More than 1 million international visitors are expected to travel to Canada in June as Toronto and Vancouver host 13 matches of the FIFA World Cup. In Toronto alone, officials are anticipating roughly 300,000 World Cup visitors who will join hundreds of thousands of others in overlapping events, including the Luminato Festival, Pride Toronto, and NXNE, throughout the month.

Research has shown that mass gathering events strain emergency department (ED) and hospital resources. Will Canada’s health systems be able to handle the increased demand? Catherine Varner, MD, MPH, an ED physician in Toronto and deputy editor of CMAJ, examined this question in a recent editorial.

“I worked games 1 and 7 of the World Series when our hospital had one [ICU] bed available,” Varner told Medscape News Canada. “I don’t think that type of situation should be allowed when we have 300,000 visitors in our city over a 1-month period and large numbers of mass gathering events happening repeatedly.”

Healthcare System Vulnerabilities

In her editorial, Varner underscored the main takeaways from 2 years of war game exercises undertaken by healthcare leaders, Canadian Armed Forces officials, and federal and provincial governments based on a hypothetical war in Europe.

“Should such a scenario occur, the impact in Canada would be seismic, and healthcare systems would be overwhelmed immediately,” she wrote.

“People who are looking at systems capacity, whatever vantage point they’re coming from, whether it be defense, infectious disease outbreaks, mass gathering events, we all come to the same conclusion, which is that we don’t have enough hospital beds in Canada in the event of an acute need,” said Varner.

Major Trevor Jain, MD, PhD, assistant professor of emergency medicine at Dalhousie University in Halifax and spokesperson for the Canadian Association of Emergency Physicians (CAEP), agreed.

“We know we have a severe ED overcrowding issue across the nation. Politicians and administrators are citing respiratory illness as the reason, but there’s evidence from the CAEP that we have an outflow problem in our hospitals. We can’t get patients out of emergency to acute care floors where they need to be treated,” said Jain.

“When you have an influx of 300,000 people for events like the World Cup, the medical usage rate for all aspects of healthcare — the paramedics on the street, the hospitals, and clinics — go up,” he said.

Jain referred to France’s experience during the 1998 World Cup games. “There was a 27% increase in volumes in the ED,” he said. Data from a retrospective observational study examining ED usage in Metz, France, during that time demonstrated a significantly increased median number of admissions on the day before, the day of, and the day after the game.

Varner also pointed to the role of provincial governments. “Multiple provinces in Canada are facing hospital bed closures when in fact we need more and more capacity because they’re not funding the hospital system in ways that maintain current service levels,” she said. “I would have thought that this flu season, when people have been dying in waiting rooms and waiting over 8 hours for emergency care, would make provincial governments blink, but it hasn’t.”

A Vulnerable Nation

Loose guidelines for mass gathering events suggest maintaining one doctor, two nurses, and four paramedics per 10,000 participants, said Jain. “The caveat is that you can’t replicate a mini healthcare system at the site because you are robbing Peter to pay Paul. Not only are we overcrowded, but there’s a deficit of doctors, nurses, and infrastructure,” he said.

“We don’t have surge capacity in our current healthcare system to accommodate an acute need for hospital beds in a mass gathering,” said Varner. She emphasized that Canada has the lowest number of hospital beds per capita, compared with peer nations, which increases the country’s vulnerability and reduces care quality. “We need a Team Canada approach,” she said.

“Unless there’s significant change in a short period of time for more staff, more structure, and proper utilization of disaster medicine specialists, it’s going to be a dog’s breakfast,” said Jain.

Varner and Jain reported having no relevant financial relationships.

Liz Scherer is an independent health and medical journalist. She frequently covers Canadian and European health news.