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'I think the fact that we’ve been able to avert disaster at this point emphasizes the fact we need to maintain the policy of physical distancing,' said Michael Warner, medical director of critical care at Toronto’s Michael Garron Hospital – people seen here on March 24, 2020 leaving the Covid-19 assessment centre at the hospital.

Nathan Denette/The Canadian Press

Early signs show parts of Canada may be starting to flatten the curve, as the feared surge of COVID-19 patients overwhelming hospitals has so far failed to materialize.

But infectious-disease experts warn that it’s still possible Canada will see a major spike in cases. Some regions, particularly Ontario and Quebec, are struggling to contain outbreaks at long-term care homes and other institutions and, experts say, relaxing physical distancing too soon could exacerbate the situation.

“I think the fact that we’ve been able to avert disaster at this point emphasizes the fact we need to maintain the policy of physical distancing,” said Michael Warner, medical director of critical care at Toronto’s Michael Garron Hospital. “In terms of a survival mechanism, we need to keep doing this.”

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For weeks, public health officials had been pointing to early April as a pivotal moment in Canada’s battle against COVID-19, saying that new cases, patients in hospital and deaths would help indicate which direction the country’s outbreaks are headed.

Midway through the month, evidence from several provinces shows that physical-distancing policies combined with increased COVID-19 testing and expanded hospital capacity are keeping the spread from getting out of control. Experts say that reducing the growth of new cases – flattening the curve – would keep the pandemic from overwhelming the health care system.

Alberta, for instance, which has more than 500 ventilators, reported having 47 patients in hospital as a result of COVID-19 on Saturday. Of those, 13 patients are in the intensive-care unit. Since the COVID-19 outbreak began, only 33 patients in Alberta have been admitted to the ICU as a result of the illness.

In B.C. on Saturday, officials reported that 63 people were in the ICU with COVID-19, a decrease from last Monday, when 72 were in the ICU. Last week, Health Minister Adrian Dix said the province’s ICU occupancy rate was 53 per cent.

Even in Ontario, which has struggled with low testing rates and widespread outbreaks at long-term care homes and other institutions, hospitals aren’t being overrun with COVID-19 cases. Reports from Critical Care Services Ontario shows that nearly 80 per cent of the province’s ventilators aren’t being used. On Sunday, Ontario reported having 738 patients in the hospital as a result of COVID-19. Of those, 261 were in the ICU and 196 were on ventilators.

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In Quebec, there were 217 people in the ICU with COVID-19 on Sunday. Officials say the province has about 1,000 ICU beds and 3,000 ventilators.

“This is the first week where you started to see some tangible evidence of flattening of the curve and that there may be an end to this in terms of the first wave,” said Jim Kellner, a pediatrician and infectious-diseases specialist at the University of Calgary.

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Lynora Saxinger, an infectious-diseases specialist at the University of Alberta in Edmonton, said there is a clear divergence in the trajectory of COVID-19 outbreaks in Western and Central Canada.

“Canadian data should be looked at almost the way we’re looking at different countries’ data,” Dr. Saxinger said. “I think the epidemic … in Quebec and Ontario is really kind of what’s driving the overall Canadian numbers.”

In those provinces, the number of new cases, hospital admissions and deaths continue to be higher than other parts of the country. On Sunday Ontario reported COVID-19 outbreaks at 86 long-term care homes, which has so far resulted in at least 1,153 cases and 115 deaths.

Quebec is also struggling with hundreds of outbreaks at long-term care homes. This weekend, health authorities, the police and a coroner launched investigations into the deaths of 31 residents at a Montreal seniors’ home.

Dr. Kellner said if the trends continue, provinces that have been able to get their outbreaks under control may be able to think about how and when to relax physical distancing. But in other parts of the country, notably Ontario and Quebec, those conversations may be a longer way off, he said.

Hospitals that have cancelled surgeries and taken other steps to reduce the number of patients in preparation for a COVID-19 surge will also have to start thinking about how to move forward, Dr. Saxinger said.

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“If our surge turns out to be more of a steady stream or a trickle, we have to adapt and figure out how we’re going to do the rest of health care too,” she said. “If we’re telling everyone to stay home with their chronic medical conditions, at some point, that becomes a problem.”

With a report from Ian Bailey in Vancouver

Author and journalist Malcolm Gladwell discusses the far-reaching impact of the coronavirus pandemic on refugees, conflict and the economy. Gladwell was in conversation with Rudyard Griffiths from the Munk Debates. The Globe and Mail

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