Transcript: A Health Care System Besieged by COVID? | Jan 12, 2021


Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and brown tie.

A caption on screen reads "A health-care system besieged by COVID? @spaikin, @theagenda."

Steve says AS CONCERN MOUNTS THAT COVID-19 COULD OVERWHELM INTENSIVE CARE CAPACITY IN ONTARIO'S HOSPITALS, IT'S ONLY THE LATEST WAY IN WHICH THIS PANDEMIC HAS DOMINATED THE DELIVERY OF HEALTH CARE. THINK OF ALL THE TESTS, TREATMENTS, AND DIAGNOSES THAT HAVE NOT HAPPENED DUE TO THIS EMERGENCY. WITH US NOW TO ASSESS THAT PART OF THIS CRISIS, AND AS IS OUR CUSTOM, WE'LL INTRODUCE OUR GUESTS FROM FURTHEST AWAY TO CLOSEST TO OUR STUDIO, STARTING: IN KINGSTON, ONTARIO: DR. CHRIS SIMPSON, INCOMING EXECUTIVE VICE-PRESIDENT FOR MEDICAL AT ONTARIO HEALTH...

Chris is in his late forties, clean-shaven. He's wearing blue scrubs and a medical cap.

Steve continues IN BURLINGTON, ONTARIO: DR. JENNIFER KWAN, A FAMILY PHYSICIAN WHO DOES A LOT OF ADVOCACY ONLINE AROUND COVID EDUCATION...

Jennifer is in her thirties, with long straight brown hair. She's wearing a white shirt.

Steve continues IN BRAMPTON, ONTARIO: DR. NAVEED MOHAMMAD, PRESIDENT AND CEO OF THE WILLIAM OSLER HEALTH SYSTEM...

Naveed is in his fifties, clean-shaven, with short black hair. He's wearing a blue suit, white shirt and blue tie.

Steve continues AND DOWNTOWN IN THE PROVINCIAL CAPITAL THERE'S: DR. MICHAEL SCHULL, THE CEO OF I.C.E.S., IT USED TO BE KNOWN AS THE INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES; HE'S A STAFF EMERGENCY PHYSICIAN AT THE SUNNYBROOK HEALTH SCIENCES CENTRE.

Michael is in his late fifties, clean-shaven, with short wavy gray hair. He's wearing glasses and a black zip-up sweater.

Steve continues WE'RE DELIGHTED TO WELCOME ALL FOUR OF YOU ONTO OUR PROGRAM TONIGHT FOR, WELL, LET'S JUST CALL IT A VERY IMPORTANT AND TIMELY CONVERSATION ABOUT ALL THE THINGS THAT ARE NOT HAPPENING WHILE WE'RE SO DEEPLY FOCUSED ON COVID-19. I WOULD LIKE TO JUST GET EACH OF YOU TO WEIGH IN FROM AROUND OUR METAPHORICAL TABLE HERE ON, FROM WHERE YOU SIT, YOUR PARTICULAR PART OF THE HEALTH CARE SYSTEM, WHAT CONCERNS YOU THE MOST ABOUT PATIENT CARE WHILE THIS PANDEMIC INTENSIFIES? DR. SIMPSON, START US OFF.

The caption changes to "Chris Simpson. Ontario Health."
Then, it changes again to "Hospitals. Code Blue."

Chris says WELL, I THINK THE THING THAT IS MOST CONCERNING AT THE MOMENT, STEVE, IS THE EXTREME ASYMMETRY IN THE WAY THAT COVID IS IMPACTING DIFFERENT COMMUNITIES IN ONTARIO. SO WE SEE MANY HOSPITALS IN THE GREATER TORONTO AREA AND SOME OTHER HOT SPOTS LIKE WINDSOR, FOR EXAMPLE, WHERE HOSPITALS ARE STARTING TO SEE SIGNIFICANT RAMP-DOWNS IN SCHEDULED SURGICAL AND PROCEDURAL ACTIVITY, AND THEIR HOSPITALS ARE REALLY FILLING UP. WHERE THERE IS APPARENTLY SOME CAPACITY IN OTHER AREAS OF ONTARIO. SO THAT CREATES SOME INEQUITIES I THINK THAT ARE PROBLEMATIC.

Steve says DR. KWAN, HOW ABOUT YOU?

The caption changes to "Jennifer Kwan. Family Physician."

Jennifer says WELL, AS A FAMILY PHYSICIAN, I'M GETTING WORRIED ABOUT MY PATIENTS' TESTS AND PROCEDURES AND SURGERIES THAT MAY BE POTENTIALLY IMPACTED BY THE WAY THE HEALTH CARE SYSTEM IS BEING OVERWHELMED WITH COVID-19 PATIENTS, AND I WANT TO MAKE SURE THAT PEOPLE ARE STILL GETTING THE APPROPRIATE MEDICAL CARE, INCLUDING GOING TO THE EMERGENCY ROOM WHEN THEY ARE HAVING A MEDICAL EMERGENCY.

Steve says DR. MOHAMMAD?

The caption changes to "Naveed Mohammad. William Osler Health System."

Naveed says I AGREE WITH DR. SIMPSON'S ASYMMETRY. THE ISSUE RIGHT NOW IS THE LACK OF CARE OUR PATIENTS ARE GETTING IN EVERY COMMUNITY. I KNOW THAT DR. KWAN IS WORKING HARD IN HER PRACTICE, BUT A NUMBER OF FAMILY DOCTORS ARE NOT SEEING PATIENTS IN PERSON. ONLY SEEING THEM REMOTELY. AND SOME FAMILY DOCTORS WHO ARE OLDER, DUE TO THE FEAR OF COVID, HAVE ACTUALLY SHUT DOWN THEIR PRACTICES TEMPORARILY. AND WHAT WE'RE SEEING IS THAT THE SCREENING FOR THINGS LIKE BREAST CANCERS, COLON CANCERS HAVE INCREASED SIGNIFICANTLY. THAT PEOPLE SHOWING UP IN OUR EMERGENCY DEPARTMENTS ARE SICKER AND THE CANCERS WE ARE DIAGNOSING ARE AT A MUCH MORE ADVANCED STAGE. SO NOT ONLY IS THERE ASYMMETRY REGIONALLY, IT'S ALSO IN THE TYPE OF PRACTICE AND WHAT RESOURCES YOU HAVE TO PROTECT YOURSELF.

Steve says DOCTOR SCHULL, HOW ABOUT YOUR EXPERIENCE AT SUNNYBROOK?

The caption changes to "Michael Schull. ICES."

