The vast majority of Toronto’s COVID-19 patients are being treated with the best available medicine: the comfort of their own beds.

So far only two of the city’s 11 confirmed cases of the disease caused by the novel coronavirus have been admitted to hospital, according to Toronto Public Health. The rest have all been recovering at home, with daily check-ins from staff.

If a COVID-19 patient doesn’t need to be in hospital for medical reasons, sending that person home is better for their own recovery, says Toronto medical officer of health Dr. Eileen de Villa — but it’s also better for everyone else.

“Hospital resources are finite. There’s only a certain number of beds, and there’s only a certain number of facilities. And we try to make sure that we use those facilities and resources only when they’re needed,” says de Villa.

Hospitals are noisy and busy, and “not the simplest place to recuperate. If really what you need is rest, most people find it more amenable to get rest in their own bed in their own pyjamas.”

But also, strokes, heart attacks, traumatic injuries, high-risk births — “these things don’t stop just because there’s an infectious disease outbreak,” she says. “So the issue is, how do we make sure our acute-care services are available and resourced in order to meet the needs of the population?”

The rapidly expanding global case count of COVID-19 — over 93,000 cases in 76 countries as of Wednesday, including 34 in Canada — tends to overshadow another fact about the disease: a large number of cases are fairly benign.

“There is a growing appreciation that many people with this infection have a very mild course of illness,” says Isaac Bogoch, an infectious disease specialist at Toronto General Hospital and the University of Toronto.

Though a percentage of those infected have died — estimates have ranged from 0.7 per cent to 3.4 per cent — data from China, where the outbreak was first detected, indicates that approximately 80 per cent of cases involve only mild to moderate symptoms.

“People with a mild illness do not need to be in hospital. They can recover in the comfort of their own home. If we have individuals with mild illness in hospital, we’re going to have capacity issues,” says Bogoch.

“If someone is well enough to be cared for at home, they should certainly go home, provided they don’t contribute to the transmission of this infection in the community.”

That critical task is primarily carried out by local public health units. When staff at Toronto hospitals do decide to send a COVID-19 patient home to recover, they co-ordinate with Toronto Public Health, which ultimately manages that case. Nine of the province’s 17 active cases are in Toronto (three, including two in the city, have recovered).

Toronto Public Health’s nurses and public health inspectors — the latter being the same group of people who inspect restaurants for food safety, but in this case typically have specialized communicable disease or infection-prevention training — stay in daily phone contact with confirmed COVID-19 patients, monitoring them for changes in symptoms.

If those symptoms get significantly worse, the patient may end up being admitted to hospital after all — as happened with one of the province’s recent cases, after initially being sent home. One of the city’s first two cases was also briefly hospitalized.

Anyone who has shortness of breath, deteriorating symptoms, or is simply unwell enough to care for themselves would be sent to hospital, says Bogoch. Being dehydrated enough to require intravenous fluids would be a reason to be admitted; as would needing a ventilator to keep breathing, though no Ontario patients have required such extreme measures so far.

If a patient’s symptoms are improving, public health staff help co-ordinate when to start testing for presence of the virus. To be considered “resolved,” or cleared of the disease, a patient has to have two consecutive negative tests at least 24 hours apart.

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Keeping hospitals clear of patients who don’t need to be there has multiple benefits. In Toronto, the SARS outbreak of 2003 was primarily a hospital-acquired infection: according to one study, 71 per cent of the GTA’s confirmed SARS cases during the height of the initial outbreak were health-care related, either staff, patients or visitors.

Infection prevention and control at hospitals has dramatically improved in the 17 years since the SARS crisis, Bogoch says. Hospitals are nevertheless full of people with compromised immune systems or other health conditions that may make catching a novel virus more likely.

Keeping mild COVID-19 cases out of hospital and preventing them from gobbling up precious capacity is important for treating the ongoing acute care needs of the city. But it will also be important if Toronto does experience a big spike in its case count in the future.

For now, all of Ontario’s cases have been travel-related: there is no evidence of community transmission, the term for the phenomenon of people passing the illness on to others who live here. But health officials in the province say we should be preparing for the possibility of community transmission.

“We’re preparing and making sure that we’re ready for whatever comes,” says de Villa.