Is Canada ready for a widespread coronavirus outbreak? Yes and no, experts say

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COVID-19: Toronto health officer says new case does not appear connected to B.C., working on flight info
WATCH: COVID-19: Toronto health officer says new case does not appear connected to B.C., working on flight info – Feb 26, 2020

As far as confirmed cases of the coronavirus go, Canada has kept the amount of people infected with COVID-19 in the country contained at 12.

But on Tuesday, Canada’s Chief Public Health Officer Theresa Tam told reporters to prepare for a pandemic.

“For now, the risk in Canada is low, but the risk is evolving. Concerning developments in recent days tell us the window of opportunity may be closing, but there is still much that Canada can do to delay spread and become more prepared,” she said.

With the exception of Antarctica, the illness has confirmed cases in every continent across the globe, but with the world bracing itself for widespread outbreak, is Canada prepared?

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Well, yes and no.

Experts say that Canada has all of the necessities for widespread disease outbreak — negative-pressure isolation chambers, supplies, medical procedures and assessment protocol — but hospital overcrowding remains a concern.

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COVID-19: Ontario health official outlines phases of pandemic plan

Hospitals already operating over capacity

According to Barb Collins, CEO and president of the Humber River Hospital, Canada is “certainly much more prepared than we were pre-SARS.”

“[There is] much more analysis going on and much more standardized language and practices around protecting staff and physicians, protecting patients and protecting the public than there would have been in the pre-SARS date,” she said, adding that the protocols and procedures for containing the virus would vary on a provincial level.
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By the height of the SARS epidemic in Sept. 2003, the Canadian government said it had 438 confirmed cases of the disease. Of that, 44 people died.

Dr. Alan Drummond, co-chair of public affairs for the Canadian Association of Emergency Physicians and emergency physician at the Perth hospital, urged against fear-mongering and said Canada learned a lot of “hard-earned lessons” from the SARS outbreak in 2003.

His concerns, he said, were with whether Canada would have the space available to take care of its infected.

Drummond said the safe occupancy rate for any hospital is deemed to be at around 85 per cent, which provides “wiggle room” or a surge capacity in case of a sudden outbreak or increased demand for health care services.

But over the last two decades, he said, Canadian hospitals have been trying to function at 100 per cent capacity or higher on a day-to-day basis — made worse in Ontario, where he said many hospitals operate at 120 per cent capacity.

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When a hospital is over capacity, he said patients going through the emergency department who are deemed sick enough to require admission find themselves without beds.

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“They end up spending time in the hallway in the emergency department, waiting two, three days for transfer to a ward or to an ICU,” said Drummond. “That leads to a backlog of patients in the waiting room.

“It also leads to a backlog of ambulances waiting on the offload ramp, unable to get back to the community to respond to emergencies.”

“We can’t function on a good day. We can’t function in a mild flu season. What are we going to do if there is a major pandemic?”

He said the impact of a disease like COVID-19 could lead to cancelled surgeries, premature discharges or transferring older patients to smaller hospitals with less intensive care to make room. If Canada were unable to prevent a pandemic, Drummond said, “some decisions are going to have to be made.”

“If that terrible case scenario ever comes, will there need to be rationing of care and doctors making the decision of who lives and dies? I suspect the answer is yes,” he said.

As for whether or not Canada has enough beds, supplies, or is fully prepared for a pandemic, Colin Furness, an epidemiologist and assistant professor at the University of Toronto, stressed there was no way to know if any amount of preparation is really enough.

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“There are no experts in what this looks like. We just haven’t done it. We haven’t been tested that way,” Furness said of Canada’s health care system. “There’s too many variables.”

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Health officials tout negative-pressure rooms, training

The Ontario ministry of health said in a statement to Global News they spent almost $206.8 million since 2019 to support 1,428 acute care spaces and increase the amount of spaces needed for beds in the hospital sector.

They said the province has at least 806 permanent negative-pressure rooms and 463 additional spaces that can be made into negative-pressure rooms in the hospital’s emergency department, should a widespread outbreak occur.

Ontario’s chief medical officer of health, Dr. David Williams, said in a press conference on Wednesday the province was doing between 30-40 tests a day, and had a lab that could do 1,000. As part of their pandemic plan, the official said Ontario would be widening its surveillance scope.

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An Alberta Health spokesperson said in a statement to Global News that provincial residents can “rest assured that we are well-prepared for any future situation that may arise,” touting a recently tested a pandemic plan in a government-wide exercise last year. Since January, the Albertan government has been gathering extra personal protective equipment and planning for separate assessment centres that can test for respiratory illness.

In their statement, they said there are 374 isolation rooms distributed throughout Alberta.

The Stanton Territorial Hospital in Yellowknife has 24 negative-pressure rooms in a brand-new facility that allows the hospital to section off entire wings as negative-pressure space, as well as one airborne isolation room in its Inuvik Hospital.

Newfoundland and Labrador said all four of their regional health authorities were equipped with isolation beds and negative-pressure rooms, although they were unable to specify how many.

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Manitoba Health, Seniors and Active Living said they have implemented a Canada-wide Incident Management Structure to coordinate the health system’s activities to share information and responsive techniques to possible cases of COVID-19 with all provinces.

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The Manitoba government said the risk for contracting the novel coronavirus remains low, but that they are “in the process” of assessing its infrastructure to determine how many isolation beds the province has.

A spokesperson from the Nunavut Department of Health told Global News it had five negative-pressure rooms in its province, including four at its Qikiqtani General Hospital, although they said it was “unlikely” that someone would become infected with the disease.

The health department added they were performing routine infection prevention and control precautions, readied with personal protective equipment as needed.

Negative air pressure rooms, which allow air in, but not air out, are considered ideal spaces for airborne diseases.

However, Furness said the beds aren’t necessary for COVID-19 cases, as this disease is spread through human-to-human transmission, droplet and contact means. More important, he said, is whether doctors entering rooms with infected patients are trained with the proper procedures, whether hospitals have proper signage, personal protective equipment and cleaning tools.

“In 2003, because we weren’t ready, a relatively small number of cases almost overwhelmed our health system. People don’t like to say that, but it did. It came close to it came closer than most people really want to talk about, and that was only a few hundred cases,” he said.

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“We’re way better prepared now.”

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Furness also noted that a majority of confirmed cases are either mild or asymptomatic, which could help prevent Canada’s health care system from being overwhelmed by an influx of patients seeking in-hospital admission.

A shift in preparation measures

That the disease is less severe is good news for hospitals, said Dr. Vera Etches, the City of Ottawa’s top health officer. However it also means the disease is more likely to spread.

Etches said that up until now, the country has been focused on individual cases, but if there were a pandemic, the Canadian government would shift to other measures to try to slow down the transmission of the infection in the entire country.

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In preparation for an outbreak, Etches suggested Canadians make arrangements to be able to stay home for at least a week, as well as childcare arrangements in order to further prevent the disease from spreading.

“What we’re trying to avoid is that a whole bunch of people get sick all at once because there’s a lack of immunity,” she said.

“Trying to distance people from one another, sometimes useful in terms of breaking that or slowing down transmission so people can work from home or people can decrease the number of large gatherings that they’re participating in. These kinds of things can slow down transmission.”

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