Pandemic 2020: We Need A Lockdown To Stop The Bleeding

A tourniquet is necessary. IMMEDIATELY.

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February 21, 2013, in Raleigh, North Carolina, Winnipeg Jets rookie defenceman Zach Redmond took a tumble during morning practice.

A teammate, unable to avoid him, skated over the back of his right leg, severing his femoral artery and sending geysers of blood pumping on to the ice.

The situation was dire — it was the sort of injury from which an average male can bleed to death in less than three minutes.

But Zach wasn’t destined to die that day.

Assistant coach Perry Pearn saved his life. While others frantically used towels to apply pressure to the gushing wound, Pearn calmly removed his jacket and twisted it into a tourniquet above the injury, choking off the flow of blood and buying the young player critical time to get to hospital for emergency surgical repair.

Redmond was told post-operatively that he had a 50–50 chance of playing again; but six weeks later he was back on skates practicing with his team.

Had it not been for Pearn’s quick and decisive response amidst the chaos on the ice that fateful February morning, Redmond would be pushing up daisies today rather than chasing hockey pucks for money.

earn’s heroics symbolize the action we need today — on a much larger scale — as we navigate the chaos of the COVID-19 pandemic.

The situation is dire. Unless we apply a tourniquet — and quickly — the lives of many thousands of Canadians will bleed away, along with our health care system and the economic foundations of our country.

Five days ago — on Saturday, March 21 — I published an essay titled “By Flattening The Curve We Are Flattening The World”. I made the case that immediate, complete societal lockdown (apart from essential workers and supply chains) is key to choking off the rapid spread of the novel coronavirus in our communities.

It’s the only way to create the breathing room we desperately need to devise and deploy emergency solutions to this crisis.

Five days have passed. Still no nationwide lockdown. Still no tourniquet.

The novel coronavirus continues to replicate furiously, jumping from host to host to host, pumping infectious copies of itself into every nook and cranny of our neighbourhoods in mindless service to the inexorable law of exponential mathematics — a law that has no agenda, a law that ignores class and race, a law that cares not one whit about politics or ideology.

Hospital beds and intensive care beds across Canada are now beginning to fill with COVID-19 patients as we careen onto the upward slope of an infectious bell curve that tracks with eerie similarity the one previously traced by Italy.

We are today where Italy was several weeks ago.

On March 21 st, the day I published “Flattened”, Canada recorded 241 new cases of the novel coronavirus — for a total of 1,295 cases.

On March 24, 701 new cases pushed the tally to 2,654 nationwide — doubling the total in three days.

Yesterday, March 25, saw the total climb to 3409. Thirty-five people are dead. And we’re barely getting started.

taly, after initially dragging its heels — after getting slapped in the face by 9000 cases and 600 dead — finally woke up to harsh reality. They finally locked everything down on March 9th.

As of yesterday — sixteen days later — Italy’s numbers had grown to 75,000 cases and 7,500 dead, respectively. Italy’s health care system lies in ruins; twenty percent of its health care workers lie either sick or dead — and the carnage is far from over.

The Italians didn’t think this could happen to them. Sandra Zampa, undersecretary of Italy’s Health Ministry, said this to the New York Times:

“Italy looked at the example of China … not as a practical warning, but as a ‘science fiction movie that had nothing to do with us.’ And when the virus exploded, Europe … ‘looked at us the same way we looked at China.’”

Canada, like Italy before it, is dragging its heels. Canadians are behaving as if this virus will treat us differently than it has treated Italy, Spain, and France — as if it will give us a pass because we’re just so darn polite.

It won’t.

I’ll reiterate: Italy was forced to full lockdown when they had 9000 cases. We will be at that number in Canada IN FIVE OR SIX DAYS.

Unless we lock everything down. NOW.

We’ve closed schools and universities; we’ve pleaded with Canadians to engage in aggressive social distancing, and most Canadians have complied; we’ve finally engaged in proper airport restrictions; we’ve closed our border with the U.S. to all but essential travel.

All of these things are important. But the Italians attempted to get by with these very same measures — before they capitulated to reality and locked down their country completely.

The measures we’ve taken will prove to be too little and too late — in Canada just as in Italy. Collectively, they’re like using a splayed hand to suppress the pulsating flow from a severed femoral artery — and then watching helplessly as blood gushes between the separated fingers.