Michael says WE HAVE VERY SIMILAR EXPERIENCES. IN ADDITION TO A GEOGRAPHIC INEQUITY OF COVID, THERE IS ALSO A SOCIAL INEQUITY OF COVID. WE'RE SEEING PARTICULAR COMMUNITIES IN ONTARIO THAT ARE BEING MUCH MORE HEAVILY AFFECTED BY COVID CASES AND ADVERSE OUTCOMES AND DEATHS AND THESE WOULD INCLUDE RACIALIZED COMMUNITIES, COMMUNITIES WITH MULTI WITH HOUSING ENVIRONMENTS THAT ARE MUCH MORE LIKELY TO HAVE MULTIGENERATIONAL FAMILY ARRANGEMENTS, LIVING TOGETHER, AND OF COURSE WORKERS WHO CAN'T WORK FROM HOME, WHO HAVE TO GO IN TO WORK, AND THAT INCLUDES A LOT OF HEALTH CARE WORKERS WHO ARE BEING ADVERSELY AFFECTED.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Steve says DR. SIMPSON, LET'S JUST DO A LITTLE MATH HERE. WE ARE TOLD THAT 400 INTENSIVE CARE UNIT BEDS ARE CURRENTLY IN USE ACROSS THE PROVINCE OF ONTARIO. I THINK WE NEED TO KNOW, HOW MANY DO WE ACTUALLY HAVE AND HOW MANY DO YOU THINK WE'RE ACTUALLY GOING TO NEED?

The caption changes to "Chris Simpson, @Dr_ChrisSimpson."

Chris says WELL, YES. THE NUMBER OF ICU PATIENTS HAVING COVID HAS GONE OVER 400. WE'RE ABLE TO MODEL OUT WHERE IT'S LIKELY TO GO WITH A FAIR DEGREE OF CERTAINTY BECAUSE, OF COURSE, ICU ADMISSIONS AND HOSPITALIZATIONS ARE DOWNSTREAM INDICATORS AND ARE A DIRECT CONSEQUENCE OF THE NEW CASES OF COVID THAT ARE DIAGNOSED. SO, IN A SENSE, WHAT'S HAPPENING NOW IN TERMS OF THE NEWLY DIAGNOSED CASES CAN REALLY ACCURATELY PREDICT FOR US WHAT THE NEXT FEW WEEKS ARE GOING TO LOOK LIKE. SO SOME OF THE MODELLING SUGGESTS THAT WE'LL BE ABOVE 500 BY JANUARY 24TH, WHICH IS NOT VERY FAR AWAY, AND THE NUMBERS, IF NOTHING CHANGES, ARE LIKELY TO GO TO ABOUT 800 BY MID TO LATE FEBRUARY. SO WE HAVE ABOUT 2100 ICU BEDS IN THE PROVINCE. THE ICU FOLKS WILL TELL YOU THAT ABOUT 75 percent OF THOSE BEDS ARE TAKEN UP BY PEOPLE WHO JUST HAVE TO BE IN THERE. IT'S UNAVOIDABLE. SO THE COVID CASES ARE COMPETING FOR, IF YOU WILL, FOR ABOUT 25 percent OF THE TOTAL CAPACITY AND WE'RE AT THAT POINT ALREADY.

Steve says SO DR. SCHULL, LET'S JUST UNDERSTAND THIS. IF WE HAVE THE CAPACITY OF 2100 AND WE'RE ONLY USING A LITTLE OVER 400 RIGHT NOW BUT WE MIGHT NEED DOUBLE THAT IN A COUPLE OF WEEKS' TIME, FILL IN ALL THE BLANKS FOR US. WHAT DOES THAT PORTEND?

The caption changes to "Michael Schull, @docschull."

Michael says THERE ARE A LOT OF BLANKS AND IT PORTENDS A VERY DIFFICULT SITUATION INSIDE HOSPITALS. I MEAN, I DON'T THINK THERE'S ANY WAY TO SUGARCOAT THIS. WE'RE FACING A POTENTIAL CRISIS WITHIN HOSPITALS IN TERMS OF THE ABILITY TO COPE, NOT JUST WITH COVID-19 CASES, AS HAS BEEN DESCRIBED, BUT ALSO ANYONE ELSE. SO THOSE ICU BEDS THAT ARE OCCUPIED WITH NON-COVID PATIENTS, THESE ARE PATIENTS WHO HAVE HEART ATTACKS, THESE ARE PATIENTS WHO HAVE STROKES, THESE ARE PATIENTS WHO HAVE INFECTIONS THAT ARE UNRELATED TO COVID-19 AND REQUIRE ICU CARE. THOSE THINGS DON'T GO AWAY JUST BECAUSE WE HAVE MORE COVID. AND SO WE'RE GOING TO NEED TO CARE FOR THOSE PATIENTS IN ADDITION TO COVID-19. SO, I MEAN, THE BLANKS WILL NEED TO BE DISPLACEMENT OF OTHER TYPES OF CARE. SO MEANING RAMPING DOWN ANY KINDS OF PROCEDURES OR SURGERIES FOR ADVANCED CANCERS AND SO ON OF PATIENTS WHO COULD END UP NEEDING ICU CARE. IT PROBABLY MEANS INCREASING CAPACITY SIGNIFICANTLY. WE'VE SEEN, YOU KNOW, FIELD HOSPITALS ESSENTIALLY BEING BUILT AND I KNOW THERE'S TALK OF MORE. IT MEANS LOOKING EVERYWHERE WITHIN HOSPITALS, INCLUDING EMERGENCY DEPARTMENTS, TO BECOME SORT OF PSEUDO ICU BEDS. AND THIS IS NOT... THIS IS FAR FROM IDEAL, AND IT MEANS THAT REALLY ANYBODY IN ONTARIO IS AT RISK HERE BECAUSE YOU DON'T HAVE TO GET COVID-19 TO BE AFFECTED. IF YOU ARE IN A CAR ACCIDENT, IF YOU HAVE A HEART ATTACK, IF YOUR LOVED ONE SUFFERS FROM A SEVERE INFECTION AND REQUIRES HOSPITALIZATION, ANYONE AT A RISK OF THAT, WHICH ESSENTIALLY IS EVERYONE, IS AT RISK HERE.

Steve says LET'S DO A SPECIFIC EXAMPLE THEN. DR. MOHAMMAD, I'LL BRING YOU IN FOR THIS. YOUR CATCHMENT AREA, IN OTHER WORDS THE AREA THAT YOU'RE BASICALLY RESPONSIBLE FOR, GIVE US THE SENSE OF THE BOUNDARIES. WHAT ARE YOU RESPONSIBLE FOR?

Naveed says WE'RE RESPONSIBLE FOR BRAMPTON AND NORTH ETOBICOKE AND SOME OF THE CALEDON AREA AND SOME OF THE NORTH MISSISSAUGA AREA, AND THIS IS TRADITIONALLY WHERE MOST OF OUR PATIENTS COME FROM.

Steve says OKAY. THAT'S A BIG AREA AND IT ALSO HAPPENS TO BE AN AREA WHERE THERE HAS BEEN A RATHER TERRIFIC... AND I DON'T MEAN THAT IN A GOOD WAY, I MEAN THAT IN A BIG WAY... SERIOUS CONCENTRATION OF COVID-19 CASES. I WONDER HOW MANY PEOPLE... DO YOU KNOW HOW MANY PEOPLE HAVE COVID-19 IN YOUR CATCHMENT AREA RIGHT NOW?

