Doctors who battled SARS have urgent advice for the Ontario government

Dozens of physicians, nurses and health care providers in Toronto were on the front lines managing severe acute respiratory syndrome (SARS) during the 2003 outbreak, which killed 44 Canadians and infected 438.

Many lessons were learned. Two doctors from the front lines offer advice to the Ontario government on steps that can be taken during the current COVID-19 outbreak, ways to prepare, and how to reassure the public.

> Screening: The government needs to immediately support health care providers and clinics to set up screening centres. Greater standalone outpatient COVID-19 screening capacity is required. Patients should not be told to go to their doctors’ offices, or to emergency departments. The risk of infecting others is too high. Places need to be set up just for screening, where patients do not sit together waiting for services. The drive-thru model in South Korea is a brilliant logistical solution. Home testing is another innovative method. The cost is well worth it.

> Hospital bed capacity: Most of those infected with COVID-19 will be well enough to stay at home. But some will need hospital care. The province needs to communicate to all that it has enough hospital capacity to care for those who will need it.

> Intensive care and ventilator supply: Fewer than 10 per cent of patients who get COVID-19 will become severely ill, requiring specialized hospital services in the ICU and support of a breathing machine. The government needs to work with local infectious disease modelling talent to project this number and determine the province’s current capacity to deliver that kind of care. After SARS, the government purchased more ventilators for a future surge in use. Where are those ventilators? How many are there? Have they been delivered to sites where they will be needed? Are hospitals converting locations to increase the number of critically ill patients they can care for? Can we expand to do so? The government needs to communicate this information.

> Personnel planning: One of the biggest headaches during SARS was determining how many health care workers we had on any given day. Physicians, nurses and other front line health care providers work in teams; if one member of the team goes down with illness, they need to be replaced. That can happen once on a team, maybe twice, but after that, the workload overwhelms the team. Each hospital needs a plan, and the province needs to steer this, and communicate to the public.

> Long-term care facilities: This is the most vulnerable group of people, as we have seen from the outbreak at Lynn Valley Care Centre in B.C., a COVID-19 hot spot linked to eight cases and Canada’s first death. Mortality will be very high if residents get infected, and the possibility of spreading the virus to both residents and staff is high. Facilities will need support to determine how best to prevent infection and treat their clients. Simply transferring ill individuals in longterm care facilities to acute care will overwhelm the hospital system. With government support, the facilities need a road map. They can rely on contingency planning for flu season.

> Communicate in real time: Ontario should pick one spokesperson to communicate with the media and general public on a near-daily basis. A familiar face knowledgeable in provincial health care will help alleviate anxiety by providing updates on disease activity, how the health care system is responding, and projected health care capacity. (Think of the commonsense and reassuring approach of B.C. Health Officer Dr. Bonnie Henry.)

> Manage the fear while managing the epidemic: There are two significant issues we are facing now. One is the health effects of the epidemic; the other is the effect of fear on behaviour (including the economic impact). If the government and other relevant stakeholder ensure that expected services will be available, and informs the public clearly and honestly that it has done so, we can profoundly mitigate the effects of this infection. It will take a lot of work, and perseverance. Some of this work has already been performed. Let’s get on with the rest of it.

Dr. Allan S. Detsky is a professor of health policy management and evaluation, and medicine, University of Toronto; former physician-in-chief, Mount Sinai Hospital, during the SARS outbreak. Dr. Isaac I. Bogoch is associate professor of medicine, University of Toronto, division of infectious diseases, University Health Network and Sinai Health System.

Places need to be set up just for screening, where patients do not sit together waiting for services. The drive-thru model in South Korea is a brilliant logistical solution