Ontario is an Italy-style COVID-19 disaster waiting to happen

OPINION: Hospitals were already overburdened. Now, intensive-care units are filling up and healthcare workers are burning out — sound familiar?
By Matt Gurney - Published on Dec 17, 2020
As hospitals get saddled with more COVID-19 cases, they have less capacity to deal with everyday emergencies. (Nathan Denette/CP)

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This feels like the latest and saddest instalment in a series of articles tracking how the second wave of COVID-19 became a crisis in Ontario. I wish that we’d been able to stop at two, but, alas: this is the third.

The first was in September, when Ontario was doing much better in this pandemic than it is today. On September 30, a day when the province reported 625 new COVID-19 cases — it’s hard to even remember those days — I wrote here at TVO.org that Ontario had set its red lines for the second wave. “Officials said that they are closely watching hospitalizations and that the health-care system's ICU-bed inventory will be critical,” I wrote then, just two weeks after I’d lamented the lack of any such red lines. “So long as the number of ICU beds required for COVID-19 patients remains below 150, the government has concluded, the health-care system can maintain normal operations … If COVID-19 patients take up more than 350 beds, the province has concluded, maintaining relatively normal health-care operations will become impossible.”

That was the first instalment in this sad series. The next came last month, on November 19, a day when Ontario reported 1,210 new cases of COVID-19. That was the day, as I wrote here, that Ontario hit that first red line — with 150 COVID-19 patients in provincial ICUs. Hitting that first red line was bad enough. What was really grim was that we hit it faster than our modelling had said we would — meaning that things were worse than we’d expected. “This is, to put it mildly, decidedly suboptimal,” I said then. No kidding.

So here we are, almost a full month later. In that time, our daily new cases have more than doubled — Ontario reported a whopping 2,430 cases on Thursday, a single-day record.

But, more importantly during this time, our ICU beds have continued to fill up with COVID-19 patients. In fact, though there is slight disagreement among different sources — exact numbers slightly vary by a handful of patients depending on what source you consult — Ontario has either passed or essentially equalled another bleak ICU-related milestone. As of today, Ontario is either slightly below or just edging past its ICU-occupancy maximum from the first wave. Things are either as bad or marginally worse than they ever were before. The second wave has effectively equalled the first. It’s getting worse, fast.

Fewer people are dying this time, thank God. Improving health-care outcomes among severe COVID-19 cases was observed months ago, all over the world. And this has a simple explanation: we learned a lot of hard lessons during the first wave and are now saving the lives of patients who would have died if they’d been infected eight months ago. This is wonderful but expected: as we gain experience with COVID-19, our health-care providers have gotten better at fighting it.

That’s great news, but it doesn’t solve our problem. The challenge before us all remains as it ever was: our hospitals are constantly overburdened even without COVID-19, and there’s only so many tests and procedures we can delay without costing lives (or destroying quality of life). As COVID-19’s burden on the system rises, our ability to respond to anything else is going to shrink. And our staff, without which the system cannot function, are going to burn out and become less effective. We are working these poor people beyond 100 per cent. That’s not sustainable for long.

This is how you end up with an Italy-style disaster. Our system has almost no flexibility built into it, and as COVID-19 eats up more and more of our capacity, we’ll have less left over to deal with all the real-but-routine crises that crop up every day. People are going to have heart attacks. Babies are going to be born and need extra help. Cancers are going to be diagnosed, and car crashes are still going to happen. Just the other day, I almost slipped on a patch of ice, and the first thing that occurred to me when I got my feet under me was that I was damn lucky. This was a particularly bad time to bust a bone or crack my head open.

And here’s the really astonishing thing: things are still getting worse. Much worse. Remember: between the second and third instalments of this grim series, over the period from November 19 to December 17, Ontario’s daily case count literally doubled — 1,210 then, compared to 2,430 today. And it’ll likely keep going up over the holidays, too. If anything, it’ll get worse.

Hospital admissions lag infections by two to three weeks. So even if things improved today, our hospitals would still be filling up right through to the start of the new year. Since things are likely going to get worse over the next few weeks, not better, we are staring at a really ugly start of 2021. We could easily break through the 350-ICU-patient red line in a week or two, and then keep right on going for a month or more. And if our hospitals become overloaded, all the gains we’ve made in treating COVID-19 patients — thus resulting in a lower death rate — could be lost.

Because it doesn’t matter if your nurse knows a lot more about how to care for you if she’s too busy caring for five other patients to put her knowledge to work on saving your life. This might be the story of the second wave. And the vaccines are still, for most of us, many, many months away.

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