The caption changes to "Naveed Mohammad, @DrMohammadOsler."

Naveed says I DON'T KNOW THE EXACT NUMBER FOR THE CATCHMENT AREA BUT I CAN GIVE YOU A SENSE. WHEN PEOPLE ARE COMING TO OUR ASSESSMENT CENTRES, WHICH IS WHERE PEOPLE ARE ARRIVING WITHOUT SYMPTOMS JUST TO GET SWABBED BECAUSE THEY MAY HAVE BEEN EXPOSED OR A FAMILY MEMBER MAY HAVE BEEN EXPOSED, THE POSITIVITY RATE RIGHT NOW IS CLOSE TO 25 percent, WHICH MEANS THAT EVERY 100 PEOPLE THAT ARE WALKING IN TO GET THEIR NOSE SWAB, 25 ARE POSITIVE. AND WHEN WE GO TO OUR COLD AND FLU CLINIC WHICH WE CONVERTED OUR ER AT PEEL MEMORIAL INTO, THE POSITIVITY RATE IS 41 percent. THESE ARE HUGE NUMBERS. OUR HOSPITAL RIGHT NOW HAS CLOSE TO 170 COVID PATIENTS, 20 IN OUR ICU, AND WITHOUT THE HELP OF THE INCIDENT MANAGEMENT SYSTEM WHICH IS BALANCING OUT ALL THE PATIENTS ACROSS THE GTA, WITHOUT THAT, WE WOULD BE IN A VERY DIFFICULT SITUATION RIGHT NOW. AND I'M REALLY AFRAID OF WHAT WILL HAPPEN OVER THE NEXT FOUR TO SIX WEEKS UNLESS THINGS CHANGE.

Steve says WELL, JUST BEFORE I ASK YOU A FOLLOW-UP QUESTION, LET'S PUT THIS IN PERSPECTIVE. A 25 percent POSITIVITY RATE IN YOUR AREA COMPARES TO ABOUT A... I THINK I SAW THE NUMBER YESTERDAY AT 5 percent FOR THE PROVINCE AS A WHOLE. SO THAT IS SIGNIFICANTLY HIGHER THAN THE REST OF THE PROVINCE. ARE YOU ACTUALLY ABLE TO TAKE CARE OF ALL OF THE PEOPLE WHO WILL REQUIRE HELP; IN OTHER WORDS, DO YOU HAVE THE ICU CAPACITY AT YOUR FACILITIES IN ORDER TO MEET THIS CHALLENGE?

Naveed says I JUST WANT TO CLARIFY THE PRIOR ANSWER TO THE QUESTION. THE 25 percent IS IN OUR ASSESSMENT CENTRE. IN OUR REGION, THE POSITIVITY RATE IS STILL AT 13 percent, WHICH IS STILL MORE THAN TWICE AT WHAT IS IN THE PROVINCE. SO WE HAVE THE CAPACITY TO CARE FOR THESE PATIENTS IN OUR ICUs AND OUR HOSPITAL... NO, WE DON'T. WE HAVE BEEN A REGION THAT HAS BEEN HARD HIT EVEN DURING THE SIMPLE FLU SEASON IN PREVIOUS YEARS. WITHOUT CREATING, AS DR. SCHULL STATED, EITHER ICU-TYPE LOCATIONS, SUCH AS THE OLD EMERGENCY DEPARTMENT IN OUR ETOBICOKE HOSPITAL, CONVERTING SOME OF OUR OTHER AREAS IN THE HOSPITAL INTO ICU AREAS, OR EVEN RENTING OUT SOME SPACE OUTSIDE OF THE HOSPITAL TO TREAT THE NOT-SO-SICK, SO SOMEBODY WHO DOESN'T NEED AN ICU BED, WITHOUT DOING THAT, WE WILL NOT BE ABLE TO MANAGE. WE WILL NEED HELP FROM OTHER ORGANIZATIONS ACROSS THE GTA AND ACROSS ONTARIO, AND THEY HAVE BEEN HELPING US CONSISTENTLY OVER THE LAST FOUR WEEKS, AND THAT'S HOW WE'VE BEEN KEEPING OUR HEAD ABOVE WATER.

Steve says GOTCHA. OKAY. DR. KWAN, LET ME BRING YOU IN AT THIS POINT HERE AGAIN. YOU WORK OUT OF A FAMILY PRACTICE, BUT I GATHER THAT YOU HAVE VOLUNTEERED TO WORK AT ONE OF THE HOSPITALS IN BURLINGTON. GIVE US SOME SENSE ABOUT WHAT YOU'RE UP TO THESE DAYS.

An aerial picture shows a large, long tent. Another picture shows the inside of the tent, with two long rows of beds in numbered boxes.

Jennifer says SO THE HOSPITAL IN BURLINGTON HAS SET UP A PANDEMIC RESPONSE UNIT, WHICH IS A TENT-LIKE STRUCTURE OUTSIDE OF THE HOSPITAL. SO IT'S MEANT FOR HOSPITALIZED COVID-19 PATIENTS WHO DO NOT NEED CRITICAL CARE IN THE ICU BUT STILL NEED TO BE MANAGED IN THE HOSPITAL WITH OXYGEN, NURSING CARE, THINGS LIKE THAT. SO IT IS VERY FUTURISTIC STRUCTURE WITH MANY BEDS INSIDE AND ROWS WITH PARTITIONS BETWEEN THEM. IT'S VERY CLEAN. THE COMPUTER STATIONS HAVE KEYBOARDS THAT ARE EASILY WIPED DOWN. LIKE, IT'S ALL FLAT. SO I THINK IT WAS BUILT WITH A LOT OF CONCERN FOR INFECTION CONTROL, ESPECIALLY IF ALL THE PATIENTS INSIDE WILL BE COVID-19 PATIENTS. SO I'M STILL WAITING TO HEAR BACK BUT I'M ON THE LIST TO WORK THERE SOON.

Steve says AND DR. KWAN, HOW CLOSE TO CAPACITY IS THAT FACILITY? CAN YOU TELL WHEN YOU'RE IN THERE HOW CLOSE TO CAPACITY THEY ARE?

Jennifer says SO I WAS IN THERE A FEW MONTHS AGO FOR ORIENTATION. AT THAT TIME, THERE WERE NO PATIENTS INSIDE. BUT I BELIEVE THAT IT HAS BEEN OPENED WITHIN THE LAST WEEK AND PATIENTS HAVE STARTED TO BE BROUGHT IN.

Steve says AND IF IT ENDS UP BEING THE CASE WHERE THEY GET FULL BECAUSE MAYBE THE EXPERIENCE IN HALTON REGION IS GOING TO BE, YOU KNOW, PICKING UP IN NUMBERS, AS IT IS ALL OVER THE PROVINCE, WHAT DO YOU DO? WHAT DO YOU DO WHEN YOU HIT CAPACITY?

