Front Burner - A COVID-19 surge is coming for Ontario

Episode Date: April 3, 2020

Ontario Premier Doug Ford has admitted that things are not looking good for the province, saying, “right now, today, there is very little separating what we will face here in Ontario from the devastation we’ve seen in Italy and Spain." He’s right to be concerned: the number of patients in Ontario’s ICU beds is doubling every four days. And according to public health officials, this is just the beginning. A surge is coming for Ontario. Today, we cover how prepared the province is and why it got this bad, with help from Mike Crawley, CBC’s Ontario provincial affairs reporter.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. Right now, today, there's very little separating what we will face here in Ontario from the devastation we've seen in Italy and in Spain. Because we know a surge is coming.

So that was Premier Doug Ford admitting that things are not looking good in Ontario. It was a bad week for the province. The number of patients in Ontario's ICUs is doubling every four days and is well on its way to threatening their capacity. Ford says Ontarians are going to be hearing some very hard numbers today. And according to public health officials, this is just the start of it.

A surge is coming for the province. The truth is, the situation is extremely, extremely serious. Right now, our best defense is to stay home, self-isolate, and don't go out. It is a matter of life and death. Today, we'll cover just how prepared Ontario is and how it got this bad. With help, of course, from Mike Crawley, CBC's Ontario Provincial Affairs Reporter, this is FrontBurner. Hi Mike, thanks for joining me.

Hi, Jamie. So let's get right into this. You and I just watched Doug Ford's daily press conference. We're speaking on Thursday afternoon, and there was a pretty incredibly somber tone. Over the next little while, we will all have to make some very, very difficult decisions. And you deserve the same information I have. You deserve to see the same data. What do we know, if anything, about what's coming Friday? So Premier Doug Ford has given an indication that he's going to tell Ontarians projection numbers, basically what is the spread of COVID-19 going to look like in the next couple of weeks?

What's it going to do in particular to the hospital system? What could be happening in the intensive care units? What are we going to potentially see even in the number of deaths? And there's been some pressure on him and on the prime minister, frankly, as well, number of deaths. And there's been some pressure on him and on the prime minister, frankly, as well, to release these kind of models, potentially to, I guess, scare people into some action to kind of make it more of a reality. Because, you know, you're hearing in the States, 100,000 deaths possible. I think there's some sort of a desire to make it really apparent to the people of Canada that, you know, potentially thousands of people could die from this.

Right. And I know you saw the premier in the parking lot at Queen's Park early Thursday morning, and he was really eager to get these numbers, this sort of modeling out into the public domain. Yeah, I just coincidentally bumped into him, asked him how he was doing. And out of the blue, he said to me, Mike, between us, I really want to get that data, those models, to me, Mike, between us, I really want to get that data out, those models. I really want people to know what I'm seeing and what could happen. And that was the message he gave in the news conference, was really to be transparent. And that's been one of the criticisms about Ontario, is that the data in the way of cases and hospitalizations has been slower than coming out in other provinces. They haven't been testing as much.

Even Canada's chief scientist, she, on Thursday, laid into Ontario criticizing the quality of the data that the province is providing on COVID-19. Based on what we're seeing and the number of tests, I have to say that I am a little bit preoccupied by the situation in Ontario because we should be doing more testing in Ontario and I hope that they're going to be able to ramp this up. And so we really haven't had as accurate a picture

as some other provinces have had about the spread of COVID-19. But even more importantly, what's going to happen in the next couple of weeks based on the growth in new infections that we've been seeing over the past few days. Okay, so let's look at the numbers that we do have, and I take your point that they're not perfect. But the numbers that we've seen so far and the analysis of them from experts, I know you've been talking to a lot of people, what does it signal to you about what we might be hearing on Friday? The real thing, Jamie, a lot of people get kind of caught up on the raw number of how many new cases there are. What's really important is

