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Critical-care physician Dr. Alberto Goffi, left, and Andrea Rigamonti, who is the medical director of the trauma-neurosurgical ICU at Toronto's St. Michael’s Hospital, have been contacting colleagues in Italy for advice on dealing with the incoming coronavirus crisis in Canada.Katie Cooper/Handout

Among the biggest challenges facing Canadian critical-care doctors as they brace themselves for the coronavirus is that most have never treated a single patient made severely ill by the new pathogen, let alone the dozens a day who could soon need their help.

At Toronto’s St. Michael’s Hospital, home to one of the largest intensive-care units in the country, two Italian ICU physicians are racing to fill that knowledge gap with a steady stream of text, e-mail and WhatsApp questions to colleagues in Italy fighting the worst coronavirus epidemic outside China.

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“We are trained to deal with mass casualties. Usually they peak very quickly, but then they stop," said Alberto Goffi, a critical-care physician originally from Avigliana, a small town near Turin.

In parts of Northern Italy, he said, “every day is a mass casualty.”

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Dr. Goffi, 43, and Andrea Rigamonti, the 49-year-old medical director of the trauma-neurosurgical ICU at St. Michael’s, said they’ve been bowled over by the generosity of the exhausted Italian doctors who are informally advising their critical-care team in Toronto.

So far, three patients who came to St. Michael’s through emergency or a family-health team clinic have tested positive for COVID-19, the disease caused by the new virus, but none has been admitted to the ICU or anywhere else in the hospital.

Until that happens, messages from the Italian front are helping St. Michael’s understand everything from the speed at which severely ill COVID-19 patients deteriorate to the best techniques for mechanically ventilating them to the ideal way to expand and reorganize an ICU in the age of coronavirus.

“Despite being overwhelmed, they find time to answer my questions,” Dr. Goffi said of the Italian physicians in his WhatsApp group. “By knowing what they’ve done and what worked and didn’t work, we are already a step ahead.”

Stories from hospitals in and around Italy’s economic hub of Milan have shocked much of the Western world, including Canada, into shutting down schools, restaurants, workplaces and mass gatherings in hopes of slowing down the virus.

Italy reported 475 deaths from the coronavirus on Tuesday alone, the largest death toll logged in a single day in any country since the virus emerged in China late last year. The virus is known to have infected more than 35,000 and killed nearly 3,000 in Italy.

At San Raffaele Hospital in Milan, where Dr. Rigamonti trained, surge planning now includes opening makeshift ICU beds in a neighbouring tennis court, “which is covered with an inflatable structure like you would see in Canada for a hockey arena,” he said.

San Raffaele has converted operating rooms into extra ICU beds, but that’s not been sufficient to care for the daily onslaught of patients who need mechanical ventilation, Dr. Rigamonti added.

One of the most pressing questions for the St. Michael’s critical-care staff, led by chief Andrew Baker, is how the Italians have saved the lives of some of their COVID-19 patients.

No antivirals or other drugs seem to work, Dr. Rigamonti said, but ventilating patients in a face-down position appears to help.

Dr. Goffi said he was surprised to hear from his Italian colleagues that many of the COVID-19 patients on life support are in their 40s and 50s. “The older [patients], they have a higher mortality rate, but to us, what was shocking is that there are a lot of relatively young people in the ICU,” he said.

The COVID-19 mortality rate among older patients has both doctors concerned for their parents, who are practising strict social distancing back home in Italy.

Dr. Goffi’s parents, Armando, 73, and Ernestina, 67, still live in Avigliana in a house that backs onto a field. “They walk in the woods and the fields but they don’t see anyone," Dr. Goffi said. “Emotionally, especially for my dad, I think it would be a nightmare not being able to get out. From that perspective, they’re quite lucky.”

Dr. Rigamonti’s mother, Anna Maria, 78, lives on her own in Monza, a city northeast of Milan. His brother and sister drop off groceries outside her door, careful not to go inside and risk passing on the virus.

“It’s hard," Dr. Rigamonti said. "She feels lonely.”

Both Dr. Rigamonti and Dr. Goffi said they are hoping desperately that the social-distancing measures Canada has enacted in the past week will save this country from Italy’s fate.

The number of known cases of COVID-19 in Canada has increased dramatically in the past few days to more than 600.

“If the worst comes,” Dr. Rigamonti said, "we want to be ready.”

Editor’s note: This article has been updated to describe where the three patients originated and the specialty for Dr. Goffi.

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