• Sharmistha Mishra, Linwei Wang, Huiting Ma, Kristy C Y Yiu, J Michael Paterson, Eliane Kim, Michael J Schull, Victoria Pequegnat, Anthea Lee, Lisa Ishiguro, Eric Coomes, Adrienne Chan, Mark Downing, David Landsman, Sharon Straus, and Matthew Muller.
• Division of Infectious Diseases, Department of Medicine (Mishra, Coomes, Chan, Muller); MAP Centre for Urban Health Solutions (Mishra, Wang, Ma, Yiu, Landsman), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Paterson, Schull), University of Toronto; ICES (Paterson, Kim, Schull, Ishiguro); Decision Support (Pequegnat, Lee), Unity Health Toronto; Division of Infectious Diseases (Chan), Sunnybrook Health Sciences, University of Toronto; Infection Prevention and Control (Downing), St. Joseph's Health Centre, Unity Health Toronto; Department of Medicine (Straus), St. Michael's Hospital, University of Toronto; Infection Prevention and Control (Muller), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. sharmistha.mishra@utoronto.ca.
• CMAJ Open. 2020 Jul 1; 8 (3): E593-E604.

BackgroundIn pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired.MethodsTo estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R0 = 2.4) resembled the early trajectory (to Mar. 25, 2020), and compared the default model projections with observed COVID-19 admissions in each hospital from Mar. 25 to May 6, 2020.ResultsFor the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity.InterpretationScenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.Copyright 2020, Joule Inc. or its licensors.

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