As a physician working in Ontario’s overburdened hospitals, I make my morning rounds in some rather unusual places.

Some weeks ago, I diagnosed a woman with terminal cancer in our hospital’s auditorium. Several days later, I received an urgent call informing me that one of my elderly patients had taken a turn for the worse. Soon after I hung up the phone she took her final breaths in our basement gymnasium.

These harrowing moments are, sadly, not rare events in Ontario. Poor planning and underfunding have pushed our acute care hospitals to the brink.

Despite an optimal occupancy rate of 85 per cent, Ontario’s hospitals routinely operate above 100 per cent capacity with rates approaching 120 per cent during the influenza season. According to the Ontario Hospital Association, the province has the lowest number of hospital beds per capita in the developed world.

While torrid population growth will see our cities swell by 5.4 million people over the next 30 years, Ontario’s bed capacity has actually fallen by 36 per cent since 1990 and hospital funding remains the lowest in the country. Because patients are not turned away when beds are full, the end result is an epidemic of hallway medicine.

Every day in our province, patients spend some of the most profound moments of their lives — whether dying of cancer or suffering from critical illness — waiting in hallways. Every day, nurses and doctors are forced to transform auditoriums, corridors and stairwells into places of healing.

Many of us who work on the front lines have long warned that such overcrowding is not just inhumane, but dangerous. As the SARS-CoV2 virus circles the globe, Ontario hospitals are likely to face unprecedented capacity challenges.

The province’s acute care system is already straining to contain “normal” volumes, and the impending pandemic could bring it to the brink of collapse. A 2017 study found that a moderately severe pandemic infecting 30 per cent of the population would increase acute care demand by 20 per cent while doubling the need for ICU beds.

In the absence of makeshift tent hospitals and the cancellation of all non-urgent admissions and surgeries, a coronavirus pandemic risks exhausting our system’s bed capacity within weeks. Overwhelmed emergency departments will struggle to accept new patients as those already admitted spill into hallways, exposing other patients and health care workers to a highly contagious and potentially deadly infection.

Overworked and stricken by illness themselves, doctors and nurses will struggle to provide adequate care. Our ICUs will quickly run out of beds, and we may need to start rationing ventilators. The cost of such a crisis will be measured in lives.

Ontario Health Minister Christine Elliott has responded to the impending crisis by encouraging calm and reassuring the public that the system, having learned from the deadly mistakes of SARS, is “working” as it should.

There is merit in both these strategies. Widespread panic is hardly helpful and the province has indeed made laudable improvements in disease detection and surveillance since the 2003 epidemic. These efforts have thus far prevented a repeat of the SARS crisis, but even the most rigorous public health planning will not save us from what is fundamentally a mathematical problem: too few beds for too many patients.

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As the SARS-Cov2 pandemic intensifies, Ontario’s containment plan will rapidly transition to a mitigation strategy.

The simple and unyielding truth is that we are not ready for the immense strain this transformation will exert on our health care system. For years our hospitals have struggled to deliver care in ordinary times. That hallway medicine has become the status quo tells us all we need to know about our capacity to cope with the extraordinary threat of a coronavirus pandemic.

This honest assessment of the challenges ahead should not be read as an invitation to panic, but as a sobering reminder that our collective failure to build a sustainable health care system has real consequences.

Without implementation of urgent measures, our hospitals, emergency departments and intensive care units are at risk of collapse. Only by acknowledging this frightening future can we begin the important work of tomorrow.