1 new case Tuesday, diagnostic test delays: What Manitobans need to know about COVID-19

By | March 10, 2020

Manitoba is under a state of emergency as the province fights the COVID-19 outbreak.

Provincial officials announced March 12 they had identified Manitoba’s first probable cases of the illness caused by the coronavirus.

There are now 21 identified cases in the province.

Here’s a rundown on what Manitobans need to know about how the health-care system is responding, what to do if you think you’re sick and how to help stem the spread of the coronavirus.

Should I be worried?

You should be responsible and informed. You should not be panicking, said Dr. Brent Roussin, Manitoba’s chief provincial public health officer.

Manitoba’s health-care system was expecting and prepared for the arrival of COVID-19, he said.

“I want to be clear that we are not helpless against this virus,” Roussin said on March 12, while announcing the first probable positive case.

“Fear and panic will not help against COVID-19, but our preparedness and credible information will,” Roussin said.

The province asks you to wash your hands often, cough or sneeze into your sleeve, avoid touching your face and stay home if you’re sick. You also must practise social distancing; gatherings of more than 50 people are no longer allowed and you should stay two metres away from others in public.

If you’ve travelled — internationally or within Canada — you must self-isolate and self-monitor for symptoms for 14 days, Roussin said, effective March 23. Some exceptions are made for truckers, people who live in border communities, as well as for cottagers, he said.

How many confirmed cases are in Manitoba?

Manitoba has 21 confirmed and probable cases of COVID-19 as of Tuesday morning. One new case was announced Monday morning, but another one that was probable has been ruled out. Another new case was announced Tuesday morning.

So far, all the confirmed cases in Manitoba are linked to travel, Roussin said. Previously, officials had said they were still investigating the origins of one case to see if it was connected to travel, but Roussin said Monday that was the case that was ruled out.

He also said on Sunday that one Manitoba patient got the virus after going to B.C.

On Thursday, Roussin announced one person was in hospital with mild symptoms and in stable condition. That person was still in hospital on Saturday, but on Monday, Roussin said no patients remain in hospital.

Contact tracing for patients continues, the province said.

The province now has a web page with information about flights that carried passengers infected with COVID-19.

Is community transmission happening?

Roussin said Sunday that the province has no confirmed cases of community transmission in Manitoba — although it’s not conducting mass testing.

The province can’t do mass testing right now because of the need to use resources efficiently, Roussin said. The province’s lab is already working around the clock and there’s a limited worldwide supply of a reagent needed to complete the test.

The provincial lab has started to make some of its own reagent to try to keep up.

In the meantime, the province is using “syndromic surveillance” to try to track the virus’s progress, Roussin said. That means tracking things like hospital admissions and critical care occupancy.

“We’re going to see more cases for sure, and we’re likely, very likely, to start seeing community transmission as more and more of this virus is imported here,” he said last week.

The province is preparing for community transmission, Roussin said. Social distancing measures implemented in the province, for example, are usually not used until after community transmission is documented, he said.

When community transmission is documented, the province will move to a mitigation phase, he said: heightening the social distancing measures that are already in place.

“We’ve been out ahead of things,” Roussin said.

What should I do if I think I have COVID-19?

If you are concerned, you can self-screen using an online tool from the province, or over the phone with an interactive voice response tool. The phone survey isn’t a replacement for Health Links or a direct connection.

Both platforms will ask you a series of questions to let you know if you need to call Health Links. The phone survey can be reached at 1-877-308-9038.

If you do need to call Health Links — Info Santé, you can do so at 204-788-8200 or toll-free at 1-888-315-9257. The service is available 24/7 and staffed by nurses.

On Tuesday, the average wait time for Health Links was roughly 29 minutes, said Lanette Siragusa, Manitoba’s chief nursing officer and the provincial lead on health systems integration quality.

Staffing levels for Health Links have been quadrupled, with more staff being trained, in response to a spike in call volumes that’s caused delays, Siragusa said. The phone line received approximately 2,400 calls on Monday alone, Siragusa said.

The service has added a dedicated COVID-19 phone line option in an effort to cut wait times, Siragusa said. Student nurses also have been brought in to help staff the phone lines.