Jennifer says WELL, I BELIEVE THE STRUCTURE IS ALSO MEANT TO HELP WITH OVERFLOW OF CAPACITY FROM OTHER REGIONS, SUCH AS HAMILTON, BECAUSE NOT EVERY HOSPITAL HAS THIS KIND OF PANDEMIC RESPONSE UNIT. SO HOPEFULLY WE WILL BE ABLE TO HELP MANAGE THAT FROM OTHER REGIONS. BUT I'M NOT QUITE SURE WHAT WILL HAPPEN IF THIS GETS FULL AS WELL.

Steve says ALL RIGHT. LET ME READ THIS FROM THE LOS ANGELES TIMES FROM JUST A FEW DAYS AGO AND THIS WILL GIVE US ALL AN IDEA ABOUT WHAT OTHER JURISDICTIONS ON THIS CONTINENT ARE DEALING WITH...

A quote appears on screen, under the title "Rationing care." The quote reads "Stretched to the breaking point by a deluge of COVID-19 patients, Los Angeles County's four public hospitals are preparing to take the extraordinary step of rationing care, with a team of 'triage officers' set to decide which patients can benefit from continued treatment and which are beyond saving and should be allowed to die. The county's top health officials have not yet declared a shift to a crisis level of care, but the leader of the public hospitals acknowledged in a letter reviewed by The Times this week that 'there will likely come a point when we simply don't have sufficient staffing or critical supplies to care for all our patients in the way we normally would.'"
Quoted from James Rainey, Soumya Karlamangla, Jack Dolan, Los Angeles Times. January 6, 2021.

Steve says OKAY. DR. SCHULL, HOW CLOSE ARE WE TO THAT IN ONTARIO?

The caption changes to "Michael Schull. Sunnybrook Health Sciences Centre."

Michael says YOU KNOW, IT'S VERY HARD FOR ME TO TELL YOU AT THIS STAGE HOW CLOSE WE ARE TO THAT POINT. I THINK WE STILL ARE A WAYS AWAY AND I THINK IT'S OUR HOPE, EVERYONE'S HOPE, ANY HEALTH CARE WORKER AND ANY ONTARIAN, FRANKLY, THAT WE MAY NOT GET TO THAT POINT. BUT I THINK IT WOULD BE REALLY VERY DANGEROUS TO ASSUME THAT WE WON'T GET TO THAT POINT OR THAT WE COULDN'T GET TO THAT POINT, THAT THERE'S SOMETHING DIFFERENT ABOUT ONTARIO. LOOK, WHAT I THINK IS VERY ENCOURAGING ARE SOME OF THE STEPS THAT, FOR EXAMPLE, ONTARIO HEALTH HAS TAKEN WITH RESPECT TO LOOKING AT ALL HOSPITAL ICU BEDS IN THE PROVINCE AS A SINGLE POOL AND TRANSFERRING PATIENTS, LITERALLY HUNDREDS OF KILOMETRES, SO THEY CAN GET THE CARE THEY NEED. I THINK THAT'S A GOOD STEP. I THINK THAT'S SOMETHING FOR EXAMPLE WASN'T HAPPENING IN THE EARLY DAYS IN NEW YORK CITY WHEN THE HOSPITALS WERE IN SOME CASES COMPETING WITH EACH OTHER, IN A SENSE, OR NOT SHARING RESOURCES. SO THAT'S A GREAT STEP. I THINK THAT'S ONE OF THE STRENGTHS OF OUR HEALTH SYSTEM. BUT THE REALITY IS, THERE IS A LIMITED NUMBER OF ICU BEDS. THERE'S A LIMITED NUMBER OF BEDS THAT WE CAN PRETEND ARE ICU BEDS. IF WE EXCEED THAT NUMBER OF PATIENTS, IF THEY'RE COVID-19 OR AS WE SAID BEFORE, OTHER PATIENTS, WE WILL HAVE TO MAKE VERY DIFFICULT CHOICES ABOUT WHO GETS TO BE IN THOSE BEDS OR BE ON THOSE VENTILATORS AND WHO DOESN'T. SO THIS IS A SITUATION THAT WE ALL WANT TO AVOID, BUT I THINK EVERYONE KNOWS IS A POSSIBILITY HERE IN ONTARIO, JUST AS IT IS IN L.A., JUST AS IT WAS IN NORTHERN ITALY OR NEW YORK CITY A FEW MONTHS AGO.

Steve says IN OTHER WORDS, THERE'S NOTHING SPECIAL ABOUT US THAT SAYS WE'RE GOING TO AVOID ALL THESE OTHER THINGS IF WE CONTINUE TO VIOLATE PROTOCOLS AND BE STUPID; IS THAT WHAT YOU'RE SAYING?

Michael says THERE IS NOTHING SPECIAL ABOUT ONTARIO, THAT IS ABSOLUTELY CORRECT.

Steve says MAYBE I DIDN'T PUT IT SO ELEGANTLY, BUT WE GET THE GIST OF IT. OKAY. LET'S... OKAY. WHAT DO WE WANT TO DO HERE? SHELDON, I WANT TO GO TO THE GRAPH ON PAGE 3 RIGHT NOW, WHICH IS... LET ME TAKE EVERYBODY BACK A FEW MONTHS. THIS WAS THE SURGICAL BACKLOG CREATED BY THE FIRST WAVE OF THE PANDEMIC WHEN WE WERE UNDER THE FIRST STATE OF EMERGENCY, AND LET'S GO BACK. THIS WAS A STUDY PUBLISHED BY THE CANADIAN MEDICAL ASSOCIATION JOURNAL, AND IT FOUND THAT BETWEEN MARCH 15TH... THE THE IDES OF MARCH, HOW APPROPRIATE... AND JUNE 13TH, THIS IS 2020...

A slate appears on screen, with the title "Clearing the surgical backlog."

Steve reads data from the slate and says
A BACKLOG OF NEARLY 150,000 SURGERIES WAS CREATED IN THE PROVINCE OF ONTARIO BY THIS PANDEMIC. AND THE ESTIMATED BACKLOG CLEARANCE TIME IS 84 WEEKS, A YEAR AND A HALF. IF AN ADDITIONAL 717 PATIENTS ARE OPERATED ON WEEKLY WITH AN ADDITIONAL 719 OPERATING ROOM HOURS PER WEEK. SO THAT'S GOING TO TAKE SOME DOING. DR. SIMPSON, LET ME GET YOU BACK IN HERE. WERE HOSPITALS ABLE TO WORK THROUGH THOSE NUMBERS AT THE RATE ONCE OPERATING ROOMS OPENED UP IN JUNE?

