Friends & Colleagues. Apologies for the length of this 1st Tweet—this topic deserves some extra characters. I joined Twitter during #COVID because I have seen that this medium can provide a quick flow of information and contribute to engaging discourse and positive change.

1/12

I resisted joining Twitter because I often saw the opposite. I thank my friend Andrew Morris ( @ASPphysician) for his encouragement and powers of persuasion for demonstrating the more constructive facets of Twitter. His public cajoling means I have a lot to live up to.

2/12

Those who know me know that I eschew self-aggrandizement and self-promotion. I do not want to clog your Twitter feeds (learning the lingo!) with unhelpful thoughts. I hope to contribute to true discourse – particularly on topics I feel need to be emphasized and amplified.

3/12

Everyone is rightly focusing on rising #COVID19 numbers. @BogochIsaac @DFisman @jkwan_md @YoniFreedhoff @NathanStall @DrSamirSinha @LapointeShaw @IrfanDhalla @ASPphysician & others have been presenting this data and arguing the case for stopping the spread for some time.

4/12

“How” to stop the spread has been the topic of contention—“why” we stop the spread seems to have been lost. We #FlattenTheCurve to prevent us from overwhelming our hospitals. Visions of Italy, Spain and NYC should be indelibly imprinted in our minds: https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-hospitals.html

5/12

We must preserve hospital capacity to attend to the acutely ill. In the spring, we prepared for a massive surge of #COVID19 cases that did not materialize. Unfortunately, many people were sick and hospitalized, and many people died. But hospitals were not overwhelmed.

6/12

The problem in Canada is that we have among the lowest # of hospital beds/capita in the industrialized world, with hospitals normally running ~100% capacity. This means hospitals are frequently well over capacity leaving little added extra room to deal with major surges.

7/12

We were (thankfully) able to deal with increased admissions in the 1st Wave—I am not so optimistic for this 2nd Wave. RIGHT NOW our hospitals are filled beyond capacity without even considering the relatively small (but quickly increasing) number of patients with #COVID19.

8/12

Many GTA hospitals are NOW 10-20% over peak capacity. Essential IPAC practices prevent us from employing our usual methods of coping with over-census. Space and human resource constraints exacerbate these challenges. There is also an enormous backlog of surgical cases.

9/12

The cause of this present hospital over-crowding is not due to an exciting acute infection like flu or #COVID. It is due to the usual reasons for hospital admission which have been increasing steadily over the last 5 years ( http://geminimedicine.ca ): http://cmajopen.ca/content/5/4/E842.full

10/12

In essence, the problem of #HallwayMedicine did not disappear because of #COVID. Moreover, it will make ANY care exceedingly difficult to provide to newly arriving #COVID patients. That is why my colleagues have been sounding the alarm over the rising #COVID numbers.

11/12

Canada is no different from other countries that have had rising numbers from #COVID and surging hospital admissions. However, we are different in that we do not have the same hospital bed capacity—this is why we need to act NOW—I hope our decision-makers are listening.

12/12