The nurse will ask a series of six questions about your symptoms, your travel history and possible exposures to figure out whether you need to be tested or start self-monitoring.

Depending on your answers, they may advise you to monitor your symptoms on your own, stay in self-isolation or go get tested. 

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If you have to go to the hospital, you or the Health Links nurse you’re talking to must phone ahead to let health-care workers know that you’re coming. When you arrive, you’ll be given a mask to wear and put in isolation, to ensure no one else gets sick.

If it is an emergency, call 911 before you go to an emergency department or urgent care centre, provincial officials said.

Don’t show up without calling ahead first so the centre can get ready for your arrival.

Who is being tested?

Right now, testing for COVID-19 is only offered to a few groups: people who have symptoms and have travelled, people who have symptoms and known exposure to the virus, and ICU patients with respiratory illness, Roussin said March 16.

Testing also is being done automatically on all samples taken from people for respiratory illness, whether or not they request testing for COVID-19.

The testing priority is people who have returned from travel, in-patients, health-care workers, samples from personal care homes and First Nations, health officials said on Thursday.

If you don’t have symptoms, don’t get tested, Roussin said. If you head to a clinic without symptoms to try to get tested, health-care workers should decline to test you, he said.

How does testing work in Manitoba?

If you need to be tested, a health-care worker will take a nasopharyngeal swab, which involves sticking a long, skinny cotton swab into your nose — no special equipment or training required. They’ll send that to the province’s lab, Cadham Provincial Laboratory, to be processed.

Many places have closed because of the COVID-19 pandemic. (Tyson Koschik/CBC)

If the swab comes up as possible coronavirus, it’s called a probable case. Those cases get sent to the National Microbiology Lab to make sure. If your symptoms are severe, health-care workers may request deep lung specimens, too.

Once the test gets to the lab, results are expected to come in 24 to 48 hours.

The province’s lab has ramped up capacity to do testing, Roussin said.

If you test positive at the provincial stage, you will be notified and given instructions for self-isolation. Health officials are working out a process to contact people who get negative results, too, Siragusa said March 16.

While you’re waiting for your results, you’ll be asked to self-isolate and self-monitor. Manitoba Health cautions that this process can be stressful, so don’t neglect your mental health. Connect with friends and family by phone, email or social media, and focus on hobbies or tasks while you wait.

About 4,500 tests for COVID-19 had been completed as of Monday, the province’s website says.

Tests are offered at 12 dedicated spots in Manitoba; five of them are in Winnipeg:

  • Access Winnipeg West (280 Booth Dr.).
  • Access Fort Garry (135 Plaza Dr.).
  • Access Transcona (845 Regent Ave. W.).
  • Mount Carmel Clinic (886 Main St.).
  • Manitoba Public Insurance Bison Drive Service Centre (15 Barnes St.) — drive-thru site.

The health-care centres will stay open for regular business, too, but patients there for testing will wait and get treated in separate areas from other patients.

If you’re there for testing, you’ll be given a mask when you arrive and asked to clean your hands. You’re also advised not to just show up — call Health Links first, to give them time to notify the clinics so they can prepare for your arrival.

There are also additional testing sites in Thompson, Flin Flon, The Pas, Brandon, Selkirk, Steinbach and Winkler with more expected to open:

  • Thompson: Thompson Clinic in Thompson Plaza Mall at 50 Selkirk Ave.
  • Flin Flon: Channing Auditorium in the Flin Flon Community Hall, 2 North Ave.
  • The Pas: Guy Hall, 28 First St. W.
  • Brandon: Nurses’ Residence Gym in the Brandon Regional Health Centre at 150 McTavish Ave E.
  • Selkirk: 622 Superior Ave. — drive-thru site.
  • Steinbach: Steinbach Community Services building at 365 Reimer Ave. — drive-thru site.
  • Winkler: Winkler Centennial Arena at 600 Park St. — drive-thru site.

At the Winkler, Steinbach, Selkirk and MPI Winnipeg sites, patients who get referred to the site can drive up to be screened by health-care workers, and, if necessary, get tested and be given advice without leaving their vehicles.