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Chris says IT'S A VERY COMPLICATED STORY, STEVE, BUT I THINK YOU'VE GOT THE ESSENCE OF IT. THERE WAS A DIRECTIVE FROM THE CHIEF MEDICAL OFFICER OF HEALTH BACK IN WAVE ONE WHICH DIRECTED THAT ALL SCHEDULED THINGS SHOULD STOP, AND ACROSS THE PROVINCE WE SAW THE RATE OF SURGERIES AND PROCEDURES GO DOWN BY ABOUT 88 percent. SO IT WAS A MASSIVE SHUTDOWN OF SO-CALLED ELECTIVE OR SCHEDULED PROCEDURES. THE RAMP BACK UP WAS QUITE SLOW AS WELL, AND BY THE SUMMER, WE WERE SORT OF ALMOST BACK UP TO OUR USUAL RUN RATE, AND IN A FEW PLACES IN THE PROVINCE AND FOR A FEW PROCEDURES, THEY WERE ABLE TO GET ABOVE 100 percent OF THEIR RUN RATE. BUT THE BACKLOG WAS NOT CLEARED BY ANY STRETCH. THIS TIME, IN WAVE TWO, WHAT WE'VE TRIED TO DO IS REALLY PUT A BOX AROUND THE SO-CALLED TIME-SENSITIVE PROCEDURES, SO CANCER SURGERY IS A GOOD EXAMPLE. SOME VERY AGGRESSIVE CANCERS THAT HAVE TUMOUR DOUBLING TIMES OF FOUR TO SIX WEEKS, YOU KNOW, IT'S VERY INTUITIVE HOW URGENT THESE ARE. AND WE'VE TRIED OUR VERY BEST TO KEEP THOSE GOING. BUT ALREADY IN THE GTA WE'RE SEEING THAT SCHEDULED SURGERIES ARE DOWN IN MOST PLACES BY AT LEAST 50 percent, AND WE'RE REALLY JUST AT THE BEGINNING OF WHAT THE NEXT TWO MONTHS IS GOING TO THROW AT US.

Steve says IN WHICH CASE, DR. KWAN, LET'S GET A REAL-LIFE EXAMPLE HERE. DO YOU HAVE PATIENTS WHO NEED SURGICAL PROCEDURES WHO ARE NOW NOT GETTING THEM BECAUSE OF THE COVID BACKLOG?

Jennifer says FOR EXAMPLE, EVEN FOR NON-CANCER SURGERIES, SAY SOMEONE HAS SEVERE OSTEOARTHRITIS IN THEIR HIP, THAT CAN BE A DEBILITATING CONDITION AFFECTING QUALITY OF LIFE. THEY'RE LIVING IN PAIN EVERY SINGLE DAY. BUT THEY WERE WAITING FOR A SURGERY DATE THAT MAY HAVE BEEN DELAYED IN THE FIRST WAVE. AND IN THE SECOND WAVE, THERE WAS A CONSTANT ANXIETY ABOUT IS THIS GOING TO HAPPEN, IS IT GOING TO GET PUSHED BACK, I'M GOING TO NEED MORE MEDICATION BECAUSE I'M JUST IN SO MUCH PAIN AND I CANNOT WAIT. I DON'T KNOW WHAT MY DATE IS. SO THEY'RE NOT IMMINENTLY DYING FROM CANCER BUT THEY ARE LITERALLY SUFFERING PAIN EVERY SINGLE DAY FROM ARTHRITIS. FORTUNATELY THIS PATIENT I HAVE IN MIND WAS ABLE TO GET THEIR SURGERY, WHICH IS REALLY GREAT. IT'S DIFFERENT IN DIFFERENT REGIONS. UNFORTUNATELY IN SOME AREAS THAT ARE MORE SEVERE, I DO UNDERSTAND THAT PROCEDURES AND SURGERIES HAVE BEEN CANCELLED.

Steve says I GENUINELY DON'T WANT TO BE ALARMIST HERE BUT I DON'T WANT TO SUGARCOAT THIS EITHER. HOW CONCERNED ARE YOU, DR. KWAN, THAT YOU ARE GOING TO HAVE PATIENTS WHO ARE EITHER GOING TO GET VERY MUCH SICKER OR EVEN DIE BECAUSE THEY CAN'T GET TREATMENT BECAUSE THE HEALTH CARE SYSTEM IS SO FOCUSED ON COVID?

Jennifer says WELL, THE HEALTH CARE SYSTEM IS, YOU KNOW, TRIAGING AND MANAGING THOSE THAT ARE EMERGENT OR URGENT CANCER TREATMENTS AND THINGS LIKE THAT, BUT I ALSO WANT PEOPLE TO UNDERSTAND THAT THE HEALTH CARE SYSTEM IS AVAILABLE FOR YOU, SO IF YOU ARE HAVING SYMPTOMS, YOU SHOULD SPEAK TO YOUR DOCTOR. THE VAST MAJORITY OF FAMILY DOCTORS ARE OPEN AND ARE AVAILABLE FOR IN-PERSON VISITS, ESPECIALLY IF YOU DO NEED TO BE SEEN IN PERSON. SO CONTACT THEM AND REACH OUT BECAUSE IF YOU HAVE A CONDITION, YOU SHOULD SPEAK TO YOUR DOCTOR. AND IT'S NOT JUST THE HEALTH CARE SYSTEM DOING THAT. I THINK A LOT OF PEOPLE ARE ANXIOUS ABOUT, YOU KNOW, GOING OUT TO THE DOCTOR'S OFFICE. IS IT SAFE? AND EVEN IF MY OFFICE, I AM SEEING DELAYED PRESENTATIONS OF MEDICAL ISSUES THAT COULD HAVE BEEN ADDRESSED EARLIER AND, YOU KNOW, PREVENTED THE DETERIORATION. SO IT'S SO VERY IMPORTANT TO SEEK MEDICAL CARE.

Steve says DR. MOHAMMAD, I'D LIKE TO PUT YOUR HEALTH SYSTEM UNDER THE MICROSCOPE HERE FOR A SECOND IF WE CAN. JUST SO PEOPLE UNDERSTAND, YOU DON'T ACTUALLY RUN A HOSPITAL, YOU RUN A SYSTEM. SO THE WILLIAM OSLER HEALTH SYSTEM CONSISTS OF WHAT?

Naveed says IT CONSISTS OF A LOCAL GENERAL HOSPITAL, WHICH IS A FULL SERVICE HOSPITAL INCLUDING AN ICU AND EMERGENCY DEPARTMENT. OUR LARGEST SITE, WHICH IS BRAMPTON CIVIC HOSPITAL, AGAIN HAVING ONE OF THE BUSIEST ERs IN THE PROVINCE. WE HAVE THE PEEL CENTRE FOR HEALTH AND WELLNESS WHICH HAS AN URGENT CARE CENTRE WHICH IS CURRENTLY OUR COVID AND FLU CLINIC AND AMBULATORY CARE PROCESS IS GOING ON THERE. WE HAVE A MANAGEMENT CENTRE IN BRAMPTON. WE ALSO HAVE A FLOOR AT THE OLD HUMBER HOSPITAL CALLED THE REACTIVATION CENTRE. SO OUR SURGERIES CURRENTLY ARE DOWN TO 41 percent OF WHAT WE USUALLY DO, AND THOSE 41 percent CONSIST ONLY OF CANCER SURGERIES OR EMERGENCY SURGERIES THAT NEED TO BE DONE RIGHT AWAY.