the growth day after day, okay? And this is what the epidemiologists tell me, this is what the people who manage the hospital system tell me. That's the number that really matters is what's the growth pattern. And, you know, the last couple of weeks, you don't see signs of Ontario's growth rate slowing down at all. The cases are increasing at a rate that pretty much means they double every four days. You're seeing the same thing in the ICUs, in the intensive care units. There's double the number of patients with COVID-19 confirmed in intensive care beds than there was four days ago. And you just got to do a little bit of math there and you see what is the potential to happen four days from now, eight days from now, 12 days from now. And some of those numbers start to get

a little scary. Can you do some of that math for me? You know, if we start with X number of cases today, where could we be in a week or in the next couple of days even? Yeah, okay. So if let's just look at intensive care units, because that's the really important thing that has to keep its head above water within the health system, right? If you look at New York City, if you look at Italy, the first thing that got overwhelmed was the intensive care wards. So right now, Ontario has 167 confirmed cases of COVID-19 in the ICU. So I'm going to round that down for easier math.

Okay, let's say it's actually only 150. But if that doubles every four days, okay, four days from now, April the 6th, you've got 300. And if that doubles, you've got 600 by April the 10th. And if that doubles, you got 1200 by April the 14th. Okay. And that's the time frame where the epidemiologists are concerned that because of the way the infections have been happening over the past couple of weeks, that that's when peak demand is going to be on the system. So let's take that number, 1,200 people in the ICUs. Ontario only has 2,000 intensive care beds across the province.

Really, it actually only has about 1,400 of those are what's called level three critical care. OK, that's what the vast majority of COVID-19 patients who get really, really sick. That's what they need. They need ventilators and that sort of thing. OK, and I would imagine other people are in need of these beds as well. And that's it. That's what I was just going to say is that, you know, people are still having heart attacks and they're still having brain aneurysms and they still get in car accidents and need intensive care. Right now, there are actually only 400 available intensive care unit beds across the whole of Ontario. Wow. Right. And we've got infection rates doubling every four days right now. This is a trajectory. In certain hospitals, in certain cities in Ontario, there are only a handful of intensive care beds available. That's the concern. Am I right to say that Ontario's

capacity around intensive care beds is less than other provinces? Quebec, for example. The premier there, Francois Legault, seems to be quite confident that their system can take an influx. Yeah, Ontario's per capita ICU bed numbers are low, lower than the Canadian average and lower than most provinces, not just Quebec. Look, though, I don't want to be totally alarmist about this because the people running the critical care system in Ontario do have plans to ramp up. OK, there are ways that they can make spaces available for a surge in COVID-19 patients. So you can see some of that actually happening out now in Burlington to the west of Toronto, out towards Hamilton. They are actually constructing basically a temporary ward where they could host only COVID-19 patients. The new structure will house up to 93 patients,

freeing up space inside the hospital for more intensive care beds. Right now, Joseph Brandt Hospital only has five patients. This is a term you're going to hear in the coming days, Jamie. It's called cohorting. So the idea is they would make entire wards only patients who are confirmed positive for COVID-19. Why does that matter? Key thing is for the doctors moving back and forth between the patients.

If you've got an intensive care unit and half your patients are COVID negative and half are positive, every time you move from a COVID positive patient, you got to take off all that personal protective equipment. So the doctors have told me they really think this cohorting needs to happen so that they could basically go in, they put on one piece of personal protective equipment, they have to protect themselves all day, but they don't have to worry about taking infection from one patient to the other. And it just makes it makes it more efficient for the doctors and nurses. And it also helps with that shortage of personal protective equipment that we've been hearing about. The hospitals in Ontario have said we are running low on protective equipment,

in particular masks. The premier buying boxes of personal protective equipment and distributing them is no solution to this problem. What's needed is a systemic approach that makes and ships this equipment and testing kits so that we can deal with this problem in a thorough way. Right. We're seeing lots of calls for this, for protective equipment, for masks. You know,

