OTTAWA —Hospitals in Canada are warning the federal government that a health system already stretched thin may not be able to cope if the novel coronavirus outbreak continues to worsen here.

The hospitals say they need help now to “dramatically scale up” respiratory virus testing, to collaborate on laboratory analysis to quickly share data with other hospitals, and to protect staff amid a COVID-19 outbreak that has arrived in flu season, according to the national advocacy group for health care organizations and hospitals.

Add to that a run on masks and other personal protective equipment, a documented shortage of critical care beds, and a new federal warning to all persons entering Canada from anywhere in the world to “self-monitor” for symptoms of COVID-19, and you see a system that could quickly come to a breaking point.

That’s despite federal insistence the health system is “well-prepared” to deal with the growing numbers of confirmed cases in Canada — 51 as of Friday — and to trace all their contacts to contain the spread, according to Chief Public Health Officer Dr. Theresa Tam.

Paul-Émile Cloutier, president of HealthCareCAN, the national advocate for more than 50 of the country’s top hospitals and health-care networks, said in an exclusive interview with the Star that he understands that federal officials are trying to assure Canadians that it’s all under control “but we know as experts and as people who work in the system, it’s not all under control.”

“I think there is a need for Ottawa to really show some leadership,” said Cloutier, adding health-care administration is a provincial responsibility but, “viruses don’t understand constitutional responsibilities.”

Cloutier said hospitals are managing now because the numbers of infections are small. But he said if it worsens that will not hold. He said the chronic strains on hospitals are clear: the demands of an aging population, growing mental health and addictions treatment needs, a high rate of burnout among medical health professionals, beds taken up with patients who should be moved into long-term care or rehabilitation centres, lack of space in the community for them, and decaying infrastructure.

“Coronavirus is an addition to what the system is now faced with,” he said.

“And I think it’s time for us to really wake up and smell the coffee and say this is really happening and our system may not be prepared if there was a pandemic tomorrow morning.”

Asked what are the hospitals’ immediate needs, HealthCareCAN’s Steve Wharry responded with a list from one hospital’s head of laboratory medicine, provided on condition the physician not be named.

“We certainly want to dramatically scale up testing,” he wrote. “We currently do a maximum of 200 respiratory virus tests per day for 12 hospitals. We believe we can scale this up to at least 500/day if we invest in liquid-handling robots and extractors, stockpile lab reagents and train people.”

He said there are limitations on laboratory information systems which record, manage, and store data for clinical laboratories, some of which have “major flaws. A lot of manual steps.”

“Our lab could probably process 500 specimens over a 16-hour shift, but it might take the rest of the week to transcribe the forms (which may be a requirement for COVID-19 testing — we’re negotiating that).”

Then there is the need to protect staff and offer them rapid testing in a pandemic.

“We have developed and tested self-collected nasal swabs and used these in numerous studies. Self-collection with a centralized drop-off could enable a safer workplace and would be a unique service for hospital staff and their immediate household family members, and keep our hospital free of infected staff.”

However, he said, the lab-testing system would need to accommodate hundreds of extra specimens per day, and figure out how to manage all the data produced.

Finally, the hospitals advocacy group says hospitals are already informally trying to collaborate on rapid development and validation of lab methods “but a major push for collaboration would be welcome and we could do this with a minimum of funding.”

The grim warnings come as the global COVID-19 epidemic escalated rapidly.

On Friday, Tam, Canada’s top doctor, warned all travellers entering Canada to monitor for COVID-19 symptoms.

International travel is down but that is still a huge number. Statistics show 2.7 million travellers entered Canada in December alone.

The World Health Organization tallied 99,624 cases in 90 countries with 3,400 deaths.

Canadian authorities said it’s worse.

Tam said she was confident the number is already more than 100,000 cases, among them: 53 people in Canada have now been diagnosed with the coronavirus that first reared its head in December in Wuhan, China.

Tam admitted federal reports may lag behind provincial health authorities. As of early evening Friday, there were 28 cases in Ontario, 21 in B.C., three in Quebec, and one in Alberta. Those hit were both men and women, aged 23 to 82. Only a handful have been hospitalized for treatment. Experts say 80 per cent will experience mild to medium symptoms of the respiratory virus.

Tam tried to reassure that most were identified as travellers from countries where the virus has hit hard: China, Iran and Egypt.

