Manitoba’s restrictions don’t go far enough and system could be soon overwhelmed, doctors say

By | October 30, 2020

Two Winnipeg doctors say they’re worried new restrictions announced Friday won’t be enough to slow Manitoba’s surge in COVID-19 cases — and they issued a grim prognosis for the ability of the city’s health-care system to cope with ever-rising hospitalizations.

As of Friday, there were 104 Manitobans in hospital with COVID-19, another record in a continuing record-breaking streak that is putting increasing strain on health care in Winnipeg. Nineteen of those people were in intensive care, with Winnipeg’s intensive care units at 96 per cent capacity, Shared Health Chief Nursing Officer Lanette Siragusa said.

Though health officials have tried to quell concerns by saying the health care system has capacity, Dr. Jillian Horton, a general internist in Winnipeg, said the system is already strained at the best of times. 

She compared the situation to taking five or six people into a household in an emergency — though it might be possible, it will stretch resources thin and hinder the way the household operates. 

“Now I want you to imagine that those five or six family members have a highly communicable illness and you have to wall them off and isolate yourself from them, and find a way to care for them and look after them while you continue to try to go about your life,” she said. 

“That’s really equivalent to what is happening in the hospitals.”

Dr. Jillian Horton is a general internist in Winnipeg. (CBC)

Something like adding ventilator capacity is incredibly difficult, she said, because not all physicians have the complex skills needed to operate them.

“You cannot just teach a physician to manage and run a ventilator,” she said. 

“I’m a general internist. I’ve been looking after really sick patients for the last 16 years — I no longer have that skill or could learn it quickly. I mean, our margins at the best of times in health care are so razor thin.”

Restrictions not enough

On Friday, as Manitoba added a record-setting 480 more COVID-19 infections to its toll, health officials announced broad new shutdowns for Winnipeg and the surrounding area, moving the capital region to the highest level on the province’s pandemic response scale. 

Though some businesses will be shuttered when the new rules come into effect Monday, and capacity will be drastically reduced at others, the province stopped short of ordering the more widespread closures that were seen this spring.

Horton doesn’t think what was announced Friday goes far enough.

“It’s like we’re trying to bargain with it. These numbers today have to tell us we are so far past [that]. There was never any bargaining,” she said. 

“This isn’t about what we want. It’s about an emergency. It’s about a crisis.… To get back the life that we want to have again, it requires really drastic measures.”

Further, she said communication from Premier Brian Pallister and Health Minister Cameron Friesen has been completely out of touch with the level of alarm, and dread, physicians have been expressing for weeks. 

“There has been a disconnect between what those physicians have been pleading with the government to do and the steps that the government has taken.”

Dr. Jillian Horton speaks with the CBC’s Andrew Nichols about where we are, and where we’re going, as Winnipeg goes to the red level, and the rest of Manitoba to orange, on the province’s pandemic response system. 10:43

Neither Pallister or Friesen were at a news conference Friday with Siragusa and Chief Provincial Public Health Officer Dr. Brent Roussin, where the red level restrictions were announced. 

In a written statement emailed to media on Friday afternoon, Pallister said his government “will continue to act on the advice of Dr. Roussin and our health-care experts.”

“It is our hope that these new measures will help slow the spread of this virus and ensure our health-care system is there for all Manitobans, when they need it.”

Doctor warns more could die without shutdown

Nearly 20 doctors signed a letter addressed to the premier and health minister that was published by the Winnipeg Free Press on Friday morning, calling for a provincewide shutdown.

“We are confident that another aggressive provincewide shutdown is coming. We see no real way to avoid that if we continue the current course. We can implement it now and, if we are fortunate, limit deaths to less than double what we have now,” the letter says. 

“Or we can shut down in three weeks and have a death count in the multiple hundreds.”

To date, there have been 65 deaths in Manitoba due to COVID-19.

One of the doctors who authored the letter echoed Horton’s warning that creating ICU capacity is not simple, and will be even more difficult with more doctors and nurses out of rotation because of COVID exposures. 

ICU care requires a lot of people, said Dr. Anand Kumar, an infectious disease expert and intensive care unit physician at Winnipeg’s Health Sciences Centre. 

Dr. Anand Kumar is an infectious disease expert and intensive care unit physician at Winnipeg’s Health Sciences Centre. (John Woods/The Canadian Press)

If Manitoba keeps averaging nearly 200 new cases a day, Winnipeg will far exceed its ICU capacity, he said. 

“The problem is … when you need life support, mechanical ventilation or other specialized things that can only be provided in ICU, when you blow past your capacity to handle ICU patients, every patient beyond there is going to die,” he said.

“So that’s a situation nobody wants to contemplate.”

Kumar said he thinks a hard shutdown is going to be needed, whether it happens now, or in a few weeks. 

“I think we’re going to end up in the same place. And unfortunately, if we’re in the same place in, like, six weeks, Christmas is gone. So that would not be ideal,” he said. 

“Not to mention that there will be a lot more deaths if we wait that long.”

This chart illustrates daily deaths, hospitalizations and ICU numbers of Manitoba COVID-19 cases. (Bryce Hoye/CBC)

The red line illustrates the percentage of COVID-19 tests that came back positive in Manitoba. (Bryce Hoye/CBC)

Dr. Allan Ronald, a retired doctor of medical microbiology who also signed the letter, implored Manitobans to take the pandemic seriously. 

“This has to be taken seriously by everyone. We are not going to be able to admit people that are falling apart because of this illness to intensive care units, because … the ICUs are full,” he said. 

“And without that, we’re going to see a large number of people dying of COVID.”

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