Advice from a pandemic hot spot MD

Opinion

Hey there, time traveller!
This article was published 02/11/2020 (1417 days ago), so information in it may no longer be current.

The facts are stark: 480 new cases reported in a single day; a test-positivity rate of 9.7 per cent; ICUs at capacity, refusing to accept additional patients.

Is this Texas? Florida? Trump? No… Winnipeg.

I grew up in Winnipeg but I’m an ER doctor in New York now. I had front-row seat to the first wave of COVID-19 here; we grappled with tough decisions and fought hard to care for patients during the surge. We watched as friends, relatives and colleagues became ill. We watched as our public-health system buckled under the weight of this pandemic and we felt the economic toll of lockdowns and restrictions.

In New York, we’re doing better now, but I’ve had to watch from afar as Winnipeg sinks further into the COVID-19 quagmire — despite having had the opportunity to learn from nine months of pandemic; despite warnings from front-line health-care workers that the province was not doing enough.

Last Friday, more than a dozen of my most senior colleagues took the highly unusual step of writing a public letter urging a lockdown. Signatories to that letter include some of the most accomplished ICU and infectious-disease specialists in the province. These are physicians who have dedicated themselves to looking after the sickest patients in the most desperate circumstances. It’s time to heed their call. Here’s what needs to happen:

Immediate closure of all spaces where COVID-19 can spread easily. Restaurants, gyms, bars and shopping malls, offices and schools have all been linked the spread of COVID-19. We’re learning that the virus moves through super-spreader events, and these settings offer opportunity for this kind of spread. A single spin class in Hamilton resulted in 74 COVID cases.

Additionally, it makes no sense to conclude these measures are needed but delay them for three days, as was announced last Friday. That’s three more days of exponential growth, and it lengthens the total lockdown time needed to control the pandemic. I know this decision is a hard one. Per-capita, Winnipeg is now the epicentre of COVID-19 in Canada. There is simply no other way. Partial measures have been tried in many other places and they haven’t worked.

Testing, testing, testing. I’ve been tested for COVID-19 four times. I get my results the next day. Roughly half of people with COVID-19 have mild symptoms or no symptoms; asymptomatic testing is essential for surveillance. These tests are available on the international market, and the province needs to work with Health Canada to make them much more widely available in Manitoba.

Furthermore, a five- or six-day turnaround, which is commonplace now in Manitoba, is ineffective. Of the 480 cases reported Friday, most were likely swabs taken Monday or Tuesday. At best, you’ve been running five days behind. This has to get fixed.

Masks. For everyone outside their homes. All. The. Time. The evidence behind mask wearing is overwhelming. The CDC has recently revised its definition of “close exposure,” and it’s clear that two metres of distance is not a substitute for wearing a mask. You need both. Masks are widely available and dramatically slow the spread.

Furthermore, everyone over the age of four should wear one. I now wear an N95 mask for eight hours continuously, and I understand that it can be hard. The key is to go slow. Put on the mask and read a book. Breathe slowly. You’ll get used to it, I promise. The Canadian Thoracic Society strongly endorses this recommendation and has been very clear that masks will not exacerbate underlying conditions such as asthma.

Fund the health-care system. The last few years have been hard for health care in Manitoba; cuts, closures and staff reductions have taken a lasting toll. Now it’s going to need to surge, and that takes resources. Looking at other jurisdictions, you can get a sense of what’s required. The province will need to double its ICU capacity in the coming weeks. It will need to open up large numbers of rehab and nursing-home beds for post-acute care. Shelter arrangements will be needed for patients who live collectively or are homeless.

The WRHA should be making plans to open large numbers of new beds to handle the surge. This requires government spending, and there’s simply no way around it. The province must make a direct investment of financial resources into the COVID-19 fight.

The next few weeks will be tough if Manitoba gets this right. The next few months will be unimaginably difficult if Manitoba gets it wrong.

Jeremy Rose is a former Winnipegger and a graduate of the University of Manitoba faculty of medicine who currently works as an emergency-room physician at Mount Sinai Beth Israel Hospital in New York City.