But that is now expanding to places like Hong Kong, the United States and in B.C. the outbreak took a worrying turn for Canadian authorities: the first known case of community transmission, where the patient was not returning from somewhere else.

Tam insisted that intensive efforts to trace all the patient’s movements and contacts in the past two weeks are underway and may yet find a connection to travel, but she said Canada must now tell all travellers, including those from the United States, who arrive — whether at land or airport entry points — to monitor themselves for symptoms like fever, cough, and difficulty breathing.

Canadian nurses are worried and have called for stricter protective guidelines for front line workers in acute-care settings.

Tam has so far turned aside those calls. But she says her agency is co-operating with provinces and scientists to determine needs, adding Ottawa can help in bulk purchasing personal protective equipment.

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However, that too is now a challenge.

Goran Abramovic, a spokesman for Wurth Canada, one of the largest distributors of protective face masks, respirators, clothing, gloves and other gear sold to many industrial users including hospitals, says demand has skyrocketed for those products.

The company sold as many face masks in January and February as it did in all of 2019, he said.

A lot of its products, many made to the company’s specifications, come from China.

Now, says Abramovic, backlogs in orders from suppliers in China and Taiwan are piling up. Factories in key supply regions had closed amid the outbreak, and the company says Chinese and Taiwanese governments imposed embargoes of personal protective equipment sales for domestic use only. But production there is returning, and factories are filling orders again, he said.

“We are now starting to see lead times of around eight to 10 weeks due to the impact that coronavirus has had on manufacturing.” So the company is fulfilling orders only from its current business customers, he said. “We are evaluating our inventory versus demand daily. We will be supporting all of our current customers as long as we have inventory in supply.”

And while it’s hard to get a straight answer from Health Canada about our critical-care inventory, it’s clear concerns have been expressed in recent years.

A 2015 academic study by critical-care doctors and services, conducted well after the H1N1 pandemic in 2009-2010, identified 286 hospitals in Canada with 3,170 intensive care unit (ICU) beds and 4,982 mechanical ventilators for critically ill patients. It said there were 22 hospitals that had an ICU that routinely cared for children; 15 of which had dedicated pediatric ICUs.

It found a wide variation in provincial capacity. Some smaller provinces like Newfoundland and Labrador have more critical-care capacity per capita than bigger provinces like Ontario.

Canada, the study’s authors said, has “far fewer ICU beds per capita than the United States, but similar numbers of ICU beds to those in many Western European nations.”

And they pointed out that while there had been provincial assessments in the past of critical-care resources, “our overall national critical-care capacity is unknown.”

The front line of the outbreak is the hospitals, some of which are now trying to move screening and testing facilities off-site, outside the hospital setting to prevent disease spread and protect workers and other patients.

It’s not the first time that Ottawa has heard the hospitals plead their case.

Cloutier says he has made the argument about the funding plight facing front line health-care institutions directly to the federal government in prebudget consultations. He has asked Ottawa to allow hospitals to compete for federal infrastructure dollars to do essential repairs and “green” renovations; to provide money for digital and data improvements to hospital operations; and to fund the indirect costs of research.

On Friday, Ottawa announced it would pour an extra $27 million into research to find a vaccine for COVID-19.

However, neither the office of federal Health Minister Patty Hajdu nor her department responded to the Star’s requests for comment about the hospitals’ concerns.

Finance Minister Bill Morneau told the Star’s Bruce Campion-Smith that discussions between federal and provincial health ministers “have been very focused on dealing with the urgent and immediate, that is going to continue on a daily basis.”

“Look, I don’t want us to get waylaid into the transfer agreements which are big long-term discussions when we’re dealing with a short and potentially intense thing we need to be discuss, they’re both important. They’re different.”

Not all in the health system are worried it will not be able to cope with the challenge ahead.

Dr. Sohail Gandhi, president of the Ontario Medical Association, said “virtual care options” were approved with the past couple of months that will allow doctors and patients to talk directly — as opposed to having to go into clinical settings with secure camera links — which will help.

He suggested it’s important to keep the current outbreak in perspective, saying influenza is still the biggest concern in hospitals, with 40,000 cases of flu a year in Canada and an average of about 3,500 deaths yearly.

“I get it, it’s new, it’s novel, but…I think it’s important to keep an eye on the situation,” Gandhi said, adding people shouldn’t panic, or become alarmist, and the general public should not be trying to buy up masks to wear in public when handwashing is the key preventive measure.