another question I had for you is the healthcare workers themselves. I saw some reports come out on Thursday about how they are also getting sick. And this could also be like a huge problem for the system, not to mention the fact that it's awful that they are also getting sick. Yeah, so my CBC colleague, Lauren Pelley, actually dug up these numbers from the province, around 230 confirmed cases of COVID-19 among healthcare workers. So this includes doctors, nurses and other health care workers. You know, I'm not getting the sense yet that it is so many that it is having an impact on the staffing levels in health care. Some of them might be from the long-term care sector where there's been, you know, a lot of deaths in Ontario and

a lot of infections that have been in both staff and residents of long-term care. On CBC Gem, brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This surge in numbers that we're seeing, sort of the doubling every four days. You know, the idea here is that we are two weeks into these emergency measures. We are two weeks into strict physical distancing measures. We're two weeks into strict physical distancing measures. And it's part of the reason or a large part of the reason why there's so much concern in Ontario is that we are not seeing the effect of these measures. That's exactly right, Jamie. The percentage day over day increase, it fluctuates a little bit from one day to the next, but it is not coming down to the rate that they wanted it to be.

It's somewhere probably averaging around 18 percent or so within the last sort of four or five days. And, you know, I'd also point out that it's three weeks ago Thursday that Ontario announced that it was going to close the schools. It's more than three weeks ago World Health Organization declared the pandemic. So even though it's been two and a half weeks now since the state of emergency was declared in Ontario, some people were starting to take social distancing measures, you know, even earlier than that. So by now, given the time it takes for people to start to show the symptoms, you would have thought that you'd see that impact in the day-over-day numbers. Maybe we'll see it in the next three, four days. Nobody knows. But I think the reason why you're seeing stricter measures being talked about in

Toronto, why you're seeing Premier Ford come out with this data about the projections, is because there is definite concern among the health professionals that the curve has not been flattened, certainly has not been flattened enough. Right. And also, you know, fair to say that what we're seeing in Ontario is differing from what we're seeing in other provinces like BC, which has seen some sort of some kind of flattening. Yeah, the curve is flattening in British Columbia, and it is not in Ontario. You know, Mike, if we're not totally sure about the quality of the data, you know, could the numbers be worse than we're seeing or better? So that's a really good question. Clearly, the case numbers could be worse. And that's why it's so important to look at the hospitalization data, because that's not an underestimate, right?

It's more important now to really, like, just look at that day-over-day data. Right. Mike, look, this is a lot for people to take in. You know, I think there are many people in this province, in Ontario, you and I are both in Ontario, obviously, right now, who might have already been feeling very anxious about this. And these numbers and hearing the premier today talk about the very hard truths that are coming, might have them feeling even more anxious, even more scared. What do you think is the big takeaway that they should be thinking about right now? they should be thinking about right now? You know, anxiety is, anxiety is a human response that has a real purpose, a real survival purpose, right? Like we get anxious because there is reason

to be scared. And I think the message is we've got to all take this really seriously. And so perhaps the hope there is that while people don't necessarily get paralyzed and think, oh my goodness, this is doomsday, that the takeaway ought to be more, I really have to be careful about physical distancing. I have to take all those hand-washing lessons to heart, all of those kinds of things that everyone has to do

to protect themselves and protect the family members, anybody that they might actually be self-isolating with. So I hope that that's the takeaway for people. And I believe that that's what the Premier's message is going to be. Right. In trying to understand how Ontario got here, I know there has been some criticism that the province didn't shut down quick enough, or it didn't shut down enough. For example, that the list of essential businesses that are allowed to stay open is just way too long.

There has been some criticism of that. The Premier says he's following the office, the advice of the Chief Medical Officer of Health. I was told that the Premier was actually reluctant to impose the state of emergency and that it was Christine Elliott, the Health Minister, that really made a big noise and said, we have got to do this. So maybe it was a little slower than it ought to have been. And yeah, a lot of businesses are still open. I drove on my way into the legislature here at Queen's Park a couple of days ago and was noticing there's traffic, like there's a lot of people out moving around. And, you know, there are a lot of

people that are part of these essential businesses that have to keep the city functioning. But maybe there is an argument to be made that the shutdown should have been a little more complete. I suppose there's still room for more shutdowns to happen. You know, and of course, it's important to hold the government's feet to the fire. But we're also talking about people's individual behaviors here. This week, there was rhetoric from both Doug Ford and John Tory, the mayor of Toronto, essentially calling out the public. I can't comprehend why some people aren't getting it. They may think it's not going to happen to me.

