Call for renewed lockdown as rising patient numbers point to 'deep, deep circumstances': Manitoba doctors

The number of COVID-19 patients in Manitoba intensive care wards has doubled in eight weeks and is now rising at a rate where hospitals may soon contend with volumes so far unseen in the pandemic, doctors warn.

Patients in Manitoba hospitals during the third wave of COVID-19 also tend to be sicker and younger than they were during the second wave, placing even more strain on hospital resources.

Faced with the prospect of hospitals becoming overwhelmed with COVID patients within weeks, hundreds of Manitoba doctors are once again calling on Premier Brian Pallister to enact more restrictions.

"They have to increase restrictions to blunt this curve, or we're going to be in deep, deep circumstances within two to three weeks, if not sooner," said Dr. Dan Roberts, an intensive care physician at Health Sciences Centre and one of 212 signatories on a letter sent to the premier Tuesday evening.

On Tuesday, Manitoba intensive care units were treating 47 COVID-19 patients. That was more than double the provincial volume of ICU patients with COVID-19 on March 10, when the number bottomed out at 21 people.

The number of COVID-19 patients in ICUs started to rise more rapidly late last month, as some of the thousands of Manitobans battling the disease became more acutely ill.

"At this rate we are going to exceed the second-wave peak by next week at the latest," said Dr. Heather Smith, an intensive care unit physician at St. Boniface Hospital, Grace Hospital and Health Sciences Centre in Winnipeg. 

"The patients are younger and sicker and the staff are exhausted."

The number of COVID-19 patients in intensive care in Manitoba peaked during the second wave at 55 patients in early December, not including COVID patients who were no longer infectious.

The total number of all COVID-19 patients in Manitoba hospitals during the second wave peaked above 400, also in December. At the peak of the second wave, the ratio of COVID patients in ICU versus hospital overall was about one to six.

During this third wave, the ratio of COVID patients in ICU to the overall number of COVID patients in hospital is about one to three.

Care capacity approaching maximum

Right now, Manitoba ICUs are able to care for all these patients, even as doctors and nurses struggle with heavy workloads.

On Tuesday, a total of 108 patients of all diagnoses — COVID and non-COVID — were being treated in intensive care wards.

During the second wave, that number peaked at 129 patients. The system is designed to care for a maximum of 72 ICU patients.

Roberts said he is not certain Manitoba hospitals will have enough staff to care for their most acutely ill patients in the coming weeks.

"You can ask Ontario what they're going through now, asking for ICU physicians and nurses from outside the province. So I don't doubt that this progression could be even worse than what we saw in December and January, and the possibility that we won't be able to cope is definitely there," Roberts said.

Glen Drobot, an internal medicine doctor based at St. Boniface Hospital, said he is concerned for his ICU colleagues.

"I think people have reached the end of what they can do professionally. It's affecting people's personal lives, it's causing burnout," he said.

"My colleagues will do the best that they can, but we're worried that that may not be enough for what we think is going to happen in the next couple of weeks."

Younger patients, longer stays

The number of COVID-19 patients and the severity of their condition are not the only factors causing concern. The average age of COVID patients in hospital and in ICU is dropping.

"The [ICU] population was elderly, being mainly senior patients and patients from nursing homes back in November and December," Roberts said. "Now we're seeing people as young as 18."

Right now, roughly half the COVID-19 patients in Manitoba hospitals are under the age of 60. Of the 47 currently in ICU, six are under the age of 40.

Younger patients tend to stay longer in hospital because they are stronger and less likely to have do-not-resuscitate orders.

While this bodes well for the death rate due to COVID-19 hospitalizations, it also means more people must be cared for at any given time.

Fearing the prospect of hospitals becoming overwhelmed, the 212 signatories to Tuesday's letter are calling on the premier to enact a lockdown that would close all non-essential businesses and expand restrictions on gatherings.

"For prevention to be effective, we need to shut down when cases begin to rise," says the letter, co-ordinated by emergency physician Dr. Lisa Bryski. 

"It is like calling the fire department when our basement is full of smoke. If we wait until the entire house is on fire, it is far too late." 

'Ineffective, late reaction'

The doctors also called for financial support for shuttered businesses and sidelined workers, including paid sick leave and vaccination leave. They also called for immediate vaccination eligibility for all Manitoba teachers, school staff and child-care workers.

Premier Brian Pallister said in a statement Tuesday he takes advice about restrictions from Chief Provincial Public Health Officer Dr. Brent Roussin.

Pallister said his government "will implement the necessary measures to protect Manitobans from COVID-19 and to ensure our health-care system has the capacity to care for Manitobans when they need it."

Health Minister Heather Stefanson also sent a statement Tuesday, thanking health-care professionals for their work and saying she meets with them on a regular basis.

"Preparations for the third wave are ongoing, and include work to address the challenges that COVID has exacerbated, such as staffing shortages and challenges with patient flow," Stefanson said.

A spokesperson for Manitoba Shared Health also noted several doctors recently wrote an open letter to Manitobans, pleading with them to observe existing public health restrictions.

The province's slow reaction to rising COVID-19 infection rates and caseloads is disappointing, Roberts said.

"This is the same ineffective, late reaction that we saw back in November with this government," he said.

"It's forgivable to make a mistake and to learn from that mistake, but it's not forgivable to refuse to face reality and learn from your mistakes — and they don't show any evidence of doing that."