Premier Brian Pallister referred recently to critical comments regarding the provincial response to the COVID-19 crisis made to the local media by a Manitoba intensive care unit doctor. I am that doctor and I’d like to respond to his comments directly.
As a prelude, I’d like to say that I am in no way a political partisan. I have no political affiliation. I consider myself a physician first and a Canadian second.
Pallister seems to suggest we are doing well in Manitoba compared to provinces outside the Atlantic bubble. Why are we excluding the Atlantic bubble? This area is the gold standard in Canada against which we should compare ourselves. Do we really want to proudly claim that we are better than Ontario, where ICUs appear to be at imminent risk of collapse? Or Quebec, with the highest death rates in Canada?
The provinces of the Atlantic bubble made the right decisions at the beginning of the Canadian epidemic. They proactively decided on a strategy of maximum suppression of viral infections (as did other jurisdictions across the world that now have outstanding results) rather than one where case counts are allowed to rise until such time as they threaten health care and ICU capacity — as we’ve done here in Manitoba and other parts of this country.
The truth that few will speak is this: the number of COVID-19 cases and deaths per capita in the Atlantic provinces is 15 times lower than the rest of Canada. Had Manitoba adopted a maximum suppression strategy, as many recommended, with resulting population-adjusted death rates similar to the Atlantic bubble, there would likely be 900 more Manitobans alive today. The raw numbers required to make this calculation are publicly available through the Public Health Agency of Canada. This is simple and indisputable high school math.
Looking forward, is it still possible to implement such measures here? Yes it is; the hard and longer shutdown that would be needed would be painful, but not a lot more painful than the shutdown that’s imminent anyway with 261 new cases reported Thursday.
It is true that the ICU physicians like myself, who advocate for shutdowns and maximal suppression strategies, don’t feel the brunt of those shutdowns directly. However, I resent the implication that we are unaffected. We all have spouses, partners, family members, friends and neighbours who do. Many have businesses and jobs at risk. I can promise you, we don’t take the risk of financial injury to them or to the rest of the community lightly.
Nor are we immune to mental-health concerns. My wife and I have octogenarian/nonagenarian parents living with us who have not been able to go out safely for a year. And a child who has lost more than a year of on-site schooling. Depression is a serious issue for all of those affected by shutdowns, my family and my colleagues included.
As a counterpoint to the premier, I’ll point out that we ICU/ER/hospital physicians, and all the other front-line health-care workers, particularly nurses, feel most of the brunt of the failure to expeditiously implement restrictions when it becomes obvious we’re losing control of case counts. I’ve had more than one nurse suggest that they feel less like heroic soldiers in a winning war and more like expendable ammunition in a losing battle.
I’m seeing spectacular degrees of burnout and emotional devastation among ICU nurses and other health-care workers, including physicians, respiratory therapists (RTs) and others, many of whom are unable to speak their reality owing to employment-related restrictions on their communications with outside parties.
If our senior political leaders want to get a real sense of what their preferred strategy of intervening only when hospital capacity is threatened has done to the mental health and well-being of health-care workers, I challenge them to hold a meeting with a group of randomly selected ICU and ER nurses, as well as RTs, outside of working hours and without names being divulged to their employers.
Finally, the premier has suggested that he would rather follow the advice of Dr. Brent Roussin and his public health team than outside experts. I have the greatest respect for Roussin and his team, even if I disagree with some of the timing and decisions the premier has ascribed to their advice. I have no doubt Roussin and his team have, in private, given and continue to give the premier the best advice they can.
I also have no doubt that the premier, as our most senior political leader, has also integrated the advice of various core constituencies, including the business and religious communities, as well he should.
However, if he has made a serious misjudgment on how to balance his obligations to these various interests and constituencies and the community at large, that is ultimately his responsibility. That is the nature of elected political leadership. Nine hundred excess deaths would strongly suggest such a misjudgment.
Dr. Anand Kumar is a physician in an intensive care unit in Winnipeg, and a University of Manitoba professor of medicine and medical microbiology.