As 2020 continues its sustained effort to grind all our hopes and dreams into dust, there actually might be a small glimmer of good news in the province of Ontario. It’s limited. It’s provisional. And it has tremendous downside risk. But given all that is going on during this horrible fight against COVID-19, I felt moved to bring you what good news there is.
So here goes: our stockpiles of personal protective equipment seem to be doing much better this time around.
I would like to ask the readers to join me in crossing ourselves or firing off a prayer or knocking wood or rubbing a rabbit's foot. Or all of the above. I really hope I didn’t just jinx us. But after all the struggles to properly equip our front-line health-care workers during the first wave, all the drama around PPE being stopped at the border and global bidding wars over what supplies there were, it does appear that our efforts in this one area have left us better equipped for what's coming our way — indeed, what's already arrived.
On Tuesday morning, I was interviewing Brett Belchtz, an emergency-room physician in the Toronto area. The doctor, a guest on the radio show I host every weekday morning on SiriusXM's channel 167, was giving me what I have to confess was overall terrible news. The situation is bleak. Some of our hospitals are already feeling the strain of the second wave, the doctor said: COVID-19 patients are filling hospital hallways — not great when dealing with an infectious virus — and some staff are already approaching physical and emotional burnout.
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And it's going to get worse. It takes a week or two for a COVID-19 patient to become seriously ill after infection, the doctor reminded me. It often takes another week for them to get to the point where they require urgent medical care. This means, Belchetz told me, that the lag from infection to placement in an intensive-care unit is about three weeks.
"Typically, what we see is that the cases we're seeing today, that are just being diagnosed, were exposed [to the virus] one to two weeks ago," he said. "The people who are very sick today were typically diagnosed about a week ago. So what we're seeing on any given day is fairly representative of what caseloads in the community were about three weeks in the past." As observed caseloads today are much higher than they were three weeks ago, the doctor said, "We can expect our hospitals three weeks from now to be two or three times worse than what they are right now."
All these figures are approximate, of course. The numbers look very different depending on what particular days you look at, and every patient is different. But, as a general planning concept, it’s a two- or three-week lag from infection to acute medical crisis, and our seven-day average of new daily cases is almost double what it was three weeks ago.
This is bad. Our hospitals are already experiencing a major surge in patients. We are rapidly approaching the lower threshold for an overwhelmed system, as identified by our public-health officials several weeks ago: 150 COVID patients in ICU is the first red line, and we're now up to 127; a week ago, it was 82. This is just math now: with case counts much higher today, two or three weeks from now, our hospitals are going to be even more strained.
Unless we flatten the curve, by the end of this year, we could be facing a genuine disaster in Ontario of the sort we've seen elsewhere in the world. Indeed, it might already be too late to avoid.
Like I said, it’s mostly bad news. But when I asked Belchetz about PPE, he offered up the only good news he had. "We're in a much better position. Those critical shortages — we're not seeing them right now. That might change. But a huge portion of industry turned to making PPE, and that's making a big difference." This is in line with what I've heard anecdotally from other sources: while every front-line medical worker would like more PPE, there's enough. For now. And enough will do. It certainly marks an improvement over the first wave.
I'd much rather we be over COVID-19 entirely, but this is at least encouraging. If we can't be at peace, at least we can secure the needed weapons and ammunition to wage the fight. In a pandemic, the "beans and bullets" we depend on are gloves, gowns, and N95 respirators.
The government, which had made securing more PPE a major part of its fall preparedness plan, says it has spent more than a billion dollars to date to secure a more robust supply. "This investment has purchased nearly 300 million masks, 900 million gloves, 50 million gowns and over 6 million face shields," a Ministry of Health spokesperson told TVO.org.
That includes importing more, but also supporting more domestic manufacturing. The government reports, for example, that 3M will be producing N95 masks by the millions at its Brockville facility; initial deliveries are set to start in early 2021, as part of a deal signed with the federal government. That's reassuring, in the sense that it will at least prevent the kind of free-for-all on the global market that marked the chaotic first wave and drove up prices for everyone.
The government also tried to establish a more robust stockpile of PPE at the province's long-term-care and nursing homes, which were scenes of such horror in the winter and fall. (In a statement to TVO.org, the Ontario Nurses Association confirmed that supplies of N95 respirators have arrived at the homes but have not yet been fit-tested at all homes — this is essential to ensure they function. It also noted that, while putting staff in PPE is obviously important, in older homes with poor ventilation, the residents themselves remain at risk.)
I’ll stress again that this good news is modest and provisional. If the second wave is as bad as feared, we may again find our system overwhelmed with cases and short on supplies. But, for now, there is at least some cause for optimism — if nothing else, the supplies of PPE are in better shape than they were the first time. It's a low bar, I grant, which is especially galling considering how much boasting there had been pre-pandemic about how Ontario's experience with SARS had left us well prepared to deal with whatever came next, which turned out to be ... SARS-2.
But even the low bars have proved a challenge this year. So it's good to note that, thus far, we've cleared this one. I'll keep my fingers crossed that I don't come to rue this column a month down the line.