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As we enter The Great Unknown, the second wave of COVID-19, is Canada better prepared than we were before?

Posted: September 6, 2020

(September 5, 2020)

By: Sharon Kirkey, Calgary Herald

One evening in mid-March, as a weird and eerie illness was making itself frighteningly real in northern Italy and New York City, Ontario hospitals were instructed to commence shutting down “non-emergent” procedures, in anticipation of a COVID-19 surge.

Dr. Jonathan Irish is a cancer surgeon. He had five cancer operations scheduled the next day at Toronto’s Princess Margaret Cancer Centre. Two of his patients had travelled by plane to get there. All five operations were cancelled.

By end of May, the directive was lifted. In a study published this week in Canada’s top medical journal, Irish and his co-authors estimate it will now take a staggering 84 weeks to clear that surgical backlog owing to COVID-19. Roughly three-and-a-half months to get through “time-sensitive” cases like cancers and coronary artery bypass grafts, and over a year-and-a-half to clear all surgeries, including joint replacements and cataract and hernia repairs — an estimated 148,364 surgeries in total.

In addition to the sheer magnitude of the backlog, “obviously, the impact on our patients has been a profound one,” Irish says.

As Canada prepares for the great unknown, a predicted resurgence of COVID-19 in the coming weeks and months, that is one lesson that can be taken from the first ripple. Flip the emergency switch, and suppress, suppress the virus, and other dominoes can topple.

The surgical ramp-downs were probably appropriate, Irish says, given what little grasp anyone had of this strange new virus. Across Canada, thousands of hospital beds — nearly 10,000 in Ontario alone, including critical care beds with ventilators — were freed in preparation for a feared flash-flood of critically sick COVID-infected people. It was a mass casualty response, Irish says, “as if 100 airplanes had crashed.”

That’s a response now off the table. “We understand now that within 24 to 48 hours, we can be responsive — we proved that in March when we created capacity for a lot of patients. It can be reactive to local testing, and it can be regional.” An uptick of cases in Ottawa shouldn’t shutdown OR’s in Thunder Bay or Windsor or across the entire system, says Irish, who is working with Ontario’s health ministry on a plan to keep operating on people who don’t have the virus, in the background of a COVID-19 pandemic.

“Look, I have kids. I have colleagues. We are all anxious about the situation,” Irish says. But where we are now is different from where we were in March. Doctors know better how to treat this once-in-a-century biological entity. “We know better how to identify the disease and contact trace. We can’t continue to function as we did in March, if there were a second wave,” Irish says.

No one can say with any certainty if, when, or how big a second wave will be. Canada’s Chief Public Health Officer Dr. Theresa Tam says provinces and territories should prepare for a “fall peak,” a resurgence, a rebound that could be several-fold worse than their previous experience. There were no actual numbers on a graphic illustrating that peak in the slides released in the latest modelling. “The national epidemic curve could be highly variable,” the Public Health Agency of Canada said in response to a query from the National Post, “and while we are hoping for the ‘slow burn’ pattern, public health authorities are preparing for a potentially high fall peak” followed by other waves “that may exceed their current capacity to respond optimally.”

If systems weren’t overwhelmed in March, and we’re better prepared than we were before, why would capacity be exceeded next time? Tam speculated that something could happen to the SARS-CoV-2 virus that causes COVID-19. It isn’t behaving like influenza. It hasn’t shown any seasonal pattern so far; it continued circulating throughout summer. It’s possible the virus could demonstrate “a certain type of acceleration under certain conditions,” Tam said.

Other countries — Italy, Spain, France, Germany, India, Brazil, Argentina, Russia and South Korea — are grappling with resurgences. U.K.’s Prime Minister Boris Johnson put areas of Northern England under stay-at-home instructions last month. French president Emmanuel Macron made masking mandatory in busy outdoor spaces of Paris in response to flare-ups. White House coronavirus adviser Dr. Anthony Fauci this week pleaded with Americans to behave — wear masks, distance, avoid crowds and other “simple things” — over the Labor Day holiday weekend. Take the pressure off the virus, the World Health Organization’s Mike Ryan has said, and it will boomerang back.

Dial in colder weather, which means more time indoors, school reopenings and a collision with seasonal flu “and we have the makings of a really difficult time ahead,” says emergency physician Dr. Alan Drummond. So what can we learn from our first go around with COVID-19 to prepare for the next?

In the beginning, there was mixed messaging, says Drummond, a lack of clarity, a “desultory, lethargic and reactive and plodding response.” The messaging from federal health officials was a no-drama, “Canada is at low risk” mantra. Except “we could see what was potentially coming and nothing was happening,” Drummond, of the Canadian Association of Emergency Physicians wrote in an email back in May.

The onslaught never happened. ER visits across the country fell sharply. People feared either contracting or transmitting the virus in packed waiting rooms. “What’s happened to the heart attacks,” Drummond and his colleagues wondered, the strokes? The people with appendicitis-like pains? People were delaying seeking care, “and we partly own that,” Drummond said this week. “We should have done a better job letting the public know our departments are safe, we’ve adapted, we’re maintaining physical distancing and it’s safe to come to the emergency department.”

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