White Coat, Black Art

'These are historic numbers': How one Toronto hospital is preparing to battle COVID-19

North York General Hospital, one of Toronto’s busiest health-care facilities, is preparing for an influx of COVID-19 patients as the number of infections continues to climb day after day across the province.

North York General Hospital is ‘hoping for the best, prepared for the worst’

Public health authorities in Ontario confirmed 50 new cases of the novel coronavirus on Friday morning. (Craig Chivers/CBC)

North York General Hospital, one of Toronto's busiest health-care facilities, is preparing for an influx of COVID-19 patients as the number of infections continues to climb day after day across the province.

Marisa Vaglica, director of emergency medicine and professional practice, says the hospital has seen "unprecedented numbers" of people arriving at the ER with concerns that they might have COVID-like symptoms since the World Health Organization (WHO) declared the pandemic in early March.  

Public health authorities in Ontario confirmed 50 new cases of the novel coronavirus on Friday morning, marking the largest single-day increase since the outbreak began and pushing the provincial total to 308. The newly announced Ontario cases bring the total across Canada to 927, including 12 deaths.

With numbers like those, the hospital, which houses one of Toronto's designated testing sites, has had to be "nimble," to adapt to a rapidly-changing situation, Vaglica told White Coat, Black Art host Brian Goldman.

"There was a lot of process-improvement in the moment… on the fly," she said.   

Ann Shook, the ED's clinical coordinator, says the department has been pushing over 500 people through every day, with the highest being 562. 

"I have worked here for 20 years and absolutely, these are historic numbers."

In order to accommodate the increasing numbers of patients, the hospital has blocked off all but one main entrance and requires everyone entering to pass through a group of nurses who ask people if they have a fever or cough, their travel history and any other risk factors. 

North York General Hospital, one of the busiest in Toronto, is preparing for an influx of COVID-19 patients. (CBC)

If someone fails the screening, they are then directed to the COVID-19 assessment centre near the hospital's lobby. 

Dr. Joshua Tepper, CEO of North York General Hospital, says the lobby has gone through a number of significant changes to transform it into a specialized screening and testing area. 

It is specially designed to allow for large numbers of people to quickly flow through because "we don't want people standing in line — that increases [infection] risk," he said. 

It also doesn't require patients to wear personal protective equipment (PPE), like face masks, gloves or gowns, due to the short supply, Tepper said.

"We've done it to make sure that people who are doing this screening feel safe because we want to keep our community cared for and our people safe," he said, adding that so far, the hospital ER and assessment centre has identified about 20 patients with COVID-19, but all were well enough to recuperate at home.

The hospital's lobby has been transformed into a specialized screening and testing area. (Brian Goldman/CBC)

'Significant strain' on crucial health-care resources

The hospital has been working overtime trying to "create new capacity" for vital equipment like PPE, ventilators and intensive unit beds, Tepper said. However, a study by a team from the University of Toronto, University Health Network and Sunnybrook Hospital, paints an alarming picture of the pressure on the health-care system in the coming weeks. 

It warns of "significant strain" on crucial health-care resources, calling for measures to "rapidly identify and create opportunities for additional capacity to care for critically ill patients."

"Our simulation using a 'conservative scenario' of a daily 7.5 per cent increase of cases predicts that Ontario's ICU bed and ventilator resources will be depleted in approximately 37 days," said the report published Wednesday evening.

How outbreak helped prepare this Toronto hospital for coronavirus

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North York's Humber River Hospital was designed and built just after the SARS outbreak of 2002-2003 — and designers learned many lessons from that ordeal, hospital president and CEO Barbara Collins told CBC Toronto. 2:50

The hospital's volunteer staff have also taken a hit amid preparations, with all of them being asked to stay home. Many are older, which "puts them at a higher risk" if infected with COVID-19, Tepper said.

"We're just trying to limit the amount of community-based spread that enters our organization. So we've really had to change just how volunteers are part of our day to day function -- to not have them here just feels so different."

North York General Hospital is taking a patient-centred approach to health care amid the pandemic, by getting "families involved in everything we do," he said. 

"We're being careful not to shut that down... We need their voices, but we're trying to do it virtually or through other means." 

However, Tepper stressed that "if you're sick, you have to come and get care," adding that he doesn't want "people sitting at home with chest pain."

Community's 'fear is real' 

Along with physical preparations, the hospital's department heads hold a daily huddle, either in person or by calling in, detailing every aspect of the evolving pandemic and how it will affect the hospital's operations.

Dr. Paul Hannam, chief of the ED, says the community's "fear is real" and they are coming to the emergency department because "they trust us and we can help their symptoms and we can advise them on what to do next."

As coronavirus cases continue to rise, there are concerns vital health-care equipment like gloves, gowns, masks, ICU beds and ventilators will run out. (John Minchillo/The Associated Press)

"I'm most proud of the fact that we were able to respond so quickly to set up processes and new spaces in which to divert these patients away from the emergency department as best we can," Hannam said. 

Despite the growing strain on the department, he is "very confident" that the ER is still capable of maintaining access for patients who need care and the department is "hoping for the best, prepared for the worst."

"We have been doing an incredible amount of work in the last two weeks, in the last five days in particular, as we manage the expectations of the public, respond to changing guidelines on a daily basis and stay up to date and plan for what's coming in the next few weeks."

Written by Adam Jacobson. Produced by Sujata Berry and Dawna Dingwall. With files from CBC New's Shanifa Nasser and Mike Crawley.

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