Global case counts of the novel coronavirus continue to strain upwards, with China’s number surging after a shift in how patients are diagnosed, new cases in the U.S. and U.K., and dozens more aboard the quarantined Diamond Princess cruise ship, including 12 Canadians.

In Ontario, the case count has actually dropped: a patient in London was confirmed free of the virus on Wednesday. Two other patients continue to recover at home in Toronto. Health officials say the risk to the public here continues to be low.

But behind the scenes, the city, the province, and the country are ramping up efforts to prepare for and contain the outbreak. The SARS crisis 17 years ago taught all three that a manageable infectious disease outbreak can quickly become catastrophic without preparation, communication and vigilance.

Here is what Toronto, Ontario and Canada are doing.

Threat of face mask shortages

Amid global and local concern, Ontario’s Ministry of Health is seeking to reassure health-care workers and the public that the province-wide supply of face masks and other protective equipment is sufficient “for the current situation.”

Last week, the World Health Organization warned of worldwide shortages of personal protective equipment, or “PPE,” as a result of the COVID-19 outbreak. Of particular concern are the N95 face masks that health-care workers wear to protect themselves from respiratory droplets. WHO said demand is up to 100 times higher than normal and reported depleted stockpiles and backlogs of four to six months.

A Ministry of Health document issued Wednesday suggests health-care workers are concerned about shortages here, too.

Have Your Say!

The ministry has set up a dedicated email account for health-care workers’ questions, feedback and concerns related to personal protective equipment, and says it is receiving a large volume of emails and is “following up to make sure critical shortages are addressed.”

The document cites several concerns. Many hospitals have developed their own stockpiles of personal protective equipment in anticipation of an influenza pandemic or other serious outbreak — but according to the document, “for many organizations, the PPE in their stockpiles has expired.” The materials in disposable respiratory masks can degrade over time, making them less effective.

Secondly, manufacturers of such masks are not automatically fulfilling bulk orders, according to the document. Instead, they are prioritizing areas with the greatest need — so building up a stockpile now, especially in an area like Ontario with so little transmission of the virus, is difficult or impossible. The WHO has asked countries with low transmission, like Canada, not to stockpile PPE in order to reserve supplies for countries that really need it, especially China.

Thirdly, the ministry is encouraging PPE “stewardship” — only using these supplies when really needed. That may include developing “more robust protocols to secure your PPE inventory in order to discourage theft, inappropriate usage and other loss.”

The Ministry of Health emphasizes that “we are confident that we have sufficient inventory across the province to respond to the situation on the ground today.” In the document, the ministry says it is in touch with manufacturers and other organizations involved in the PPE supply chain almost daily, and that it is working to understand and collect information on the existing supply in the province.

The province maintains its own PPE stockpile, and the Canadian government has a “National Emergency Strategic Stockpile” of medical equipment and supplies that can be requested by provinces and territories during infectious disease outbreaks.

A spokesperson for Ontario’s Ministry of Health did not answer questions about how long the province’s stockpile is meant to last, because “the inventory of supplies is fluid as products are used within the system.”

The WHO director-general and Ontario’s chief medical officer have both warned that unnecessary use of N95 masks and other protective equipment is straining the system.

“Working with partners across the health sector, the Ministry of Health has developed systems to identify organizations who are having challenges getting the supplies they need, and have processes in place to ensure that providers are able care for their patients safely now and in the future. Following WHO direction, we are prioritizing use of supplies for health workers,” a spokesperson said.

Emergency Operations Centre activated

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In late January, after the province confirmed its first presumptive case of COVID-19, the Ministry of Health quietly activated its Emergency Operations Centre.

This is not the same as declaring a state of emergency: only the premier, the Lieutenant Governor in Council, or the mayor or other head of a municipality can make that call, as several towns battling floodwaters did last April, and as premier Ernie Eves did during the vast 2003 power blackout. The COVID-19 outbreak is nowhere near that level of concern.

Activating the Ministry Emergency Operations Centre provides a central co-ordination point for responding to threats to Ontarians’ health and to the health-care system as a whole, a spokesperson says.

The ministry has been conducting a daily teleconference that loops in people from throughout the health-care system, during which it provides updates on the situation globally and in the province, such as how many COVID-19 cases are under investigation and have lab results pending. That number has dropped steadily over the past week: on Feb. 6, there were 62 being investigated as potential cases and had lab results pending. On Thursday, there were only 15.

City changes its quarantine protocol

Toronto Public Health previously told the Star only two people were in “self-isolation”: the husband and wife both confirmed to be sick with COVID-19. But recently, the department announced a change.

The Public Health Agency of Canada, Toronto Public Health said last Friday, is now recommending that anyone who has travelled to China’s Hubei province, the epicentre of the outbreak, should self-isolate at home for 14 days too, regardless of symptoms. Those travellers should also contact their local public health agencies within 24 hours of arriving in Canada.

Anyone who has travelled to mainland China should monitor themselves for fever or respiratory symptoms, and if any develop they should immediately seek care and cite their travel history.

Asked how these changes have changed Toronto Public Health’s caseload for the COVID-19 outbreak, a spokesperson would not provide exact numbers. “The number of people we are tracking related to this situation changes daily and we are therefore not sharing this information at this time,” said Lenore Bromley.

Research boost

Over 300 scientists from around the world gathered in Geneva, Switzerland this week for a rapidly organized COVID-19 research forum. The summit was intended to clarify the most urgent questions on how to tackle the outbreak, and to organize support from many different national funding bodies, including the Canadian Institutes of Health Research.

Canada said Thursday it would funnel $6.5 million into research helping to stop the spread of the virus.

Scientists, including several from Canada, organized around critical topics like short-term medicines, the longer-term development of vaccines, the efficacy of public health interventions and the social impacts of the outbreak.

“We need a vaccine against misinformation as well,” Dr. Michael Ryan, the WHO’s emergencies chief, said of the research goals Thursday.