Well, it can happen to anyone, anyone in the world. We have scenes in Toronto, people hopping over fences of places. We put up fences to close down by way of recreational facilities. I don't get, I do not get what, these are adults. These are not four-year-old children. And they're adults who know we're in a human health care emergency here and they're still doing this. So I hope this...

Are people in Ontario physical distancing the way that they should be? Well, there's some evidence from an organization called CityMapper, a project that monitors data and traffic patterns in cities. And so you're seeing in places like New York and Boston and San Francisco, they've really ramped back their average amount of moving about from this data. In comparison, they're moving around a lot less than people in Montreal or in Vancouver. But in Toronto, it's the worst. It's actually where, if you compare all those six cities, Toronto, the data shows that Toronto people are moving around publicly more than any other place.

And so that might give you some evidence that, beyond the anecdotal, that people in Toronto are not necessarily just staying at home. And a similar situation at Cherry Beach sports fields. Caution tape was ripped down, people could be seen gathering in groups. At least 14... To hear that Toronto's doing worse than New York, Boston, Vancouver, Montreal, like as a Torontonian, come on Toronto, you know, I think we can certainly do better than this. It certainly seems like we can do better than this. Mike, is there any other big pieces of information that you think people need as they go into the next week? It sounds like a difficult one for this province, for Ontario, the next couple of weeks. Well, certainly keep your eye on the hospitalization data.

Watch what happens within intensive care and total hospitalizations. Watch what's happening in the hospitals and in the long-term care facilities around personal protective equipment, availability of things like that for the healthcare workers. Look at the deaths in long-term care homes, right? Because they're the canary in the coal mines. We've had a big spike in deaths in Ontario from long-term care homes stretching all the way from Sarnia to Ottawa. That, again, kind of gives you an indication of what was going on with the virus a couple of weeks ago as it was spreading into those locations. And then I guess watch for whether governments impose stricter measures. I mean, the province has a lot of powers under the state of emergency declaration, and they could restrict movement, impose curfews, all kinds of things. I'm not saying that's what is going to happen, but I will not be surprised

if there's some ratcheting up of the restrictions on people's movement and a ramping back of the number of businesses that are allowed to just continue operating. Okay, Mike Crawley, thank you so much. Thanks, Jamie. All right. So some updates at the end of the day Thursday from Ontario. CBC is reporting the death toll is now 88 people in the province. This is a number that is in flux as more reports continue to come in. And shortly after Mike and I spoke, Toronto Mayor John Tory signed a bylaw mandating two-metre physical distancing in public for the next 30 days. I've signed this bylaw to further drive home the message that people have to keep their distance from each other to avoid spreading COVID-19 further in our city. Police say they will be enforcing this immediately. Anyone found in violation could be fined $5,000. This doesn't include people that

you live with. There will be an ongoing blitz of parks to ensure this is happening. Also, Toronto is working with the provincial and federal governments to get more personal protective equipment. The city has asked for 184 million pieces. They will go to frontline workers, first responders, shelters and long-term care homes. That's all for this week. FrontBurner comes to you from CBC News and CBC Podcasts. The show was produced this week by Mark Apollonio, Imogen Burchard, Elaine Chao, Shannon Higgins, Allie Janes, Ashley Mack, and Nahayat T. Zush.

Derek VanderWijk does our sound design with help this week from Matt Cameron and Ebian Abdiguer. Our music is by Joseph Chabison of Boombox Sound. The executive producer of Frontburner is Nick McKay-Blocos. I'm Jamie Poisson. Thanks so much for listening and talk to you all

on Monday.