and prepared that’s the key at this phase.”
When asked is the province has enough beds to deal with a significant outbreak, Williams said at this point it’s not a concern due to the low level of infected people, and even lower number who required hospitalization.
“Right now our number of hospital beds we’ve used so far is one,” he stressed. “But that doesn’t mean we don’t prepare. And part of that is to do all the levels of planning. All these institutions … start to put their pandemic plans in place, they start to look at their resources, what their capacity is. That’s just part of the process.”
Williams said the first step in planning for a pandemic is “containment.”
“That’s what we’ve been doing over the last month,” he explained.
“The next phase is to ramp up increased surveillance. You widen the surveillance scope.”
Bogoch says that’s already happening, with challenges.
“In terms of scaling up, I can tell you that provincial health laboratories are scaling up to do more testing, hospitals are having conversations about how they can treat an influx of patients. Public health is certainly working at how can we increase our capacity for working with communities affected by this virus.”
“We know this will impact Canada we’re not sure what the magnitude of this will be in Canada. It’s tough to prepare for something when you’re not sure how severe it’s going to affect your health care system and your population.”
“We aren’t working in an area with unlimited resources and that complicates matters as well.”
UHN says it is focusing on enhanced detection and screening, ensuring appropriate isolation and use of protective equipment, and developing care protocols while “building capacity to care for all patients who require hospital-level care during this issue.”
“This includes making sure we have the right number of trained people, supplies and spaces to care for patients,” a UHN spokesperson said.
Common sense advice
While governments and hospitals plan for a possible pandemic, Bogoch offered some sound advice for the average person.
“It must be daunting to read snippets of information in the news, and hear about pandemic, pandemic, pandemic, and people might feel a little bit helpless and that’s not the case. Because there are things that people can do to prepare for this.”
“Number one, people that have chronic medical conditions or other health care related issues, this is the time to ensure that chronic medical conditions are attended to. So people get their prescriptions filled, if people haven’t seen their physicians in a while related to whatever chronic illness they have, diabetes, heart disease, kidney disease, it’s time to ensure that those issues are tended to.”
“So get your prescriptions filled.”
And we’ve heard it all before, but Bogoch said we should adhere to the same safeguards implemented during a typical flu season.
“The same rules apply,” he noted. “If you’re sick, stay home from work. If you’re coughing and sneezing, don’t cough and sneeze into the air around you. Cough and sneeze into your arm.
“And of course impeccable hand hygiene, especially if you’re out in public.”
As of Wednesday, there are 12 confirmed cases of coronavirus in Canada.
Watch: Practical ways to prepare for potential spread of COVID-19