Steve says OKAY. THAT'S FIVE DIFFERENT LOCATIONS THAT YOU'RE ACTUALLY RESPONSIBLE FOR, ALL TOLD, IN THE WILLIAM OSLER HEALTH SYSTEM. LET'S DO THE FOLLOW-UP QUESTION HERE: HOW MANY EMPLOYEES HAVE YOU GOT THERE IN THE FIVE DIFFERENT LOCATIONS?

Naveed says IF YOU INCLUDE ALL OF OUR EMPLOYEES AND CONTRACTED EMPLOYEES THAT WORK IN OUR ORGANIZATION, WE'RE JUST UNDER 10,000.

Steve says 10,000. ALL RIGHT. I PRESUME THEY'RE GETTING TESTED ALL THE TIME. SO HOW MANY PEOPLE UNDER YOUR PURVIEW HAVE TESTED POSITIVE FOR COVID-19?

Naveed says THE NUMBER OF EMPLOYEES THAT ARE OSLER EMPLOYEES WHO HAVE TESTED POSITIVE ARE NORTH OF 300. CURRENTLY WE HAVE 50 ACTIVE CASES OF COVID-19 IN OUR EMPLOYEES. THE PROBLEM WITH 50 ACTIVE CASES IS THAT EACH OTHER EMPLOYEE THAT WAS EXPOSED TO THOSE 50 CASES ALSO NEEDS TO BE OFF FOR 14 DAYS. SO IF YOU TAKE SEVEN OR EIGHT EMPLOYEES THAT ARE EXPOSED ON A UNIT TO ONE PERSON THAT MAY HAVE TESTED POSITIVE, THAT'S 400 EMPLOYEES RIGHT NOW THAT WE CANNOT ACCESS TO PROVIDE SERVICE.

Steve says SO YOU'VE GOT... YOU KNOW, ON THE ONE HAND IT'S A GOOD NEWS/BAD NEWS THING. BY MY MATH, YOU'VE ONLY HAD A 3 percent POSITIVITY RATE, WHICH IS PRETTY GOOD, IT'S BELOW THE PROVINCIAL AVERAGE, DESPITE THE FACT THAT YOUR FOLKS ARE ON THE FRONT LINES AGAINST THIS THING. ON THE OTHER HAND, YOU'VE GOT A SCHEDULING AND HUMAN RESOURCES NIGHTMARE HAPPENING HERE; IS THAT FAIR TO SAY?

Naveed says WELL, I THINK TO BE CLEAR, YES, WE HAVE VERY STRICT SCREENING PROCESSES. WE HAVE VERY STRICT PERSONAL PROTECTIVE EQUIPMENT AND PERSONAL PROTECTIVE PROCESSES. THE PROBLEM IS THAT NOT EVERYONE THAT SHOWS UP WITH A SYMPTOM OF A COUGH OR A COLD OR A RUNNY NOSE OR A HEADACHE TESTS POSITIVE FOR COVID, BUT THEY ALL HAVE TO BE OFF UNTIL WE CAN CONFIRM THAT THEY'RE NOT POSITIVE FOR COVID. OR NOT EVERYONE THAT HAS BEEN EXPOSED TO SOMEBODY TESTED POSITIVE FOR COVID BUT THEY ALL HAVE TO BE OFF FOR A NUMBER OF DAYS. SO IT HAS CREATED A SIGNIFICANT AMOUNT OF ISSUES FOR STAFFING. AND REMEMBER, WE NEED PEOPLE THAT CAN CARE FOR SICK COVID PATIENTS, WHETHER THEY'RE IN AN ICU UNIT OR A STEP-DOWN UNIT OR IN AN EMERGENCY OR A GENERAL MEDICAL FLOOR. SO SOMEBODY WHO MAY WORK IN AN OUTPATIENT CLINIC NEARING RETIREMENT OR SOMEBODY WORKING DOING DRESSINGS, THEY DON'T QUALIFY FOR THAT. SO IT'S THOSE TYPE OF NURSES AND PHYSICIANS THAT WE NEED ACROSS THE GTA AND ACROSS ONTARIO, AND THAT'S WHERE THE BIGGEST SHORTFALL IS.

Steve says OKAY. I WANT TO TALK ABOUT FEAR A LITTLE BIT HERE. DR. SCHULL, LET ME GET YOU INTO THIS FIRST. THIS IS NO DISRESPECT OBVIOUSLY TO ANY OF THE HEALTH CARE FACILITIES THAT ANY OF YOU WORK IN, BUT THE REALITY IS, ANY SANE PERSON DOES NOT WANT TO BE IN A HOSPITAL IN THIS PROVINCE RIGHT NOW UNLESS THEY HAVE TO BE. I'M TALKING ABOUT AS A PATIENT. I WANT TO KNOW HOW FEARFUL, DR. SCHULL, THE PATIENTS THAT YOU SEE ARE WHEN THEY FIND THEMSELVES INSIDE A HOSPITAL IN AN ERA OF COVID-19?

The caption changes to "Patients taking care."

Michael says WELL, I CAN SPEAK PRIMARILY TO THE EMERGENCY DEPARTMENT, WHICH IS WHERE I WORK. YOU KNOW, ONE OF... IF THERE ARE ANY SILVER LININGS, I THINK WE ALL NEED A LITTLE BIT OF OPTIMISM, IT IS THE WAY IN WHICH OUR PROTOCOLS HAVE CHANGED, THE ORGANIZATION OF THE HOSPITAL AND THE EMERGENCY DEPARTMENTS HAVE CHANGED TO MAKE THEM SAFE. SO IN FACT NOW IF YOU COME INTO THE EMERGENCY DEPARTMENT AND YOU SIT IN THE WAITING ROOM, YOU'RE GOING TO SIT WITH A BARRIER BETWEEN YOU AND EVERY BELIEVES IN THAT WAITING ROOM AND YOU'RE GOING TO BE WEARING MASKS. IF YOU TRANSIT THROUGH OUR EMERGENCY DEPARTMENT AND ARE ENCOUNTERING STAFF AND SO ON, WE ARE EXTREMELY CAUTIOUS ABOUT COVID-19 AND PREVENTING CONTACT BOTH SO THAT THE PATIENT REMAINS SAFE AND THAT HEALTH CARE WORKERS REMAIN SAFE. REMEMBER THAT MANY OF THESE PATIENTS ACTUALLY HAVE COVID. SO, YOU KNOW, FOR THE MOST PART WE HAVE NOT SEEN HUGE OUTBREAKS IN HOSPITALS. THERE HAVE BEEN A FEW LARGER ONES. THERE WAS THE ONE IN LONDON, ONTARIO, WHICH I THINK NOW IS UNDER CONTROL, WHICH WAS VERY CONCERNING. BUT I THINK PATIENTS SHOULD FEEL SAFE. THE HOSPITALS ARE SAFE. AND IF YOU NEED CARE, GO AND GET CARE. AND I THINK THE OTHER THING THAT THEY SHOULD REMEMBER IS THAT THERE ARE OPTIONS. SO, YOU KNOW, AGAIN, NECESSITY IS THE MOTHER OF INVENTION, AND COVID-19 HAS LED TO THE DEVELOPMENT OR THE EXPANSION OF VIRTUAL OPTIONS. SO, YOU KNOW, WE'VE SEEN, CERTAINLY IN THE FIRST WAVE, A MASSIVE INCREASE IN PRIMARY CARE BEING CONDUCTED ONLINE, AS JENNIFER WAS MENTIONING. 56 TIMES MORE VIRTUAL PRIMARY CARE VISITS IN THE FIRST WAVE THAN PREVIOUSLY. WE'VE ALSO SEEN THE DEVELOPMENT FOR THE FIRST TIME THAT I KNOW OF IN CANADA OF VIRTUAL EMERGENCY DEPARTMENTS. SO MY EMERGENCY DEPARTMENT AND SEVERAL OTHERS NOW PROVIDE VIRTUAL EMERGENCY DEPARTMENT VISITS. SO YOU CAN GO ONLINE AND SEE A DOCTOR, AN EMERGENCY DOCTOR, SAME-DAY SCHEDULED VISITS. THE IDEA IS IT BE IF YOU NOT HAVE A PRIMARY CARE DOCTOR OR IT'S A PRIMARY CARE PROBLEM, IF YOU GO TO THE EMERGENCY DEPARTMENT, YOU CAN GET CARE, AND THE DOCTOR MAY SAY, NO, YOU NEED TO GO TO THE EMERG FOR THAT PROBLEM. SO IT IS SAFE TO GO TO THE HOSPITAL, IF YOU NEED TO, NUMBER ONE. AND THERE ARE OPTIONS SO YOU DON'T NEED TO GO. AND I THINK PEOPLE SHOULD BE AVAILING THEMSELVES OF THOSE.

