I can’t remember the exact date, but it would have been two, maybe three years ago. I was hosting a radio show in Toronto at the time, and one of the city’s daily papers had written an article about chronic hospital overcrowding. It wasn’t the first such article; in fact, there had been many. But, for whatever reason, it was the one that made it “click” for me. “We have no capacity for a mass-casualty event,” I commented to a colleague at the time. Ontario’s hospitals are so overcrowded on a routine basis that virtually all capacity is needed just to sustain normal daily operations. There is almost no slack in the system to handle the unexpected.
That article, and that realization, was the start of my fascination with the state of our hospitals. At the time, the fascination was entirely in the abstract. About a year later, I found myself caught up in the dysfunction myself after my young son suffered a mild injury, and we couldn’t access care at an overwhelmed hospital emergency room. That led to a series of articles here at TVO.org exploring the state of our health-care system — particularly, our ERs. Those articles led to an examination of our backlogged long-term-care facilities and then to a close look at mental-health care in Ontario. These articles, taken together, paint a picture of a system that’s at full capacity at all times.
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Let’s pivot to another look back through old articles. (In this case, not so old, but still.) On January 4, 2020, exactly two months ago today, Stat News, a health-care-focused news website, published an article. Citing local Chinese government reports, Stat News reported that dozens of cases of an unusual pneumonia were being observed in the Chinese city of Wuhan. “Eleven of the 44 were seriously ill, the Wuhan Municipal Health Commission said, though there were no reported deaths to date,” Stat News reported.
It’s tempting to say that the rest is history. But it’s not, at least not quite yet. The “Wuhan virus” — now dubbed COVID-19 — isn’t history, but rather a current event. At time of writing, Iran, Italy, and South Korea are the new centres of infection. China seems to be bringing the epidemic under control, but only by effectively keeping 750 million people at home, at massive economic cost — something that could not be easily replicated in the West. Japan is considering postponing the 2020 Summer Olympics. Saudi Arabia has suspended religious pilgrimages. The United Kingdom is considering recalling retired doctors back to work. And Seattle is grappling with an outbreak at a nursing home.
This has moved incredibly fast. A virus that no one knew with certainty existed two months ago is now so imminent a threat that central bankers in the U.S. and Canada have slashed interest rates to prop up the economy. Toilet paper has sold out in Australia as shoppers stock up in fear of quarantines being imposed. And the Chinese economy has ground to a halt, disrupting supply chains globally. Did anyone have this on their 2020 bingo cards when the year began barely eight weeks ago?
One of the meta-risks facing Western societies today is that our governments need months, years, or even decades to bring plans to fruition, but we live in a world where the news can change in weeks (or days). The Doug Ford-led Progressive Conservative government actually has a sensible, realistic plan to ease overcrowding in our primary-care hospitals. By adding 15,000 beds to the long-term-care system, patients who are ready to be discharged from a primary-care hospital could be cleared out more efficiently. This would allow the hospitals to operate more effectively.
It’s a good plan. It is practical and achievable. But it’s not enough, not nearly enough, and even getting that first phase complete is going to take years — five years from 2018, according to the Ford government’s own plan.
And we may need those hospital beds cleared out in weeks, maybe days.
Health-care planning is tricky. Health care is already, by far, the biggest expense for provincial governments. Funding the system in a way that deliberately maintains excess capacity is a hard sell in financially constrained times. And, as a doctor friend of mine recently observed, in any health-care system, demand will increase to meet supply — if a bed is available, a doctor is more likely to put a marginal patient in it, erring on the side of caution, than they are to keep it empty in case of sudden emergency. It’s the old Field of Dreams policy for hospital admissions: if you fund beds, patients will come.
Still, experts knew for years that there was danger in operating the system so close to, or even beyond, maximum capacity. The politicians knew. The public was warned. We didn’t listen. If we escape serious consequences now, it’ll only be thanks to luck. Luck matters. But it’s not something to bank on.