Still unsafe to see grandma: Assessing the risk of Manitoba’s broad reopening strategy

By | April 30, 2020

After seven weeks of dutiful compliance to pandemic-induced public health orders, Manitobans have been rewarded with a very broad reopening strategy that may be the most ambitious so far in Canada.

It is not, in some ways, very clear.

On Monday, most retail stores will be allowed to reopen, though many won’t be able to find the staff and some may be reluctant to bother. 

Dental clinics, physiotherapy offices and therapeutic massage practitioners can go back to work, in theory, but their professional organizations are still scrambling to figure out the ramifications and locate protective equipment.

Restaurants can reopen their patios, but many are not certain how they will be able to manage long lines of customers on the sidewalks near their businesses.

Parents have been advised they can access child-care spaces if they are working, but many daycares are still scrambling to be able to deliver this service.

People heading to campgrounds will have to balance their freedom to do so with the logistical impairment of being advised not to purchase any groceries, gas or other supplies in vacation country.

These are just some of the headaches associated with a 34-page plan Premier Brian Pallister unveiled on Wednesday.

There is even greater confusion surrounding verbal guidance from Dr. Brent Roussin, Manitoba’s chief provincial public health officer.

At no point during this pandemic has Roussin ever offered proscriptive advice — that is, rules rather than recommendations — about how people ought to gather in their homes, greet elderly relatives outside care homes, and socialize with neighbours.

Dental clinics are allowed to reopen Monday in Manitoba. Many intend to do so only for urgent procedures. (Trevor Brine/CBC)

Roussin has been very clear it’s a very bad idea to socialize with anyone you don’t live with, especially vulnerable elderly people. His catchphrase “now is not the time” will forever be remembered as the definitive slogan from the early phase of the COVID-19 pandemic in this province.

But he has never told anyone they may not engage in any particular social activity, as a rule.

This may be problematic as Manitobans learn they are permitted to have a pint of pale ale on a patio on Monday, but are still advised not to imbibe that beverage on their own patio with their neighbours.

Continued caution required

The broad reopening of the economy, which Pallister and Roussin have characterized as cautious, relies on continued prudence on the part of Manitobans when it comes to physical distancing.

On one hand, our leaders appear to be saying it is now safe to resume a range of economic, social and leisure activities. On the other, they are saying it is more crucial now than ever not to relax our collective commitment to wash our hands and staying the heck from each other.

This apparent contradiction was exemplified on Wednesday by Roussin’s response to a simple question: Is it now OK to go visit grandma?

“As we’re starting to loosen things we need to protect those most at risk, and so, you know, it’s still a time of caution,” said Roussin, suggesting it remains a terrible idea but not quite saying so.

“[Just because] we’re able to loosen things doesn’t mean we’re safe. It just means that this is the time that we can start loosening some of the public health restrictions.”

It remains up to the listener to deduce the doctor is suggesting grandma remain enclosed in bubble wrap for the time being.

How many more deaths are acceptable?

Roussin’s guidance of the province during the initial phase of the pandemic can only be described as successful, given Manitoba’s early adoption of pandemic measures, definitive declaration of public health orders, relatively low COVID-19 case numbers and what has become a very flat disease growth curve.

Nonetheless, the information emanating from his office is often vague.

Roussin has said many times that he expects the number of COVID-19 cases to rise once the economy is reopened.

On Wednesday, he declined to predict how many cases of the disease or how many more deaths would result from fewer restrictions on businesses and public movement.

Roussin suggested he does not have any models that can predict the effect of the first phase of Manitoba’s reopening strategy on COVID-19 cases.

All he would say is he will monitor the number of positive COVID-19 cases, the number of people showing up at hospitals with serious respiratory symptoms, and the number of people who show up in intensive care wards in the coming weeks.

“This [reopening] is going to be careful. It’s going to be cautious and we have the ability to roll this back as soon as we get a sense that things are turning back,” he said.

“It’s a broad reopening. There’s a lot of things that are able to reopen, but within that reopening, it’s very restrictive.”

Many potential new disease vectors

The problem with the broad reopening is it won’t be easy to quickly determine which sector of the reopened economy is responsible for potential spike in COVID-19 cases.

Contact tracing — the time-consuming process of determining where a COVID-19 patient may have acquired the novel coronavirus that causes the illness — will be required to determine whether any given Manitoban contracted it from a dentist, delicatessen or a dog-food retailer.

Manitobans must continue to practise physical distancing, officials advise. (Trevor Brine/CBC)

So many new businesses are opening up all at once, it will be a challenge for Roussin and his public-health colleagues to identify new vectors for the disease.

Hence the importance of continuing physical distancing and keeping in place the travel restrictions that have helped insulate this province from the worst of the pandemic.

Roussin has suggested restrictions could return if infection rates increase. He did not say how more cases of COVID-19 would be acceptable, how high a growth rate would be acceptable or how many more hospital cases would be acceptable.

The short answer to that question is more cases are expected. Otherwise, Lanette Siragusa, Shared Health’s chief nursing officer and systems-integration lead, would not have noted the ability of the province to create 100 more intensive-care-unit beds.

There is risk associated with reopening. Roussin and the premier have signalled it is an acceptable risk, given the low numbers of COVID-19 cases and hospital patients at the moment.

All Manitobans ought to be aware of this risk before they determine it is OK to relax a little.

There is no rule against going to visit grandma, but it remains a bad idea.

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