“Too Early to Lower Guard”: How Canada Avoided an Outbreak of COVID-19 in Hospitals

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Canada has not seen the expected increase in COVID-19 cases in hospitals that many fear will overwhelm the healthcare system and lead to a spike in death, but experts say easing physical distancing at any time could jeopardize this.

There are almost 30,000 suspected and confirmed cases in Canada, but chief public health officer Theresa Tam said on Wednesday “cautiously optimistic,” the rate of new cases has gone from about double every three days to every 10 days.

“We did really well. If you compare yourself to the situation in Italy and New York City – we’re not there, “said Dr. Michael Gardam, infectious disease specialist and chief of staff at Humber River Hospital in Toronto.

“And with each passing day, it is less and less likely that we will get there. “

But as Canada crosses the dark milestone of 1,000 COVID-19 deaths, Tuesday being the deadliest day to date with 147 recorded deaths, hospitals and critical care units have so far managed to manage the situation.

“We have seen a slow and steady increase in hospital admissions and a very slow and steady increase in ICU admissions,” said Gardam, a SARS and H1N1 veteran who has followed this epidemic closely.

“So all of this suggests that we’ve definitely flattened the curve and we’re at a point where, probably next week, we’ll see these numbers start to drop. “

How did Canada avoid a push?

Almost half of the deaths from COVID-19 in Canada have occurred in nursing homes and retirement homes, Tam said earlier this week, which means the situation is likely to worsen as many these patients die before going to the hospital.

“Even if the number of cases slows, the number of deaths will unfortunately increase,” Tam said at a press conference in Ottawa on Monday.

Canadian hospitals have taken an “all on deck” approach to ensure they will be able to care for a wave of patients, said Dr. Isaac Bogoch, a doctor specializing in infectious diseases at the Toronto General Hospital.

This included stopping elective surgeries and other procedures, increasing the capacity of laboratories for testing, reassigning staff to the front lines and expanding critical care beds.

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“Fortunately, to date, we have not really demanded as much of this peak capacity,” he said. “But of course we know it is still too early to let our guard down. “

Dr. Lynora Saxinger, Professor of Infectious Diseases at the University of Alberta, said in an email that Canada may also have avoided the worst-case scenarios that other countries had experienced with COVID-19, in large part by chance.

“I think it’s probably a combination of timely public health actions and the chance of not having large super spreader incidents before these limits, as we’ve seen in countries where the actions of a single patient were responsible for thousands of infections, “she said.

Saxinger has referenced ” Patient 31“A 61-year-old woman in South Korea who exposed more than 1,000 people to the virus after attending religious services at a branch of the Shincheonji Church of Jesus in the southeastern city of Daegu .

“Certainly anything that increases the possibility of contact between infected people, who may not be so sick, and susceptible people, who are essentially all people who have not been infected, can make this worse. Anytime. “

Saxinger said physical distance measurements are “absolutely essential” to control the coronavirus epidemic in Canada, and that lifting of these measures should be done in a “very careful” manner.

Is Canada still at risk of leaping?

Even if the curve flattens, Canada continues to report more than 1,000 new cases of COVID-19 per day – cases that will likely need to be treated in hospitals and intensive care units and strain the health care system. health.

“Rather than a flood, we get a steady flow, and it is extremely important not to be complacent here and to really make sure that our physical distancing and public health measures that are in place are maintained in place, “said Bogoch.

“What we really want to see is a reduction in the number of new cases per day. Then and only then can we begin to relax a bit on the side of the hospital and appreciate that we will have the appropriate resources to take care of the patients who come through the front door. ”

Canadian hospitals and intensive care units have so far managed to avoid being overwhelmed by COVID-19 cases. (Shutterstock)

Death and hospitalization rates may also continue to increase even after the daily case numbers have flattened due to the delayed snapshot we have data, as it can take up to 14 days before symptoms COVID-19 do not occur.

“Today’s data reflects what happened a few weeks ago,” said Dr. Srinivas Murthy, infectious disease specialist and associate clinical professor of pediatrics at the University of British Columbia.

“So we really need to give him time to really understand what the path of the disease is in any region. “

Murthy said a flare-up could still occur in Canada due to the “unpredictable” manner in which it occurs – such as an outbreak in a long-term care facility or a large number of cases due to non-compliance physical distancing by people.

“Breakouts are always likely, in fact, not just possible,” he said. “We just hope it doesn’t happen. “

Canadian hospitals have been preparing for a wave of COVID-19 cases for months on an “all on deck” approach, says Dr. Isaac Bogoch at the Toronto General Hospital. (Luca Bruno / The Associated Press)

Calgary emergency room doctor Dr. Joe Vipond said that while the outbreak in hospitals and intensive care units may have been worse at this point in Canada, the situation is also completely “volatile” .

“It can reappear in an instant if we let go of our guard and so we have to keep all of our measures in place until we stop seeing the cases and it could take some time,” he said.

“We don’t really know where we’re going. And so I think the worst thing we can do is start thinking “Well, I’m glad we missed that. Because what we should really think about is, “I’m so glad we had this extra time to prepare.”

“And if it’s not as bad as we thought at the end of it all – celebrate it. But we are too early to start celebrating now. “

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