Lock down Manitoba because 'it's too late' for targeted restrictions, doctors urge government

The time is now for a provincewide shutdown due to surging COVID-19 numbers straining the health-care system, more than adozen Manitoba doctors say.

In a letter addressed to the premier and health minister published by theWinnipeg Free Presson Friday morning, the doctors saidthey feel duty bound to express their concerns about where things are heading.

"We're well past the stage where even a robust community response will significantly slow the epidemic. Fortunately, your government has already shown us what needs to be done," the letter said.

What's needed, the letter says,ismass closures like thoseimplemented in Manitoba and elsewhere when COVID-19 emerged in the spring.

The letter came out hours before the province moved Winnipeg and the surrounding area to code red, or critical,under Manitoba's pandemic response plan following arecord number of daily cases and the province's highesttest positivity rate.

The rest of the province was moved up to level orange, restricted, which is one degree below red.

Thechanges come into effect Monday.

Before news of the daily reported record 480 cases was announced Friday, the doctors warned that once Manitoba hits more than200 daily cases,COVID-19 "will overwhelm resources" in a span of one or two weeks.

"We cannot allow this epidemic to progress unchecked."

Manitoba has recently repeatedly broken records for test positivity, daily cases, hospitalizations and intensive care unit admissions.

Two of the doctors who signed the letterhave expressed concerns to CBC News this week Dr. Anand Kumar, an infectious disease expert and intensive care unit physician at Health Sciences Centre, and Dr.Philippe Lagac-Wiens,a medical microbiologist and physician at St. Boniface Hospital.

Thedoctors saidthe springtime lockdowneffectively "crushed the progress of infection within weeks" because of widespread collaboration among communities and government.

Manitobans "bore tremendous hardship" due to that lockdown to protect the vulnerable, but the doctors saidlifting restrictions let the virus back in.

Current approachno longer working

The doctors saidthe same sacrifice is warranted again because evidence suggests the spread is in the early stages of exponential growth.

They pointed to El Paso, Texas a community with roughly the same population as Winnipeg as an example of why the current incremental targeted approach, or escalation strategy, won't get things under control in Manitoba.

The targeted approach has involved ramping uprestrictions in hot spots, then gradually phasing them out as conditions improve.

El Paso had daily case counts between 150 and 200 as of Oct. 1, but by mid-monththose counts ballooned to between 350 and 550 per day, the doctors said. By Thursday of this week the Texas city had registered 1,100 cases in one day, more than 900 people were in hospital, over 220 were in ICUsand 111 were being ventilated.

"We simply don't have that kind of capacity, even with emergency measures," the doctors warned, sayingthetargeted incremental approachwon't work in Manitoba anymore.

"This incremental approach [is] not suited for epidemics involving a rapidly progressive and dangerous infection such as the COVID-19 virus. And it will fail," the letter said.

"By the time definitive evidence of failure of the incremental targeted approach to stop epidemic progression is apparent, it's too late. You are two or three weeks behind. A targeted intervention we start today might work if that intervention had an immediate impact. It does not. The number of infections we are seeing now was determined by our interventions (or lack of them) several weeks ago."

Manitoba's intensive care bed capacity is "dwindling," Shared Health's chief nursing officer said Wednesday. St. Boniface Hospital, where there's anoutbreak, officially ran out of ICU beds Thursday.

Manitoba Health Minister Cameron Friesen said Thursday the current approach isn't working, and he hinted more restrictions would be coming soon.

'My grandma ... I think of her'

The doctors whosigned the letter aren't the only ones speaking out.

"This has me quite afraid," Dr. Joanna MacLean told CBCInformation Radiohost Marcy Markusa on Friday morning.

"I'm worried that the stresses that are being placed on the health-care system might get overwhelming."

MacLean, a resident in emergency medicine at the U of M, is also worried about the long-term effects on the community at large, her loved ones andherself.

The people most severely impacted by COVID-19 include those above the age of 65, though Manitobans age 20 to 40 make up the bulk of cases.

A millennial herself, MacLean cautions her generation to not be complacent. She sympathizes with people experiencing COVID-19 "fatigue" butimploreseveryone to think ofthe people in their lives who are mostvulnerableright now.

"For me that's my grandma I think of her," she said.

"I am going to stayhome as much as I can, I am not going to work if I feel unwell, I am going to wash my hands all the time, I am always going to wear my mask when I am out in a public space. If we can really focus on those fundamentals and do them with love and a community spirit in mind I really think that we can flatten the curve."

The following doctors signed the letter:

• Anand Kumar, MD
• Dan Roberts, MD
• R. Bruce Light, MD
• Eric Jacobsohn, MD
• Steven Kowalski, MD
• Allan Ronald, MD
• Greg Hammond, MD
• Fred Aoki, MD
• Philippe Lagace-Wiens, MD
• Terry Wuerz, MD
• Kelly McDonald, MD
• Faisal Siddiqui, MD
• Sukarno Chaudhry, MD
• Joel Enock Nkosi, MD
• David Hochmann, MD
• Dave Easton, MD
• Paddy Griffin, MD
• Eric Bow, MD