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Commuters hold the hand rail in a subway in Montreal on Friday, March 13, 2020. THE CANADIAN PRESS/Paul ChiassonPaul Chiasson/The Canadian Press

How much worse can the new coronavirus pandemic get?

One would be hard-pressed to find anything but alarming answers to that question.

Europe has now become the epicentre of the global pandemic – it is recording more cases daily than China did at the peak of its outbreak.

This, despite having weeks to prepare.

The grim epidemiological reality is that every Western country now faces the prospect of an Italy-like explosion of coronavirus.

Shut it down: It's time to get serious about social distancing

Who’s ‘flattening the curve’ on the coronavirus, and who isn’t? A global graphic comparison

Three weeks ago, Italy had three cases. A week later, it had 231. Then things escalated quickly, unexpectedly.

Today, Italy has more than 18,000 cases and 1,200 deaths, with no end in sight to the carnage.

Similarly disturbing patterns are beginning to emerge in Spain, Germany and Britain, although none of their numbers are nearly as bad as Italy. Yet.

Many have dismissed Italy as an outlier, a country that simply waited too long to act, allowing the virus to get a foothold.

The first coronavirus case wasn’t detected in Italy until Feb. 20, so it’s quite possible the virus was spreading undetected. (China reported the first cases of what is now known as COVID-19 in late December, 2019. Canada’s first case was reported on Jan. 25.)

Italy was no slouch, though. It was the first European country to ban flights from China. Earlier this week, it also imposed the most drastic public health measures ever seen in a democracy, placing all 60 million citizens in quarantine and locking down the country, except for some grocery stores and pharmacies.

But it failed to test widely; the outbreak persisted and hit like a bomb.

Could this happen in Canada, or the United States?

As much as we don’t want to hear this: Yes. Yes it could.

On Thursday, we saw a flurry of activity from the provinces implementing a host of social-distancing measures, such as school closings, banning large public gatherings, and calls to restrict non-essential travel.

These moves are not going to stop the outbreak, but they have the potential to slow it down. In the coming weeks, we’re going to know if that was too little, too late.

Public health officials have done great communication work keeping the public calm and informed with regular updates on confirmed COVID-19 cases, and offering up practical advice on hand-washing and such.

But talk isn’t sufficient any more. As the threat escalates, we need more robust action.

That starts with knowing what we don’t know: How many people are really infected in Canada?

We need to put our surveillance systems on steroids. South Korea is doing 10,000 coronavirus tests a day. Canada is doing … well, nobody seems to know.

The U.S. has massively botched testing, and there is no indication that Canada has done much better.

Instead of hard data, we’re getting troubling news that testing criteria are inconsistent and that we’re running out of tests.

While Italian health officials were wallowing in ignorance, thousands of people were getting sick and now the Servizio Sanitario Nazionale (the national health service) is overwhelmed.

Reports from physicians and nurses on the front lines are positively chilling.

In Canada, we’ve kind of been lulled to sleep by our low known numbers.

But a series of interactive projections published Friday by the New York Times should give us pause, or perhaps fright.

If we keep on the current trajectory, roughly one-third of the population could be infected. (Some infectious-disease experts say that could be two-thirds.) For Canada, that means 10 to 20 million coronavirus cases, and up to 100,000 deaths.

Those numbers can be blunted, with aggressive social distancing and testing, to somewhere between 16,900 and 40,700 deaths.

Just as important, slowing infections – or flattening the curve – could spread those infections over 18 months instead of 18 weeks. Practically, that means there would be a need for 36,000 intensive-care beds between July and October in the worst-case scenario, compared with 26,000 ICU beds between October and January.

Who’s ‘flattening the curve’ on the coronavirus, and who isn’t? A global graphic comparison

That is essential to avoid the health system being overwhelmed, as it has been in Italy.

As we grumble about cancelled trips to sunny climes, about having the kids in our hair because schools are closed, and about toilet-paper shortages, we need to take a moment to ponder just how bad this pandemic could be if we are complacent.

Of course, we can hope that the projections are wrong. We can hope that, by some miracle, the coronavirus will not spread in Canada the way it is elsewhere in the Western world.

But hope isn’t a strategy.

Editor’s note: Editor's note (March 14, 2020): An earlier version of this story said Italy’s quarantine measures started two weeks ago. In fact, they start earlier this week.