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Emergency room physician Dr. Yael Moussadji who is heading up Calgary's physician pandemic plan in Calgary, Alberta, Canada April 1, 2020. She says Calgary’s hospitals are likely to need extra physicians with all kinds of backgrounds, including community doctors and pediatricians.TODD KOROL/The Globe and Mail

Physicians in Calgary are planning for around 200 to 600 COVID-19 patients a day to show up at local hospitals at the height of the pandemic, depending on the success of physical-distancing measures.

Doctors who are leading the effort to prepare hospitals in Calgary, which has by far the most cases in Alberta, are calling on colleagues to help with an expected surge of patients, even if it means taking on clinical duties outside their usual practices or coming out of retirement.

Dr. Yael Moussadji, an emergency physician and chair of the physician work-force pandemic plan, said Calgary’s hospitals are likely to need extra physicians with all kinds of backgrounds, including community doctors and pediatricians. Up to one-third of admitted COVID-19 patients may require a ventilator, and others will still require high levels of care, she said. At the same time, physicians must be available to treat patients without COVID too.

“We’re casting our net wide to appeal to physicians throughout the zone, regardless of what their background is,” she said in an interview.

Dr. Moussadji and her colleagues are working with Calgary’s City-Wide Medicine Emergency Pandemic Operations Command (MEOC) and issued their call based on projection models that suggest the city does not have enough acute-care physicians to look after the many patients expected in the weeks ahead.

Alberta health officials are expected to soon release their own modelling that will show what they expect in terms of the potential surge of COVID-19 patients. Premier Jason Kenney told the legislature on Wednesday that 2,250 acute-care beds will be set aside for COVID-19 patients and that the province expects to need 250 intensive-care beds

The Calgary models predict that, in the worst-case scenario, as many as 587 COVID-19 patients a day could arrive at the city’s four hospitals during the pandemic’s peak. The best-case scenario, which assumes social distancing is effective, still projects about 185 patients with COVID-19 will arrive in a single day. The peak is expected to hit in about five or six weeks, organizers said.

They caution that their models lack empiric data and are based on assumptions that make the projections unstable and uncertain.

But even in the best-case scenario, they say they expect the number of patients who come daily to the city’s hospitals will be higher than anything in Calgary’s history, said Dr. Gabriel Fabreau, a specialist in internal medicine and assistant professor of medicine at the University of Calgary. He made the prediction to 750 physicians during a recruitment webinar on the weekend.

“We cannot become Italy. I don’t say that in a disparaging way to Italy. But we have seen these pictures,” he said. “We cannot say to ourselves that we don’t have any evidence of what it looks like when a health-care system becomes completely overwhelmed by this virus.”

The Calgary physician pandemic planning group expects to lose a significant portion of the health-care work force because of illness and self-isolation after an exposure. They worry, too, about the possibility of deaths.

Reports from China, Italy and Spain show health-care workers are at a higher risk of infection than the rest of the population because of frequent exposures. Physicians and other health-care workers outside Canada have died from COVID-19 acquired in hospital.

As of Thursday, the Calgary zone had 589 confirmed cases of COVID-19, representing 61 per cent of the province’s 968 confirmed cases. There were 247 in the Edmonton zone.

Calgary’s physician pandemic plan was developed based on principles of disaster medicine and field medicine, and can be rapidly scaled up as needed, Dr. Fabreau said.

Physicians who enlist will undergo specialized training in proper donning and doffing of personal protective equipment, called PPE. The planning group is collaborating on COVID-specific guidelines for different aspects of clinical care, including palliation, infection control and ICU care. These will be available to help guide physicians.

Physicians will work in eight-hour shifts and are organized into teams, led by physicians with expertise in managing patients who are acutely ill. As the number of patients increases, more enlisted physicians will be called into service in hospitals and community clinics.

The plan includes strategies to send patients home as soon as possible, or to long-term care facilities or medical centres that provide less acute care. Alberta Health Services is also looking at non-hospital spaces that can be turned into temporary units for COVID patients.

Around 150 physicians in Calgary have enrolled so far, Dr. Fabreau said. He added that physicians are being asked to take on additional risks by signing up.

“We acknowledge that we collectively have fears and anxieties for ourselves and for our families. I myself have three young children. We all have people that we love.”

The College of Physicians and Surgeons of Alberta has contacted 225 physicians who retired in the past two years, offering to potentially reinstate them and connect them to Alberta Health Services to be redeployed where they are best suited.

The Canadian Medical Protective Association, which provides medical-legal support to Canada’s physicians, sped up its membership process to cover physicians who are re-entering the work force or changing roles in response to COVID-19.

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