Provincial officials acknowledge Ontario was caught off guard by the rapid growth of COVID-19 recently and the intense pressures it put on suppliers of medical supplies and equipment needed to save lives and protect health-care workers.

Premier Doug Ford defended the government’s response, which suddenly came on strong last week with an emergency declaration and public appeals to local manufacturers to switch production lines to hospital masks, gowns and ventilators needed for an expected surge of patients.

“If you would have asked me a week ago would we have 78 cases in one day, I wouldn’t have been able to answer that because we didn’t see the drastic spike,” Ford said of Monday’s increase to more than 500 confirmed cases with six deaths.

A major reason Ontario hospitals have found themselves short of much-needed supplies and equipment is their usage of a “just-in-time” strategy of replacing inventory just as it is used up, said Anthony Dale, president of the Ontario Hospital Association.

“Gone are the days of hospitals having massive warehouses,” Dale said on Monday.

Instead they rely upon the “just-in-time inventory management technique,” developed by the auto sector in the 1970s, to increase efficiency, cut costs and decrease waste, he explained.

The strategy was severely interrupted by the impact of the pandemic on factories in China.

“We had the world’s factory, China, shut down large parts of its manufacturing capacity for several months,” Dale said.

Personal protective equipment (PPE) in short supply include surgical masks, N95 respirator masks, testing swabs and gowns. Equipment in short supply includes ventilators.

Ontario is competing with jurisdictions around the world to replenish stocks.

Travis Kann, spokesperson for Health Minister Christine Elliott, said that in recent days the government and stakeholders have succeeded in purchasing 12 million sets of surgical gloves, one million N95 respirators and almost six million more surgical masks.

He said the federal government will be providing another 500,000 N95 respirators, one million surgical masks, 750,000 gowns, 500,000 pairs of surgical gloves, 750,000 face shields, and 20,000 units of hand sanitizer.

“We expect these supplies to be delivered at various times over the coming days and weeks,” he said.

“When everyone around the world is grabbing N95 respirators, grabbing ventilators ... we have to take the initiative to start doing this ourselves and we can’t rely on the rest of the world when they’re in a crisis,” Ford said.

“I’d rather be safe than sorry. I’m kind of like the guy who has the belt and the suspenders.”

Ontario’s chief medical officer of health said the province’s advance planning was thrown a loop when the new coronavirus pivoted fast and hard to Italy.

“In a week-and-a-half, things changed drastically,” Dr. David Williams told reporters during his daily briefing Monday.

“The challenge that we found out as we got into it more and more is that the suppliers were dealing with an ever-increasing demand so you’re not just ordering on your own volition, you’re dealing with a very highly competitive global situation.”

Some suppliers also “changed their mind” on filling orders, he added. “It’s a moving target.”

Dale said the stockpile of N95 masks ran down in January and February as hospital employees and doctors did “fit tests” to determine what size of masks they needed. They also used them in “scenario planning” to prepare for the pandemic.

Asked about rumours that boxes of masks have been stolen from hospitals, Dale said he is aware of them but could not confirm them.

“We’ve heard anecdotes over the past several months, but all these supplies should be rather well secured,” Dale said.

Doctors working in hospitals have described how supplies are being rationed.

“We have enough but are severely restricted. In normal times you could choose to wear whatever you want, whenever you want, but now N95s are reserved for aerosolizing procedures such as intubations and chest tubes,” said a physician who spoke on the condition of anonymity because he was not authorized to speak to the media.

“We’re rationing in this weird calm before the storm,” he added.

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Said another hospital-based doctor: “We were told not to wear surgical masks because they aren’t necessary. But now with the talk of asymptomatic cases and cases that present as a heart attack but later turn out to be COVID-19 positive, it seems foolhardy to blindly go around without a surgical mask.”

Dale said hospitals are carefully managing their supply stockpiles:

“Hospitals are working very closely together to manage what we know are scarce and limited resources. We are counting on help from the Government of Ontario and the Government of Canada and all of the other provinces to procure new supply.”

He said he was buoyed that the private sector is stepping up to lend a hand. He cited the example of Thornhill Medical, which has offered to help fill the demand for more ventilators.

“It’s amazing to see. This is bringing out the best in people,” he said.

Much of the hospital sector was working at above capacity even before the pandemic hit. The Ontario Hospital Association has long been trying to draw attention to the fact there is little wiggle room in the system.

“We absolutely will get through this as a province. But there will be major lessons learned. You cannot have hospitals functioning well above 100 per cent on a sustained basis,” Dale said.

While individual doctors and nurses have been soliciting donations of masks and gloves on social media for some time, Monday marked the first day of a personal protective equipment (PPE) drive at Michael Garron Hospital, where people and businesses dropped off two pallets worth of medical supplies.

Over the course of the day, 30 people drove into the underground parking lot, where social distancing measures were practised while their donations were unloaded by staff.

“We’re not running out of anything just yet. We have supplies that will last two weeks,” said Mitze Mourinho, president of the Michael Garron Foundation.

“But we need to maintain that stockpile,” she said. “There’s just no supply.”

Local businesses ranging from dentists’ offices and tattoo parlours to hair salons and fertility clinics have reached out with offers to share any supplies they have on hand, said Mourinho.

While the hospital didn’t ask for hand sanitizer, it has been contacted by distilleries that have switched over production and are offering the product free of charge to health-care workers.

“We’ve heard from 3-D printers who have prototypes of masks as well as automotive companies looking to pick up or deliver,” said Mourinho.

On the front lines of health care, infectious disease specialist Dr. Isaac Bogoch of the University Health Network said he hopes pleas by the Ontario government and others for manufacturers to switch production will bear fruit quickly.

“We have a tremendous industrial complex in Canada that may be sitting idle right now,” he said.

“This is an unprecedented event and even the most prepared health care system is going to be stretched.”

He urged “less talk, more action. There is no time. This is now.”