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Remember, only people who require screening or testing with symptoms of COVID-19 should head to these sites. People should be referred to these sites by Health LInks, Roussin said.

Right now, there are no home testing or mail testing options.

How can I protect myself?

Public health officials generally advise everyone to practise social distancing techniques, which include these recommendations:

  • No gatherings of more than 50 people.
  • Minimize prolonged contact (more than 10 minutes) and close contact (less than two metres) with people in public.
  • Avoid greetings that involve touching (like handshakes).
  • Disinfect frequently used surfaces.
  • Consider avoiding travel, as well as crowded places and events, especially if you are at higher risk.

Follow standard flu or cold prevention techniques. That means washing your hands often, using soap and warm water, for at least 20 seconds before drying thoroughly.

Cough or sneeze into your sleeve or use a tissue (which you should then throw out, before washing your hands). If you’re sick, stay home, even if your symptoms are mild.

If you have kids, make sure they avoid sharing food or drinks, or anything that goes into their mouths, with others. Don’t organize play dates for your children, Roussin said on Thursday.

Getting outside and staying active outdoors is a probably a good thing, Roussin said, although it’s difficult to give general rules without knowing an individual’s specific circumstances. If you do go outside, don’t forget about social distancing.

“I would encourage people, you know, get out to the park, stay active, stay healthy. There’s more to our health than just avoiding this virus,” he said. “But keep in mind those general social distancing strategies.”

The virus spreads primarily through close contact with infected individuals who are showing symptoms, Roussin said. He stressed the greatest risk comes from close, prolonged exposure to someone who is sick.

“All Manitobans have a role to play” in stopping the spread of the virus, he said.

If you recently travelled outside of Manitoba, you should self-isolate and self-monitor for 14 days after your return.

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He also cautioned Manitobans to be wary of phishing scams reported since the outbreak began, where scammers call people posing as fake public health officials and ask for credit card information. Don’t give any financial information out over the phone, Roussin said — a real public health official would never ask for that.

Health Minister Cameron Friesen has previously said there’s no need to start stockpiling groceries or other gear in preparation for isolation — despite advice from federal Health Minister Patty Hajdu, who said in February it would be wise for Canadians to set aside a week’s supply of medicine and food.

Friesen has said, however, it’s always smart to ensure you have a good supply of any medications you take.

The province said on Friday that prescriptions will be limited to 30-day supplies, to prevent the stockpiling of medications and ensure a continued supply.

Roussin cautioned Manitobans against “panic buying” in his March 13 news conference.

“We’re certainly advising against fear,” he said. “But I’m all for credible information, making informed choices and getting ourselves prepared for seeing this virus in our community, and really making those changes to our lives.

“If you’re not making even the smallest change to the way you live your life, you’re not playing your role in minimizing the spread of this virus.”

The federal government also announced on March 16 it will bar entry to all travellers who are not Canadian citizens, permanent residents or Americans.

The federal government later announced that the Canada-U.S. border will close to all but essential travel, trade and commerce as of Saturday.

Prime Minister Justin Trudeau also announced no one who is displaying symptoms will be permitted to board a flight to Canada, and air operators will be required to complete a basic health assessment of every passenger based on guidelines from the Public Health Agency of Canada.

What’s self-monitoring?

If you haven’t shown symptoms yet but you were exposed to the virus, or potentially exposed, you might be asked to self-monitor. You could also be asked to do this while you’re in self-isolation.

Self-monitoring means monitoring your general well-being to see if symptoms develop. It also means taking your temperature twice daily. You might be asked to avoid taking acetaminophen or ibuprofen, which could hide symptoms like fever.

If you develop a fever of 38 C or higher, or if you have any COVID-19 symptoms, you need to self-isolate right away — avoid physical contact with others — and get tested. That’s when you’d call Health Links, to give them time to let the health-care facility know to expect you and prepare for your arrival.

The symptoms you need to be watching for are fever, cough, shortness of breath or breathing difficulties, muscle aches, weakness, headache, sore throat, runny nose or diarrhea.

What’s self-isolating?