We do have a couple things going for us compared with the unfortunate Italians. Canadians tend to greet each other with a version of “How’s it going, eh?” — perhaps attended by a perfunctory handshake. Italians are rather more demonstrative, inclined to offer warm embraces and a kiss on each cheek. They were, I should say: the rapid spread of CoVID-19 has put an abrupt end to those affectionate practices.

Of greater significance, the Italians are significantly older, on average, than we are; and CoVID-19 has a distinct preference for the elderly.

ut like the Italians we left our airports wide open for far too long, allowing thousands of infected travelers to stream into every region of our country.

Like the Italians, we haven’t tested nearly widely enough-even if we wanted to test properly, we don’t have the capacity to make it happen.

Like the Italians, we haven’t engaged in the aggressive contact tracing so critical to the containment success enjoyed by countries like Singapore and Taiwan

Like the Italians, we are woefully short of hospital space and ICU beds and ventilators.

Like the Italians, we are dangerously short of personal protective equipment for our health care providers.

That’s why we need complete lockdown.

A lockdown will achieve two essential goals:

  1. It will immediately and dramatically suppress the spread of this virus.
  2. It will buy time for us to generate emergency solutions to the above shortcomings.

How long the lockdown will need to remain in place is a subject of intense debate (and beyond the scope of this piece). Suffice it to say that with aggressive generation of resources, and with careful planning, it shouldn’t be required for more than four to six weeks.

Many, many bright medical minds are at work on strategy, on potential treatments, and on developing a vaccine. There will be light at the end of the lockdown tunnel.

On the vaccine front, some very good news: the most recent evidence suggests that the virus is mutating less rapidly than previously feared. That bodes well, both for vaccine development and for the generation of herd immunity.

Mountains of COVID-19 data are accumulating rapidly — we know more with each passing day. The pandemic environment is no longer completely chaotic, as it was at the outset when we knew nothing and agreed on nothing.

Although the crisis remains extraordinarily complex, we now have plenty of evidence to weigh as we carefully plot our way forward.

It’s extremely important to emphasize one key aspect to a sensible lockdown: the elderly, and the medically at risk, must be segregated away from everyone else.

Again, we must learn from Italy, where aging, elderly Italians tend to age with their families rather than in care homes. In a terrible irony, when the universities and schools in that country closed to promote social distancing, the distance between young people and their grandparents shortened dramatically as students and kids stayed home. The situation intensified when full lockdown went into effect on March 9 th.

It was the perfect storm. It was, as Dr. David Katz put it in an Op-Ed in the New York Times, like throwing numerous lit matches in with small patches of dry tinder. The elderly sickened and died at a furious rate.

We must follow the example of my wife’s ageing parents in Calgary, who have been on the equivalent of lockdown for a month.

They largely stay at home. They visit us and our children only by FaceTime, and they’ve ventured out only for short walks in contact with no one, and once or twice for a drive in their car. Groceries and essentials are delivered to their front steps as needed.

That should be the lockdown model, as much as possible, for everyone over 65 and for anyone who is medically compromised.

he other point to emphasize is that lockdown must be strictly enforced.

It’s tempting to shake our heads disapprovingly at the Italians, 40,000 of whom have been charged with lockdown violations. But a recent poll suggested that fully twenty percent of Canadians believe that the virus scare is overblown, and our behaviour corroborates that.

Witness the continued crowds on Vancouver’s seawall and beaches, the traffic at malls across the country, the knots of young people hanging out together, the play dates that continue to happen, the social gatherings that carry on unperturbed — as the viral freight train rounds the bend and hurtles down upon us.

It’s all intensely disturbing for those of us working the medical front lines. As a colleague, Dr. Hart Stadnick, tartly observed on social media a few days ago:

“Some of us have volunteered to stand on the railway tracks, and that’s fine, we signed up for it. But if the masses could quit shoveling coal into the locomotive, it would be appreciated. Stay the fuck home.”

We’ve lost precious, precious time. But it’s still not too late.

The best time to enact a lockdown was weeks ago. The next best time is NOW.

But the window is steadily closing.

Every hour we delay will cost additional lives.

Every hour we delay means more patients will be denied a ventilator.

Every hour we delay means more of our loved ones dying — alone — in a CoVID-19 isolation ward.

Every hour we delay means more people will die from heart attacks, strokes, and trauma for lack of proper care amidst a health care system in chaos.

We mustn’t delay any longer.

Apply the lockdown now.

Apply the tourniquet.

Before we bleed out.

Originally published at on March 26, 2020.

Pediatric Emergency Physician

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