Ontario hospital officials have plans in place to postpone elective surgeries, reopen shuttered hospitals and draw on the provincial stockpile of ventilators in case there is a surge of critically ill patients with COVID-19 in the province.

The strategy, which includes rapidly increasing the number of available hospital beds across Ontario, will only be used as needed to protect the health-care system from being overwhelmed by very sick patients.

Health officials in Ontario have watched the new coronavirus sweep through other parts of the world, straining those countries’ health systems.

In China, the government has built more than a dozen new hospitals to treat patients with COVID-19, while in northern Italy, hospitals have run out of resources, including breathing machines, and are struggling to save all those with severe symptoms. On Thursday, Italy reported its death toll from COVID-19 had topped 1,000; less than three weeks ago the county had just nine cases of the coronavirus and no deaths.

Kevin Smith, President and CEO of Toronto’s University Health Network (UHN), said Ontario is preparing for the worst-case scenario but so far hasn’t seen the need to increase capacity in hospitals. Currently, almost everyone in Canada diagnosed with COVID-19 is recovering at home, he said.

“Our hope is we will continue to see that kind of recovery strategy without hospitalization,” said Smith, who is hospital lead for the Toronto region’s response to critical care needs.

“But if that isn’t the case, we are day-to-day, hour-by-hour, more ready than we were an hour ago or a day ago to treat a spike in patients in hospital.”

Most patients with COVID-19 will have mild to moderate illness and will be able to recover at home. About 20 per cent of cases will have severe symptoms and need hospital care, with some requiring specialized treatment in intensive care units (ICUs). On Thursday, Ontario reported 17 new coronavirus cases bringing the provincial total to 59.

In a Thursday statement, the Canadian Association of Emergency Physicians warned there is “no surge capacity in Canadian hospitals,” with many operating above safe capacity limits.

Clinicians in Toronto and across Canada are aware of the challenges the world is facing in caring for patients when demand exceeds a health system’s capacity, said Dr. Robert Fowler, a critical care physician and chief of the Tory Trauma Program at Sunnybrook Health Sciences Centre.

“We experienced that with SARS in 2003 — too many sick patients in too short a time — plus the transmission of illness from patient to patient and health-care worker to health-care worker. We learned hard lessons from that.”

And while Canada, and especially Toronto, is now much better prepared for a pandemic, health experts are still concerned about a sudden increase in patients with COVID-19 in Ontario, Fowler said.

“Even though only a minority get critically ill, that may still overwhelm our system, even on a good day,” he said, adding that in Ontario, the baseline for many intensive care units is to have one or two open critical care beds. Currently, Ontario has about 1,700 ICU beds spread out amongst its hospitals.

“We operate our system with very slim margins of capacity. If Ontario happens in the same way as Europe, we could quickly exceed our capacity.”

Should Ontario see a spike in hospital admissions due to sick patients with COVID-19, Fowler said the first thing hospitals will do is postpone elective or previously scheduled surgeries to free up hospital beds and staff. This measure will also keep people who otherwise don’t need care out of hospital and reduce the risk of spreading the coronavirus.

Hospitals may also clear entire wards of patients, if needed, to add additional beds to treat those with COVID-19, Fowler said.

Smith said he believes people will understand the need to postpone elective surgery because patients are already calling UHN asking whether they need to go ahead with an elective surgery in light of current public health recommendations to avoid crowded areas.

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“They are anxious about coming to hospital if they are not acutely ill.”

Delaying elective surgeries also means the ventilators used for routine surgeries can be repurposed to help COVID-19 patients who need breathing assistance, Smith said.

Following the 2003 SARS outbreak, Smith said the provincial government stockpiled ventilators in preparation for a future pandemic and that these specialized breathing machines will be delivered to Ontario hospitals should the need arise during the outbreak of COVID-19. The province has also looked into purchasing additional ventilators and has plans to secure them, if needed, he said.

The province is also prepared to use both decommissioned hospitals and new, yet-to-open hospitals in Ontario if there is drastic need for additional hospital beds, Smith said.

Toronto General Hospital, a part of UHN, operates the largest organ transplant program in Canada. Smith said other hospitals have pledged to help ensure this critical service continues during a COVID-19 outbreak by taking in additional patients.

“We will do our very best to ensure we don’t see a dip in transplantation during this time,” said Smith, adding that emergency cardiac surgeries and emergency cancer surgeries will also continue at UHN, which sees among the most complex cardiac and cancer patients in the region.

In a statement to the Star, a spokesperson for the Ministry of Health said Ontario health officials “continue to monitor the situation and bolster response measures as appropriate.” The province, in collaboration with Public Health Ontario and its federal, provincial and territorial counterparts, is getting the health system ready to respond “to a number of scenarios associated with this virus,” the spokesperson said.

Dr. Jerome Leis, Medical Director of Infection Prevention and Control at Sunnybrook, said the province is working with hospitals, community partners and public health units to focus on the system’s capacity to withstand a large increase in the number of patients during the pandemic.

“We need to curb the peak of the pandemic, so it doesn’t overwhelm our health-care system.”

One such measure is out-of-hospital assessment centres that can quickly screen and test people who may have COVID-19. These dedicated test facilities, separate from hospitals but staffed by health-care workers, will help keep people away from already busy emergency departments. This will relieve pressure on hospitals and help keep potentially sick people away from patients and hospital staff.

Leis, co-author of a recent study that looked at data on COVID-19 testing in Toronto emergency departments, likens cases of COVID-19 in a pandemic to a large iceberg. The large, bottom of the iceberg are those who have mild illness, while the tip of the iceberg holds the sickest patients.

“If the bottom of the iceberg is large — when there is community spread — the tip of the iceberg will also be large in proportion. And that’s when the sheer numbers of sick patients can quickly outstrip the (health-care) system’s capacity.”