The coronavirus could hit 35 to 70 per cent of the Canadian population, making “a huge number of people ill,” many critically, and makeshift hospitals and quarantine centres could be needed to shore up a health system that has virtually no give, experts predict.

According to a disease-transmission model developed by University of Toronto researchers, the virus’ overall attack rate in Canada could exceed 70 per cent. That number drops sharply, by about half, “if we add modest control,” said epidemiologist Dr. David Fisman, one of the model’s creators, but it will take “aggressive social distancing and large scale quarantines” to reduce it further, he said.

“That’s still a huge number of people ill, and critically ill people are a large fraction in this disease,” Fisman said in an email. “I’m not going to share more specific numbers because I think they will scare people to no particular end.”

The first confirmed death in Canada from COVID-19 brings home the reality that while most people infected with the rogue virus ultimately fully recover, the infection can be fatal.

A man in his 80s with underlying health problems, a resident of a North Vancouver nursing home, died Sunday night.

As of Monday, there were 78 known confirmed and presumed cases of the virus in Canada, including six cases linked to an earlier leg of a voyage of the Grand Princess cruise ship, the same ship that had been floating off the coast of California for days before it docked in an Oakland port Monday. At least 21 people aboard, including 19 crew, have tested positive for the virus. Ottawa was preparing Monday to fly the 237 Canadians aboard the ship to Canadian Forces Base Trenton, where they will be assessed and undergo a 14-day quarantine. Any infected Canadians won’t be allowed to board the plane and instead will be referred for treatment in the U.S. Canada’s chief public health officer is now recommending Canadians avoid all cruise ship travel.

The second repatriation of Canadians aboard a virus-infected ocean liner comes amid growing concerns about the country’s readiness for an escalating public health threat. “We have scenarios where there are more people requiring ICU beds than there are acute care beds (all hospital beds) in Ontario at peak,” said Fisman, a professor in the division of epidemiology at the Dalla Lana School of Public Health. “We see in Italy that G7 countries can have total collapse of health systems under the strain of this, even early in the epidemic.”

Doctors in Alberta have complained of a “lack of forward thinking” and poor communication about emergency planning. B.C. nurses have warned they’re already working short, and there are concerns about dwindling supplies of face masks, eye shields and other protective equipment. Federal Health Minister Patty Hajdu Monday acknowledged that Ottawa is “very alive to the fact that some provinces are indicating they have deficits.

“We are gathering that information and we have said all along that we will be there as the federal government to support them with the resources they need, whether those are financial resources or practical resources.”

It will be a tall order. Hospitals are already running beyond capacity. “You’re working at 120 per cent capacity and now you have this on top of your normal work,” said Paul-Émile Cloutier, president and chief executive officer of HealthCareCan, which represents hospitals and other medical facilities across the country.

On the ground, there are concerns around supplies of gowns, gloves, masks, oxygen, drugs, ventilators, and laboratory capacity for virus testing.

“We need to scale up the testing of these viruses,” Cloutier said. “It’s taking far too long in some centres to get the results.”

Deputy Prime Minister Chrystia Freeland and Prime Minister Justin Trudeau are asking premiers to identify their “state of readiness” and any critical gaps in supplies or capacity ahead of Friday’s first ministers meeting in Ottawa. In a letter to the premiers, Freeland said the government is leading a bulk procurement of personal protective equipment.

Still, front-liners are worried, Cloutier said. “They’re worried because they’ve only seen the beginning and they think that if there is a pandemic it’s going to be extraordinarily difficult to manage the capacity of the needs of our patients coming through the system.”

Fisman’s team has experience dealing with SARS, H1N1 and Ebola and recently reported that the outbreak in Iran was far larger than originally reported. Among other data, their model estimates basic reproduction numbers — how many other people one infected person is likely to infect — as well as the number of mild and asymptomatic cases that are flying under the radar, believed vastly higher than reported case counts.

“China’s epidemic was controlled through massive quarantine, enforced via threats of death penalty, and with lockdown of 750,000 people at peak,” Fisman said.

In Canada, modest public health control efforts would mean finding and isolating around 50 per cent of mild cases through testing, but no social distancing or quarantine.

More aggressive measures would be the kind of countrywide lockdowns now occurring in Italy, which have left streets in the capital Rome and other cities deserted, as well as school closures and banning of mass gatherings and sporting events.

A new study finds that older people, as well as people with sepsis or underlying clotting problems, are most likely to die from the virus. Published in The Lancet, the study, based on 191 patients from two hospitals in Wuhan, the epicentre of the outbreak, also found that people shed the virus for longer than expected, an average of 20 days in survivors, and as many as 37 days. Prolonged shedding suggests people may still be capable of spreading the pathogen.

“The extended viral shedding noted in our study has important implications for guiding decisions around isolation precautions and antiviral treatment in patients with confirmed COVID-19,” the Chinese researchers reported.

We have scenarios where there are more people requiring ICU beds than there are acute care beds

In hospitals, rooms, wards and potentially entire floors will need to be set aside because the infected can’t be kept in ordinary rooms like any other patient, Cloutier said. “I’m not saying you need to build new hospitals,” he said. In China, where the virus has infected more than 80,000, a 1,000-bed hospital was panic built in just 10 days.

But if the virus spreads widely in Canada, “what are you going to do with those patients that are already in hospital,” Cloutier said. “Are you going to ask them to leave? What happens if it’s a patient (who needs) home care, and there’s no capacity there?”

With virtually zero spare bed capacity, Fisman, of the U of Toronto, said planners should prepare now for makeshift hospitals. There should be designated hospitals for coronavirus patients and registries of healthcare workers who have had the virus and recovered who can now work safely with patients.

Studies suggest 80 per cent of cases in China are mild. Those who die take 25 days to die on a ventilator. Those who survive are off ventilators after two weeks, but then spend another two weeks hospitalized.

— With files from the Canadian Press