Canadian intensive care units are filling up. The language from politicians is more urgent, more dire, with specifics still elusive. And most worrisome, personal protective equipment for health-care workers, or PPE, is running low all over. There is a palpable sense that the Canadian health-care system is about to be bent, and perhaps break. Even as the deaths begin, this is the lull. It is unlikely to last.

“No, we likely did not have enough (PPE),” said Canadian Health Minister Patty Hajdu in her daily briefing on the COVID-19 pandemic. “I think federal governments for decades have been underfunding things like public health preparedness, and I would say governments across the world are in the same situation.”

We are finding the seams. Quebec Premier François Legault said Tuesday that Quebec was down to between three and seven days of PPE left; on Wednesday, the Ontario Hospitals Association called on the prime minister and the premier of Ontario to “clearly and specifically inform hospitals when new PPE supplies will be delivered to individual organizations.” That hospitals don’t know is itself a terror.

“Any planning scenario has us potentially overwhelming our health-care system,” said Dr. Theresa Tam, Canada’s chief public health officer. “We know a surge is coming,” said Premier Doug Ford, who invoked the deathly spectre of Spain and Italy. Toronto’s medical officer of health, Dr. Eileen de Villa, invoked the unfolding disaster of New York.

Physical distancing is critical going forward; PPE is the most critical piece right now. Nurses at Barrie’s Royal Victoria Hospital are being given a single surgical mask for a shift even after the recent deal between the nurses’ union and the province on appropriate protection; on Tuesday, the hospital sent its workers a memo saying the hospital was seven days from running out of PPE “based on current usage.”

Toronto hospital administrators have asked employees if they have any sources of PPE, specifically the higher-filtration N95s, and one told them the hospital tracked down every lead. An email from Sunnybrook to workers said “unfortunately, there are scams galore.”

Another Toronto-area hospital has employed PPE that has been considered inadequate by some doctors and nurses, including goggles one doctor compared to IMAX glasses. A significant gown shortage was reported at Etobicoke General Hospital and Brampton Civic Hospital. A hospital in the University Health Network is asking employees to keep N95 masks in their lockers between shifts, even as the masks degrade.

“I would prefer if they came outright and said it’s not the best protection, you will get sick with repeated viral load exposure, and no, we don’t have the proper equipment,” said one UHN nurse. “People should have the choice to serve in those conditions.”

The federal government has a comprehensive push on, as does the province. The scramble is global, with so many countries in need of surgical masks, N95 masks, face shields, protective or surgical gowns, gloves. Equipment moves every day, but neither the federal nor the provincial government does much to confirm dates in advance, or amounts. Ford said a big federal shipment was expected Wednesday or Thursday, and it was confirmed that a shipment was headed to Quebec in the next two days.

But the race is life and death. The Washington Post reported the U.S. federal stockpile of PPE was almost depleted, and in a purchasing power fight with the United States, Canada is a small fish.

Asked Wednesday, Prime Minister Justin Trudeau could not guarantee there would be enough protection for health-care workers. Tuesday, Treasury Board President Jean-Yves Duclos emphasized the push to locally source manufacturing, which is a new national priority. He said, “We’re going to produce a great amount in the next few weeks ... the Canadian government is ready to mobilize as if we are at war.”

But the war may arrive at the front lines first. Health-care workers are asking themselves: What would I do if the equipment ran out? Over 100 have tested positive for COVID-19 already in Ontario. The virus spreads so easily.

“There are heroes out there in health care,” said one Toronto nurse who works for University Health Network, “but most people are average, everyday people who want to live. No one I have talked to will work without protection.” Another nurse from St. Michael’s agreed.

“We could find a nightmare scenario where we just cannot offer care,” said one doctor who is involved in planning at a major Ontario hospital. “They have a legal right to refuse under labour law, if the situation is unsafe for the worker.” A doctor who works in rural family and hospital care said he thought doctors would keep showing up, because they can’t refuse unsafe work. He is sourcing his own PPE at this point.

CUPE, the union which represents hospital workers, announced the province altered protective guidelines Tuesday night to exclude N95s for “registered practical nurses, personal support workers, cleaners and doctors, among other staff in hospitals and all staff in long-term care and home care.” The union announced, without specifics, “a one-day province-wide workplace action.”

The system is bending. On Wednesday, the city of Toronto established more stringent restrictions on gatherings for 12 weeks. The province said, finally, that it would cut down the bloated essential businesses list. The virus continues to stalk seniors’ homes, and is creeping further into the most vulnerable places: prisons, psychiatric hospitals, homeless shelters and public health spaces. There are registered practical nurses, pharmacists, cleaners, paramedics, police officers, firefighters, grocery or LCBO or other essential workers, and all of them deserve PPE.

Right now there is not enough. And it will hit hospitals hardest, first.

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“If we all just stopped moving for two weeks, and nobody talked to anybody for two weeks, and we all stayed put, in fact we would see this virus die,” said Hajdu. “That is the reality. The virus needs hosts to continue to infect in order to continue to grow. And so how long we are in this actually depends on our actions today.”

The race to stop the virus needs to be run every day going forward, and will need to be won. The race to protect our health-care workers, from both a surge and the virus, is ongoing. It needs to be won now.

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