Steve says LET'S FOLLOW UP WITH DR. KWAN ON THAT. WHAT PERCENTAGE OF YOUR PATIENTS ARE YOU TREATING VIRTUALLY AS OPPOSED TO IN PERSON?

Jennifer says I WOULD SAY 50-50. THOSE THAT NEED TO BE SEEN IN PERSON WOULD BE, FOR EXAMPLE, PRENATAL APPOINTMENTS, WELL BABY CHECKS, IMMUNIZATIONS FOR BABIES, SOME PRESENTATIONS SUCH AS ABDOMINAL PAIN. IT'S HARD TO DESCRIBE OVER THE PHONE OR VIRTUALLY. SO OFTEN I WILL NEED TO SEE THOSE PATIENTS IN PERSON. AND VARIOUS INJECTIONS AND PROCEDURES. SO 50-50. THE VIRTUAL OPTION IS ACTUALLY GREAT FOR A LOT OF PATIENTS WHO ARE SCARED TO GO TO THE OFFICE BECAUSE WE CAN AT LEAST DISCUSS OVER THE PHONE WHAT MAY NEED TO BE DONE FIRST. AND A LOT OF ESPECIALLY ELDERLY PATIENTS WHO ARE WORRIED ABOUT CATCHING COVID, THAT CAN BE QUITE REASSURING FOR THEM AND OTHER THINGS SUCH AS SIMPLE MEDICATION RENEWALS.

Steve says IF IT'S 50-50 NOW, WHAT WAS IT BEFORE COVID?

Jennifer says BEFORE COVID WE DIDN'T REALLY HAVE THE VIRTUAL CARE OPTION. I WOULD CALL PATIENTS IF IT WAS SOMETHING SIMPLE BUT THAT WAS NOT SOMETHING THAT WAS COMPENSATED BY OHIP SO IT WASN'T REALLY AN AVAILABLE OPTION FOR MOST PATIENTS. SO THAT HAS BEEN A POSITIVE DEVELOPMENT IN THE WHOLE PANDEMIC, THAT PATIENTS HAVE ACCESS TO VIRTUAL CARE, AND I DO HEAR A LOT OF POSITIVE FEEDBACK FROM PATIENTS SAYING THEY APPRECIATE THE SERVICE.

Steve says DR. SIMPSON, LET ME RETURN BACK TO THAT ISSUE OF HOW CONCERNED, HOW FEARFUL THE PATIENTS THAT YOU DEAL WITH IN KINGSTON ARE WHEN THEY HAVE TO COME TO YOU FOR CARE. WHAT ARE YOU SENSING?

Chris says I'VE HAD THE SAME VIRTUAL CARE EXPERIENCE THAT DR. KWAN DESCRIBED. SO IN MY CLINIC, IT'S ABOUT 50-50. I TRY TO SEE THE NEW PATIENTS IN PERSON AND THE FOLLOW-UPS TEND TO BE VIRTUAL. FOR THE PROCEDURES THAT I DO, LIKE IMPLANTING PACE MAKERS, OBVIOUSLY THAT CAN'T BE DONE VIRTUALLY. EVEN IN KINGSTON WHERE WE'VE BEEN EPIDEMIOLOGICALLY ADVANTAGED, YOU COULD SAY, AND WHERE COVID RATES HAVE NOT BEEN AS HIGH AS ELSEWHERE, THERE STILL IS THAT SAME FEAR. AND WE SAW IN OUR EMERGENCY DEPARTMENT IN WAVE ONE DRAMATIC DECREASES IN THE PEOPLE COMING IN WITH HEART ATTACKS, FOR EXAMPLE. I'M A CARDIOLOGIST. AND IT'S NOT THAT THOSE HEART ATTACKS WEREN'T HAPPENING. THEY WERE HAPPENING AT HOME. AND NOW, AS DR. MOHAMMAD SAID EARLIER, WE'RE SEEING LATER PRESENTATIONS OF DISEASE, MORE ADVANCED CANCER INSTEAD OF COMING IN WITH A HEART ATTACK, PEOPLE ARE NOW COMING IN WITH HEART FAILURE, YOU KNOW, THE CONSEQUENCE, THE DOWNSTREAM CONSEQUENCE OF A HEART ATTACK. SO EVEN IN PLACES WHERE COVID HAS NOT BEEN AS HIGH IN INCIDENCE AND PREVALENCE, THE FEAR IS THE SAME, AND I JUST REALLY WANTED TO ECHO THE MESSAGE. YOU KNOW, I FEEL SAFER SITTING HERE IN MY HOSPITAL OFFICE TODAY THAN I DO AT COSTCO. THE VAST MAJORITY OF TRANSMISSION IS HAPPENING IN THE COMMUNITY, AND WITH THE NOTABLE EXCEPTIONS OF SOME OUTBREAKS IN HOSPITALS, HOSPITALS ARE SAFE AND PATIENTS WHO NEED TO BE HERE SHOULD STILL BE COMING.

Steve says LET ME DO A FOLLOW-UP ON THAT BECAUSE THAT'S A GREAT POINT. WE HAVE HEARD THAT BECAUSE THE PROVINCE HAS IN ITS WISDOM DECIDED TO SHUT DOWN BASICALLY ALL THE SMALL BUSINESSES IN THE PROVINCE, PEOPLE ARE PACKING PLACES LIKE COSTCO AND WAL-MART AND THE OTHER, YOU KNOW, BIG BOX SUPERSTORES. IS THAT A GOOD IDEA, IN YOUR VIEW?