Manitoba Health says most people who get COVID-19 will have mild symptoms. Those people will be asked to self-isolate at home, instead of heading to the hospital (which will only be recommended for the severely ill).

Self-isolation means staying home and keeping yourself out of situations where you might infect other people. That means you can’t go anywhere you might be in contact with people — or, basically, anywhere.

You’ll need to limit contact with people who haven’t been exposed, even if they’re family members or people you live with. If you need groceries or supplies, ask friends or family to pick them up for you, or use a grocery delivery or pickup service, and instruct whoever drops them off to leave the package at your door to avoid direct contact. 

If you have service providers who come into your home, cancel their visits if you can. If they provide necessary care, like home care, you need to notify them. Otherwise, no visitors.

If you live with someone, avoid situations where you could have close contact, avoid sharing household items and wash items thoroughly with soap and warm water after using them.

Stay in your own room or separated from others — at least two metres (six feet) away. If you can, use a separate bathroom, flush with the toilet lid shut and clean everything frequently. Clean commonly touched objects like doorknobs and computers regularly, and wear disposable gloves while you clean. Ensure your home is properly ventilated by opening windows and doors if weather allows.

You still need wash your hands regularly and cover up coughs and sneezes.

What happens if I ignore instructions about self-isolation?

As of 4 p.m. on Friday, public gatherings over 50 people are banned in Manitoba.

The public health order allows shopping centres, groceries, pharmacies and other retailers to remain open, provided they keep people one to two metres apart.

It also applies to public transportation, which must allow passengers to remain at a distance from one another.

Restaurants, bars and live performance venues are limited to 50 people or half capacity, whatever is lower. 

Public health inspectors and peace officers may be used to enforce the order, Roussin said on Friday

At first, violators would be asked to comply. If they do not, successful prosecutions could result in penalties of up to six months in jail or or $50,000 for individuals who fail to comply with the order.

The Public Health Act allows the province to take action to protect the health of the public, including “coercive means,” Roussin said earlier in the week.

“It could include a communicable disease order under the act, to order them to self-isolate. And it could go all the way to an order to apprehend that person, if we felt they were an immediate risk to public health.”

What’s been closed so far?

The province declared a state of emergency on Friday. Schools closed at the end of that day, and are set to remain closed until April 13. Casinos have also been closed.

Under the public health order, restaurants, bars and live performance venues are limited to 50 people or half capacity, whatever is lower. Places like gyms, bingo halls and fitness centres must be closed.

The City of Winnipeg closed its recreation centres, pools and libraries until further notice. Front counter services have been suspended for the parking authority, animal services, community services and the assessment and taxation department, but you can still call 311.

Fire paramedic stations are now closed to public access, but emergency services can be reached by calling 911.

Many other organizations have also made changes or announced closures or cancellations. You can find the latest on closures here.

How is the province reacting to COVID-19?

On Friday, the province declared a state of emergency in order to enforce a public health order. It gives officials the power to enforce social distancing measures and give out penalties. 

“This is to prepare us, to put us on that footing, so we’re able to react and be nimble,” Premier Brian Pallister said. 

Under the state of emergency, Manitobans must observe a 50-person gathering limit. That does not apply to health-care or social services facilities, or workplaces.

Anyone breaking these orders can face a fine of up to $50,000 or months in jail — however, they will first be asked to comply.

To help curb the spread of the virus, Manitoba schools suspended classes as of Monday, Manitoba Education Minister Kelvin Goertzen announced on March 13. Classes will stay out until at least April 13.

The province is working with Manitoba Health to make sure front-line health-care workers have access to child care, Pallister said. Parents who are front-line health-care workers or emergency services providers who can’t find alternative child care are asked to call 204-945-0776 or 1-888-213-4754 (toll free).

All casinos closed on March 17.

The province provides daily updates on the status of the virus.

The province also has asked all employers to help employees find ways to work from home, and to suspend their requirements for sick notes if people are ill.

“Our health-care system needs to be responding to the pandemic, not spending time writing notes for ill staff,” Roussin said March 16.

What about hospitals and health-care centres?

Visitor access is suspended at all Manitoba hospitals. Exceptions for compassionate reasons will be made on a case-by-case basis, Roussin said.

