How Canadian doctors are preparing for potential FIFA World Cup public health challenges

As Toronto and george vancouver pitch up to co-host FIFA domain transfuse games this summertime, an emergency doctor worries that Canada's overburdened health-care system won't be able to handle any extra demand that could result.

In an editorial published Monday in the Canadian Medical Association Journal (CMAJ) Dr. Catherine Varner points out that Canada's health-care system is already in a "constant state of surge capacity." Add in hundreds of thousands of visitors, she wrote, and it could be a recipe for disaster. 

Her concern is supported by years of research showing that health issues — like infectious disease outbreaks, food-borne illnesses and alcohol overconsumption — can strain emergency rooms during or after mass gatherings. 

For example, researchers found that a strain of measles was introduced to Vancouver during the 2010 Olympic Winter Games and resulted in an outbreak of 82 cases three months after the event.

Researchers have also noted that during the Calgary Stampede, there is an increase in emergency department visits related to trauma, substance-abuse and minor injuries. And research has also found that World Cup matches could trigger an increase in the number of cardiac emergencies.  

There's also the possibility of large-scale attacks that can send many to hospital, like the one that took place early last year at Vancouver's Lapu-Lapu festival. 

Varner started looking into these sorts of examples after working at a Toronto hospital during the Toronto Blue Jays' World Series run this past fall.

"We had one ICU bed available and I could not imagine what we would do if we faced an event downtown where we needed to see a lot of patients quickly," she said of the hospital she works at.

And while Varner says she knows that in extreme cases there's a process in place to quickly move patients and free up the emergency department, she questions how that would work given the current state of health care in Canada.

"The challenge is execution of those plans in a health-care system that does not have enough hospital beds on any given day," she said. 

Canada is co-hosting this year's FIFA World Cup along with the United States and Mexico. And with six games scheduled in Toronto and seven in Vancouver, the country could see hundreds of thousands of visitors over the course of four weeks. 

Crowds of fans interacting with each other before, during and after matches is the perfect breeding ground for various infectious diseases, specifically respiratory or food and water-borne ones, according to a report from Public Health Ontario. 

Following a months-long risk assessment, the provincial health agency determined that measles, COVID-19 and food and water-borne outbreaks like food poisoning or hepatitis A, are "likely" during the World Cup games.  

Dr. Brian Conway, the medical director of the Vancouver Infectious Diseases Centre, says he's most concerned about measles, given the recent outbreaks across Canada that have caused the country to lose its elimination status.

"Measles is so contagious," he said. "It will spread potentially like wildfire. And that'll put a strain not only on the health-care system … but the public health system will be doing contact tracing amongst a lot of people." 

Conway, who is not part of any health-care planning for the World Cup, said people should make sure they're up to date with their vaccinations. 

Sexually transmitted infections (STIs),  some of which are on the rise in Canada, are another key concern for Conway, who says condoms and treatment for STIs should be easily available. 

He says he hopes existing disaster and surge plans will "be enough to deal with anything that comes forward." 

Dr. Mark Lysyshyn, the deputy chief medical officer of health with Vancouver Coastal Health, is also confident that the city will be able to handle any sort of public health emergency. 

"The health system does respond to issues like this with some regularity and does have mechanisms in place," said Lysyshyn, who is part of public health planning for Vancouver's FIFA games.

"Although the health-care system operates at pretty much capacity, it does have a lot of mechanisms to get extra capacity." 

And while Lysyshyn acknowledged that it's not ideal to have to cancel surgeries or move people around, he says that's how the system here works.

"We have to prioritize the system to deal with the problems that are most urgent." 

While St. Michael's Hospital trauma surgeon Dr. Andrew Beckett says all hospitals have robust plans to accept a large number of people in need of immediate medical attention. 

"The Taylor Swift concert, we had plans in place," said Beckett, who is also the medical director of the hospital's trauma program.

When it comes to the World Cup, Beckett says he's part of a planning group alongside leadership from Sunnybrook Health Sciences Centre and Sick Kids. 

"We're looking at ways of being able to surge capacity within the hospitals by shutting down some elective surgeries if needed. Also recalling [staff] that may be in the area and available to help out in a crisis," said Beckett. 

He also said they would triage patients to hospitals depending on the severity of their injuries and the level of care needed. 

Beckett says the province has provided additional funding to support emergency resources during the World Cup games, though he couldn't say how much.

Ontario's Ministry of Health didn't respond to questions about extra staffing or resources available to support an increase in demand, nor did it confirm whether additional funding is available for hospitals. 

In an email last week, a spokesperson said the government will work with all health-care partners to "ensure they have the tools they need to deliver high-quality care." 

In a report to city council, Toronto Public Health (TPH) listed several ways it's preparing for various health emergencies, including launching a food safety portal to keep track of inspections and more easily share information about possible illnesses with the public.

As for extreme heat or wildfire smoke, the health unit says it will amp up its communication to visitors and will have misting stations and water trucks available.

The city is also launching a wastewater testing program for the stadium and fan zone areas, which can be an early indicator of circulating infections.

Videojournalist

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