No need to panic. But we do need to pay attention to this. Hospital capacity is something not well understood and there are plenty of misconceptions about what's normal, what's safe & what's happening. Let me try to clarify 1/ https://toronto.ctvnews.ca/ontario-hospitals-warned-to-prepare-surge-capacity-plans-within-48-hours-1.5232837

Most busy acute care hospitals not uncommonly operate at > 90% capacity, including (and importantly) the ICU. It's not ideal but it's what we're used to & it's generally safe because we still have the resources to manage our patients 2/

During exceptional periods (eg. flu season), the capacity can easily go to 100% or greater. We can still manage this for a short period of time. We can work harder, longer hours & ask extra staff to help out too. Still safe. 3/

The problem is that when that "exceptional period" becomes sustained, the resources start to get depleted. The resources are physical (beds that can't be freed up), human (staff get burned out, sick) and structural (surgical procedures, non-emergent care) 4/

Imagine having extended family come & visit unexpectedly and every few days, new relatives arrive & decide they want to stay too. You get more food, you adjust sleeping arrangements. But you only have so many rooms and so much time to offer to each 5/

True not every hospital is packed. We are NOT over capacity @UHN right now. We have room to help, for now anyways. But 50% of the ICU patients in Scarborough are CoVid+ and Brampton has been overwhelmed for weeks. What happens then? Maybe not so safe 6/

Patients are transferred from distressed hospitals to others that can accommodate. But this is not unconditionally available. Eventually the help cannot be so easily managed, especially at margins that start around 90% to begin with 7/

When the surge capacity is called for it can reach 115% or more. It means beds must be freed for critically ill patients and staff must be deployed to care for them. Not just any staff. (Trained staff who are not infinite in supply) 8/

Shifting to surge means surgeries might have to be cancelled because ICU beds available for post-op monitoring are instead being filled by patients with more emergent needs (eg Covid). Scarborough & Brampton will not remain anomalies. Others will follow 9/

So the sky is not falling on our health care system. But it sure is looking very grey and the rumbling of distant thunder are coming ever closer. There are too many people who don't have shelter at the best of times & they will suffer even more now 10/

What can we all do? Start understanding that our resources are not infinite and a vaccine dream can't and won't change that. We can do a lot of harm still if we keep going like this. Business is NOT usual 11/

No matter what you read or hear, know this : The hospital is still a safe place. It is still important to come to ER if you are sick. Do not avoid the care you need. We are HERE for you and want to help BEFORE you get sicker than needed 12/

I leave you with this. Maybe the greatest Canadian ever. Insurmountable odds. Unbelievable courage. Compassion. Determination. We are part of the fabric of this great country. Let's show it. Let's do it. Everyone of us. 13/ End #CanadaCares

@threadreaderapp please unroll