For pediatric patients, one parent or guardian will be allowed to visit at a time.

A 30-bed isolation unit is being prepared at the former women’s pavilion at Health Sciences Centre in case it’s needed, provincial officials said on Thursday.

Most COVID-19 patients can be put up in any single room for isolation, Manitoba Health said. However, hospitals are also preparing negative pressure rooms, Roussin said, which are special, private rooms that control ventilation to allow air in, but not out, to prevent cross-contamination. The rooms would be used to conduct any procedures that could generate aerosols from a person’s airway, including intubation.

The province has dozens of negative pressure rooms in all five health regions, a Manitoba Health spokesperson said in a March 18 email. It also has positive pressure rooms, which are protective environments for patients with compromised immune systems.

In addition, some non-essential surgeries will be delayed in order to free up more resources to respond to the pandemic, starting Monday, the province said on Friday.

Hospitals will continue with scheduled surgeries that cannot be delayed, such as those for cancer and trauma. 

Time-sensitive orthopedic, obstetrical, gynecology and ophthalmology surgeries will also continue, Siragusa said. 

On Tuesday, Siragusa said non-essential diagnostic tests unrelated to COVID-19 will also be delayed unless they’re deemed urgent. This includes some X-rays, including labs, blood tests and imaging.

The same goes for non-invasive cardiac tests, she said, which will be postponed for the time being.

Patients whose surgeries or non-essential diagnostic tests have been delayed were being contacted starting Friday. If you haven’t been called, you can assume your surgery will go ahead as planned, Siragusa said. 

All elective surgeries for patients older than 70, patients with significant co-morbidities like diabetes or cardiovascular conditions and immune-compromised patients will be postponed, according to directions to health-care workers on Shared Health’s website.

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On March 17, public health officials recommended suspending visits to long-term care facilities, with the possibility of exceptions for compassionate reasons.

The province posted signs at long-term care centres on March 13, discouraging visits from ill or potentially exposed people. They also ask people who have travelled internationally in the past 14 days, or who have been instructed to self-isolate, to stay away. The sites have changed the way residents get meals, too, so people aren’t all eating together.

CancerCare Manitoba also advises patients who have symptoms of respiratory illness not to visit their sites. Instead, those patients should call their health-care team and follow their instructions on next steps. Cancer patients should check the website for regular updates.

Health-care workers who have travelled internationally must inform their organization’s occupational health services. If they are deemed to be essential, they may be allowed to work with precautions in place, Roussin said March 16, though work is still being done to finalize guidelines for health-care staff.

The province also is working with Doctors Manitoba to offer appointments over the phone or by video chat. Patients can contact their medical clinic ahead of time to see whether their appointments can be done virtually. Clinics may also reach out directly to patients to offer the service as it gets underway.

Public health officials have sent a memo to health-care workers discouraging any non-essential travel out of the province. All health-care workers who return from international travel must inform their management or occupational health teams.

Does the province have enough equipment to deal with COVID-19?

As of Thursday, Manitoba has 266 ventilators after receiving 23 more, and 16 more will be delivered in the coming weeks, Roussin said.

The province has 85 ICU beds, a provincial spokesperson said on March 17. 

Plans are underway to open 30 isolation beds in the previous women’s centre pavilion at Health Sciences Centre to ensure capacity for COVID-19 patients, the health minister said.

Manitoba, like other provinces, is taking inventory of the personal protective equipment and other supplies currently in the province, and planning for what else will be needed, the health minister said. Personal protective equipment, also called PPE, includes special masks, N95 respirators, gloves, gowns and eye protection.

Friesen said the province currently has enough equipment in stock for months to come, but out of an “abundance of caution,” the province is buying more.

The province will spend roughly $35.2 million to buy supplies that can go to regional health authorities, service delivery organizations, personal care homes and fee-for-service clinics. The equipment ordered will also include disinfectant wipes and hand sanitizer.

Training and refresher lessons are being offered to staff on how to use the equipment properly, a provincial spokesperson said in an email on March 18. Fit-testing for the N95 respirators, which need to be fitted to the wearer, is also ongoing.

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