The people who run Ontario's hospitals are all hoping the health system will not be flooded with COVID-19 patients, but they are planning for the possibility it that will.
Hospital administrators, doctors and nurses have for weeks been poring over their pandemic plans and getting ready to put them into action. Those plans involve redeploying staff, postponing scheduled surgeries, moving patients who don't need acute care and ensuring adequate supplies of protective equipment and ventilators.
"Our entire focus is completely shifted wherever possible on preparing for the growth of COVID-19 cases," said Dr. Kevin Smith, chief executive of the University Health Network (UHN) in Toronto. "The entire health care system has mobilized to address what we anticipate to be a very challenging time."
Smith and his colleagues across the province have cast a wary eye on Italy, where the rapid spread of COVID-19 overwhelmed hospitals within weeks because of the sheer numbers of patients who needed intensive care beds and ventilators.
"We're acting now but also we continue to plan for the future, about what could the next four weeks, six weeks, 12 weeks or longer look like," said Dr. Joshua Tepper, CEO of the 431-bed North York General Hospital.
"What happens if we start to see a lot of people who are quite unwell?" said Tepper. "How would we organize the hospital? How would we have the right equipment and the right team in place?"
North York General Hospital is considering whether parts of its facility outside the intensive care unit (ICU) can be "turned into places where critical care can be safely and effectively delivered," said Tepper. "We're planning now so if that time comes in the weeks ahead, we'll be able to be more nimble."
UHN, which includes Toronto General and Toronto Western hospitals, has about 130 patients who are categorized as "alternate level of care." That means doctors believe they can be discharged from hospital, but they continue to occupy beds because they are waiting for care elsewhere, such as space in a long-term care home.
The hospital is considering options for moving those patients safely, and Smith said that may even include hotels. "People are being very creative and bringing those kinds of ideas to the table," Smith said. "If we could safely redeploy those people to a less acute environment and then have 130 more beds, that would be obviously be very beneficial."
One of Ontario's largest hospitals, the 500-bed Southlake Regional Health Centre in Newmarket, is considering creating a screening area outside the hospital, perhaps in a tent.
It has postponed about 70 per cent of its scheduled surgeries, as has UHN. That has helped free up ward beds, so those hospitals are now running with about 85 per cent of beds occupied — down significantly from the usual scenario of being full beyond capacity.
All the hospital administrators who spoke with CBC News say the well-being of staff is a significant concern.
At UHN, staff are getting extra training on education on donning and doffing protective equipment and on how to prevent the spread of the coronavirus during particularly risky procedures such as putting a tube down an infected patient's throat.
"We really need to be careful that health care workers don't themselves become infected," said Smith.
Every staff person who comes through the door at North York General Hospital is screened for symptoms of COVID-19, including Tepper.
He said front-line nurses and physicians have been "working at a very high pace" in recent months as the hospital faced high demand during flu season, and he's aiming to find models of working so staff remain physically and emotionally healthy through the pandemic.
"This is not something we can get through on adrenaline," said Tepper.
A significant concern for Southlake's CEO Arden Krystal is the number of hospital staff who will be unavailable for the next two weeks as they left the country for March break and must remain in self-isolation for 14 days upon their return, under a directive from provincial health officials.
The hospital will need to reallocate personnel to parts of the hospital that end up short-staffed, she said.
Southlake's emergency operations centre is now running, as is one at Sunnybrook Health Sciences Centre in Toronto. That's been the case since late January, when Canada's first case of COVID-19 was detected in a man who came to the hospital after returning from Wuhan, China.
For Sunnybrook's director of emergency preparedness, Rob Burgess, the limited supplies of personal protective equipment for nurses and doctors is front of mind.
"Without that equipment to help support our staff, it makes it very difficult to provide health care to patients," Burgess said.