We need to expand our imagination, even as our individual worlds contract. On Friday two particularly notable things happened: one was Ontario trying to tell people how bad scientists think this might get. There was a vast and almost ungraspable range of possible deaths, between 3,000 and 15,000 over a period up to two years. And there was the hopeful idea that we can still keep our medical system from being overrun.

Then there was the revelation that the United States is a wild beast right now, an apex predator as it collapses. Donald Trump’s intention to cut off 3M’s exports of N95 masks to Canada might change. But it’s a potential terror, too.

We are going to need to change the way we think, and soon, because we are at the precipice of the truly difficult times.

“We have to go off-book with our thought process,” said Dr. Michael Warner, the medical director of critical care at Michael Garron Hospital in East York. “I think we can figure it out; I think that the population just needs to understand what it is we’re actually up against, with some real numbers.”

The true takeaway from the Ontario numbers is they are not a prophecy beyond this: many more deaths are coming, and the province’s intensive-care capacity could be overrun within a few days. The province seems to think it can still survive a surge, if everyone follows social distancing properly, with the addition of 900 more ICU beds.

Maybe. Hopefully. Health Minister Christine Elliott said every hospital can add to their capacity in the way they see as most appropriate: hotels, motels, retirement homes, field hospitals. They’re needed yesterday. But asked about staff, she said the province was looking for volunteers, and had 10,000 applications: retired nurses, medical students for contact tracing, volunteers.

But not doctors. And not respirologists, who work ventilators. That is where, especially if there is not enough personal protective equipment, or PPE, it can break.

“The thing that’s important for people to understand is, I don’t know what 900 beds means,” says Warner, whose own PPE drive has brought in over a million pieces of protective equipment for over 20 hospitals. “Is that 900 beds with ventilators, with monitors, with IV pumps, with medications to treat critically ill patients? If any one of those variables is inadequate we can’t actually go to the next level.

“It’s similar to PPE in that it works as a system. So 900 beds, great. Where are the doctors, where are the nurses, where are the respiratory therapists, where’s the PPE? And that 3,000 (deaths) assumes we have 900 beds online in the next few days.”

Maybe Canada can convince Trump that his N95 gambit would be Pyrrhic. But the projections should still scare us, and hospitals, too. Doctors will tell you hospitals are built to follow protocols and avoid liability.

“Everything moves at a snail’s pace,” said one Toronto emergency doctor. “It’s all administrative bulls---, and you can’t get meaningful changes happening. Nothing happens.”

Hospitals in the GTA should listen to their front-line personnel, and more protocols will have to change. We need palliative nurses in ICUs to talk to families about end of life, so doctors can keep serving patients. Warner notes Ontario doctors only get paid by OHIP when they write up notes on each patient, and that is time that could be freed up: just pay doctors by the hour. He notes a virtual setup allowing him to make thousands of decisions for patients and his crew instead of hundreds would help, if the Wi-Fi were better.

“Schlepping from bed to bed, putting on PPE, all that stuff, doing orders, and writing notes, that’s not the most effective use of my time if I have so many patients,” says Warner.

We’re not thinking differently enough yet. Premier Doug Ford finally trimmed the essential services list of business in Ontario, but left existing construction crews and renovations working. We know what needs to happen, and that isn’t it.

As Warner says, “3,000 means people following all the public health measures that were announced today, and he also said we could get it lower if we went to the next level. Well, why don’t we go to the next level yesterday? Why are we waiting for things to get bad to go to the next level?”

Canada has been too slow the whole way: in social distancing, in border control, in preparation, in putting up new defences for a virus built to beat all the traditional ones. Doctors on the front lines have been yelling for weeks. What the holdouts on social distancing do today will reverberate in a week or two. It will be worse then.

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So now hospitals are setting up COVID-19-only areas, while health-care workers ration masks and contemplate hard decisions. As one doctor said, “We should have broken the protocol three weeks ago, one month ago. Prevention was really the only option. We’re now isolating well, but it’s like if someone was a smoker their whole life and they're going to get lung cancer, you can't just quit a month before and avoid it.”

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And that, as much as anything, is how we need to change our thinking. We need to mentally prepare for darker times. Because they’re coming.

“We have triage tools to say, if we have five patients who need this ventilator, and the patient who’s using this ventilator is going to die, we’re going to take that patient off and give it to one of the five who’s most likely to survive,” says Warner. “We’re not very far from that situation.”

He has to make that call. Every hospital does. And that, as much as anything, is how we have to change our thinking, expand our imagination. That is what has to give meaning to our isolation, our social distance, to the hard stuff.

Because this is just the start, and it hasn’t gotten truly hard yet. And we will need to face what’s coming.

Correction — April 4, 2020: The photo caption in this article stated the Joseph Brant Hospital is being built in the wrong city. It is in Burlington, Ont.

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