BEFORE STORM, A RACE TO PREPARE
‘GRAVE’ CONCERNS
It’s the calm before the storm, the phoney war or maybe just a patch of good luck.
The long-feared surge of COVID-19 cases has yet to wash over Canada’s healthcare system the way it has in Italy or New York. But the system is treating that fact as only a respite, and working feverishly to try to marshal the protective equipment, hospital beds, breathing machines and other resources needed if and when the tempest arrives.
As doctors, nurses and other medical staff brace for the potential onslaught, opinions are mixed on whether Canadian hospitals will, in fact, be ready.
“We’re all working very, very hard,” said Dr. Pat FoxRobichaud of the Canadian Critical Care Society, just off a call with ventilator manufacturers. “What I hope is that we’ve flattened the curve enough that we’re going to be well-prepared if we get a surge.”
But at the same time, she said, “I would say we’re planning for when we don’t have enough.”
A leaked Ontario government document talked of how ventilators might be rationed out if the system is overwhelmed.
Others are more blunt in their assessment.
“Doctors, nurses, frontline workers are telling us they don’t feel adequately prepared,” said Dr. Sandy Buchman, president of the Canadian Medical Association. “We’re gravely concerned that the equipment we’ve been trying to get in the pipeline may not be there in time.”
Complained one Montreal anesthesiologist, who asked not to be named: “We don’t have enough of anything and the government should have taken care of this in January, not now.”
Even so, there is a wary optimism, in at least some quarters, about health care’s readiness for a major peak in seriously ill COVID-19 patients.
“A broad testing of well people in our community right now is not what we’re going to be doing. That is the strategy that we will be looking at if and when we come to the downside of our curve, when we’re again looking at introductions coming into B.C. from other places.”
At the other end of the spectrum is Quebec, where case counts are currently soaring; 732 new cases were announced just on Tuesday. But Quebec has also been significantly ramping up testing and expanded its test criteria last week to include people with milder symptoms. So while more testing may be a factor in Quebec’s spike in cases, it should also make it easier to determine when the curve is truly flattening.
Ontario has come under widespread criticism for its sluggish testing rate. With nearly 40 per cent of Canada’s population, Ontario has the lowest per-capita testing rate in the country at about 350 per 100,000 people — less than half the per-capita rate of the other large provinces. It currently processes about 3,000 tests per day.
Ontario’s health ministry says anyone with symptoms may qualify for a test at one of its assessment centres, but it does identify priorities for when testing supplies are short, including healthcare workers, long-term care residents and staff, and hospitalized patients with respiratory symptoms.
David Williams, Ontario’s chief medical officer, said there are other measures to watch when it comes to flattening the curve, such as calls coming into its Telehealth line and the use of “syndromic surveillance,” where various types of data are analyzed for early signs of an outbreak. But he also said testing will improve over time.
“I’m hoping that with our lab capacity continuing to ramp up, we want to head for 10 to 15,000 (per day), that we may have some opportunity to even do wider testing, perhaps in some other areas to make sure we’re not missing anything in that regard,” Williams said.
Another option is to look at hospitalization rates, which is likely a more accurate measure of a province’s situation due to the variation in testing standards. But hospitalization numbers tend to lag behind even further than case counts, so it will take longer to know whether Canada is making progress. Most provinces also don’t report detailed information about hospitalizations online.
Phillips said testing still has to be the long-term solution, and he’ll remain skeptical Canada has the situation under control until it reaches the point where officials are testing people with even mild symptoms, and then following up positive cases with aggressive contact tracing.
“As we get increasingly close to being able to test more and more people out in the community, we need to have these restrictions on testing lifted,” he said. “The notion that we really don’t need to go after this stuff in the community, we just tell people (with mild symptoms) to self-isolate, I don’t agree that that’s enough.”