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The COVID-19 assessment centre located at Scarborough Health Network - Centenary Hospital, is photographed on Mar 26 2020. In all, 200 Ontarians ill with the disease were hospitalized in intensive care as of Saturday, a nearly fivefold increase over the past nine days.

Fred Lum/The Globe and Mail

One hospital has set up a tent it can use as a makeshift emergency room in the event of a “DEFCON 1” pandemic scenario; another has relocated dozens of patients waiting for beds in long-term care homes or other more appropriate services to a hotel; and a third institution has transformed an urgent-care centre into space for 100 in-patients.

As hospitals across Ontario brace for an expected surge of new coronavirus cases, they are pulling out all the stops to open more beds, not just by transferring existing patients but by setting up makeshift operations and turning space in their existing buildings into wards for COVID-19 patients.

Hospitals in Ontario face the spectre of running out of beds if the coronavirus continues to spread widely. In the worst-case scenario, the number of patients with COVID-19, the disease caused by the virus, could exceed hospital capacity as early as next week, according to projections from Ontario public-health officials.

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In all, 200 Ontarians ill with the disease were hospitalized in intensive care as of Saturday, a nearly fivefold increase over the past nine days.

The difference between the best- and worst-case scenarios for Canada’s most populous province will come down to the success of physical-distancing measures aimed at reducing the spread of the coronavirus, Peter Donnelly, chief executive of Public Health Ontario, said at a news conference on Friday.

Dr. Donnelly presented projections showing that hospitals across Ontario are planning to add another 900 intensive-care beds for COVID-19 patients to the 410 currently available. The province would have more than enough beds in the best-case scenario, the figures show. But in the worst-case scenario, demand would exceed capacity by April 14.

Hospitals are scrambling to make enough room for all the patients who become ill with COVID-19. William Osler Health System is setting up “surge capacity” tents at two of its hospitals as part of its pandemic plan. The first one went up this weekend in the parking lot at Brampton Civic Hospital northwest of Toronto and a second one is slated for Etobicoke General Hospital in the city’s west end.

Oscar Karbi, corporate chief of emergency services at William Osler, said the hospitals will use the tents as triage areas for patients if the coronavirus escalates, forcing hospital officials to trigger the fourth and final level of their pandemic plan, which he described as the “DEFCON 1” stage.

“We are nowhere close to that,” Dr. Karbi said in an interview. “We are actually operating just fine.”

William Osler’s hospitals are currently caring for 31 patients with COVID-19. If its hospitals are deluged with patients, William Osler would deploy physicians and triage nurses to the tents, where they would separate patients into high- and low-risk groups. At Brampton Civic, for example, low-risk patients – those with no symptoms of the disease – would be sent to the fracture clinic, which is routinely used to back up the emergency department. High-risk patients would be directed to the emergency department’s main entrance.

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The tents were donated by GlobalMedic, a not-for-profit that supplies the semi-permanent structures for disaster-relief operations around the world. Brampton Civic is the first hospital in Canada to receive one of its tents during the coronavirus crisis, GlobalMedic executive director Rahul Singh said.

Trillium Health Partners in Mississauga, west of Toronto, is adding 100 new beds to its Queensway Health Centre for in-patients who do not have COVID-19. The hospital created the beds by temporarily closing its urgent-care centre.

Hôtel-Dieu Grace Healthcare, a community hospital in Windsor, Ont., has taken in more than 200 patients from the city’s acute care hospital in the past month to prepare for a possible surge in COVID-19 admissions, said Bill Marra, vice-president of external affairs at Hôtel-Dieu.

Windsor Regional Hospital, the acute-care institution, has been hit particularly hard by the virus, with 21 patients who have tested positive for the disease as of Sunday. Mr. Marra said hospitals are looking at developing a field hospital “just to prepare for the worst-case scenario.”

Joseph Brant Hospital in Burlington, Ont., will see its bed capacity jump to 559 from 291 through a variety of measures, including relocating a hospice, which was temporarily housed in the hospital, and building a temporary pandemic unit to accommodate patients who need treatment for COVID-19.

Kingston Health Sciences Centre, the largest acute-care hospital in Southeastern Ontario, has 200 empty beds available for patients with COVID-19, said Kieran Michael Moore, medical officer of health for Kingston and neighbouring communities.

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The hospital cleared nearly half of its 440 beds by cancelling elective surgeries and moving many patients waiting for a spot in a long-term care home or other services in the community to a hotel.

The hospital normally uses three floors of the hotel for patients from remote communities in Northern Ontario. But as the virus began to spread early last month, Dr. Moore said the hospital stopped transferring patients from the north. “We absolutely wanted to protect the northern population from the virus,” Dr. Moore said in an interview.

As of Saturday, the hospital had only two patients with COVID-19, which Dr. Moore attributes to aggressive testing for the disease in the region.

With occupancy in Ontario hospitals hovering around a record low of 80 per cent, they have, at least for the time being, seen a chronic problem diminish: Patients are no longer lingering in many emergency departments waiting for a bed to become available.

William Osler’s Dr. Karbi said the coronavirus pandemic has caused patients to avoid the emergency departments, so volumes are way down. "It’s an interesting way of solving the hallway medicine problem,” he said.

With a report from Carly Weeks

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