Chris says WELL, I THINK, YOU KNOW, THE WAY THAT I LOOK AT IT IS THAT COVID IS GOING TO SPREAD TO WHATEVER EXTENT PEOPLE ARE IN CONTACT WITH EACH OTHER. IT'S A SIMPLE SORT OF STATISTICAL REALITY OR FACT THAT THE MORE ONE HUMAN IS IN CONTACT WITH OTHER HUMANS, THE MORE COVID WE'RE GOING TO SEE. SO MEASURES THAT ARE TAKEN TO REDUCE THE NUMBER OF PEOPLE IN CONTACT WITH EACH OTHER IS GOING TO BE THE ONLY WAY THAT WE CAN REDUCE COVID NUMBERS GOING FORWARD.

Steve says I GET THAT. BUT BY TELLING PEOPLE THEY CAN'T GO TO SMALL BUSINESS LOCATIONS WHERE THE NUMBERS MIGHT BE SMALLER AND WHERE THE MEASURES TAKEN CAN BE MORE INTENSE TO KEEP PEOPLE APART... IN OTHER WORDS, NO MORE THAN 5 percent TYPICAL CAPACITY IN A SMALL BUSINESS AT ANY ONE TIME... BECAUSE WE'RE NOT DOING THAT, PEOPLE ARE LITERALLY JUST DESCENDING ON THE BIG BOX STORES IN HUGE NUMBERS. THAT'S NOT KEEPING PEOPLE APART. IS THIS POLICY WORKING, I GUESS IS MY QUESTION.

Chris says I GUESS THE NUMBERS WILL ULTIMATELY BE THE JUDGE OF THAT. BUT EXACTLY AS YOU SAY, WELL-INTENDED POLICY THAT THEN RESULTS IN UNINTENDED CONSEQUENCES THAT RESULTS IN MORE PEOPLE BEING IN CONTACT WITH EACH OTHER WILL INVARIABLY LEAD TO HIGHER TRANSMISSION RATES, THERE'S NO DOUBT ABOUT THAT.

Steve says WE'RE DOWN TO OUR LAST FEW MINUTES HERE AND I'D LIKE TO GIVE EACH OF YOU, I DON'T KNOW, 45 SECONDS OR SO, JUST TO GIVE ADVICE TO THE PEOPLE WATCHING THIS RIGHT NOW. YOU HAVE ALL OUTLINED WHAT THE FUTURE LOOKS LIKE IF WE DON'T GET OUR ACT TOGETHER. SO DR. KWAN, GO AHEAD. BE THE DOCTOR AND GIVE US SOME ADVICE RIGHT NOW. WHAT DO WE NEED TO DO IN THE NEXT LITTLE WHILE?

Jennifer says SO I JUST WANT TO REITERATE THAT IF YOU'RE HAVING AN EMERGENCY, YOU SHOULD GO TO THE HOSPITAL. I GET CALLS FROM PATIENTS SAYING, WELL, I HAD SEVERE CRUSHING CHEST PAIN YESTERDAY AND I COULDN'T BREATHE AND I FELT LIKE MY HEART WAS POUNDING OUT OF MY CHEST AND I WAS GOING TO PASS OUT. I THOUGHT I WAS HAVING A HEART ATTACK. THE NEXT DAY YOU COULD BE DEAD SO YOU SHOULD GO TO THE HOSPITAL WHEN YOU THINK YOU'RE HAVING AN EMERGENCY. THE SECOND PART IS THAT I ALSO WANT TO ADVOCATE FOR, YOU KNOW, RAMPING UP OF VACCINATIONS ACROSS THE BOARD IN ONTARIO, ESPECIALLY FOR OUR FRONT LINE WORKERS AND FOR PEOPLE WHO MAY NOT HAVE ACCESS OUTSIDE OF THE HOSPITAL SYSTEM. I'M HEARING A LOT OF PEOPLE, YOU KNOW, EVEN ER DOCTORS WORKING IN RURAL AREAS SAYING THEY DO NOT HAVE ACCESS TO THE VACCINE YET, SO I'M HOPING THAT WILL BE CHANGED IN THE NEXT DAYS, AS SOON AS POSSIBLE, BECAUSE MANY PATIENTS ARE... MANY DOCTORS ARE STILL WORKING WITH COVID-19 PATIENTS AND DO NOT HAVE PROTECTION. SO HOPEFULLY, YOU KNOW, WE WILL SEE THE VACCINATIONS RAMP UP.

Steve says OKAY. I HAVE AN EYE ON THE CLOCK HERE AND WE DON'T HAVE MUCH TIME LEFT. DR. MOHAMMAD, IF I COULD GET YOUR ADVICE AND A LITTLE MORE ECONOMICALLY, IF I CAN SAY THAT?

Naveed says WE'RE NOT GOING TO FIX THIS PROBLEM IN THE HOSPITALS. IN THE HOSPITALS WE'RE ONLY GOING TO DEAL WITH THE RESULTS OF IT. PLEASE STAY HOME. PLEASE FOLLOW DIRECTIONS. PLEASE STAY OUT OF THE STORES UNLESS YOU NEED TO GO. PLEASE DO NOT TRAVEL. AND PLEASE DO NOT GATHER. THANK YOU.

Steve says 30 SECONDS TO DR. SCHULL AND 30 SECONDS TO DR. SIMPSON. GO AHEAD.

Michael says I WOULD COMPLETELY AGREE WITH NAVEED TO NOT TIRE OF THESE RESTRICTIONS. WE ARE ALL TIRED. BUT WE NEED TO FOLLOW THE GUIDANCE OF HEALTH. AND GET VACCINATED AS SOON AS THE VACCINE IS AVAILABLE TO YOU.

Steve says LAST WORD TO ONTARIO HEALTH.

Chris says I WOULD SIMPLY SAY THIS ISN'T JUST ABOUT LOOKING AFTER COVID PATIENTS. IT'S ABOUT PROTECTING OUR HEALTH SYSTEM FOR EVERY ONTARIAN. THIS IS A CHANCE FOR EVERY ONTARIAN TO TAKE AN ACTIVE ROLE, EXERCISE THEIR CIVIC RESPONSIBILITY TO HELP PROTECT OUR HEALTH CARE SYSTEM TO EVERYONE'S BENEFITS.

The caption changes to "Producer: Sandra Gionas, @sandragionas."

Steve says DRS. SIMPSON, KWAN, MOHAMED, AND SCHULL, WE ARE VERY GRATEFUL YOU COULD TAKE TIME OUT FROM THE VERY VALUABLE WORK YOU ARE DOING TO SPEND SOME TIME WITH US ON TVO TONIGHT AND HELP OUT OUR VIEWERS AND LISTENERS AS WELL. TAKE GOOD CARE EVERYBODY AND THANKS SO MUCH.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

All the guests say THANK YOU.

Watch: A Health Care System Besieged by COVID?