What Manitobans need to know about COVID-19

By | March 12, 2020

The latest:

  • 14 of the 15 presumptive and confirmed cases of COVID-19 in Manitoba are believed to be related to travel, public health officials said Wednesday morning. Investigations continue in the 15th case.
  • There’s currently no evidence of community transmission in the province, but health officials said we’re likely to see it here as more travel-related cases emerge.
  • There are no new presumptive cases of COVID-19 Wednesday morning, provincial health officials said.
  • One new dedicated testing site opened in Brandon Wednesday morning, with more in the works.
  • Seven new presumptive cases were announced late Tuesday afternoon, nearly doubling the province’s total to 15.
  • Services at licensed daycares, except for home daycares, will be suspended at the end of Friday, public health officials announced on Tuesday.
  • All casinos are closed.
  • Public health officials recommend suspending visits to long-term care facilities, with the possibility of exceptions for compassionate reasons.

Manitoba is ramping up its health-care system to take on COVID-19, after the province announced March 12 it had identified its first presumptive cases of the illness caused by the coronavirus.

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 presumptive positive case.

That case, involving a Winnipeg woman in her 40s who had travelled to the Philippines, was later confirmed by the National Microbiology Lab in Winnipeg.

“Fear and panic will not help against COVID-19. But our preparedness and credible information will.”

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’re also asked to practice social distancing — avoid gatherings of more than 50 people and stay two metres away from others in public.

If you’ve recently travelled internationally, the province asks you to self-isolate and self-monitor for symptoms for 14 days after returning to Canada.

How many cases are in Manitoba, and what do we know about them?

Manitoba has 15 presumptive and lab-confirmed cases of COVID-19 as of Tuesday, including seven cases announced on Tuesday alone. That announcement nearly doubled the province’s previous total.

Fourteen of those cases are related to travel, public health officials said Wednesday morning. Investigations continue into the remaining case.

Here’s what we know about the first 15 cases in Manitoba, in the order they were announced to the public:

  • Case 1: A woman in her 40s from Winnipeg, who had been in the Philippines (announced on March 12).
  • Case 2: A man in his 30s from Winnipeg, who had recently travelled internationally (announced March 12).
  • Case 3: A man in his 30s from Winnipeg, who had recently travelled internationally (announced March 12).
  • Case 4: A man in his 40s from Winnipeg, who had recently travelled in South Korea, the Phillipines and Japan (announced March 13).
  • Case 5: A man in his 70s from Winnipeg (announced March 15).
  • Case 6: A woman in her 70s from the Interlake region (announced March 15).
  • Case 7: A woman in her 50s from Winnipeg (announced March 15).
  • Case 8 (presumptive): A man in his 80s from Winnipeg (announced March 16).
  • Case 9 (presumptive): A man in his 60s from a community in the Southern Health Santé-Sud Health region (announced March 17).
  • Case 10 (presumptive): A woman in her 60s from a community in the Southern Health Santé-Sud Health region (announced March 17).
  • Case 11 (presumptive): A woman in her 60s from Winnipeg (announced March 17).
  • Case 12 (presumptive): A woman in her 50s from Winnipeg (announced March 17).
  • Case 13 (presumptive): A woman in her 40s from Winnipeg (announced March 17).
  • Case 14 (presumptive): A man in his 30s from Winnipeg (announced March 17).
  • Case 15 (presumptive): A woman in her 50s from Winnipeg (announced March 17).

Contact tracing is ongoing for all cases, the province said.

Public health officials said preliminary investigations indicate individuals aboard certain flights on March 7 and 8 may have been exposed.

  • Philippines Airlines Flight PR 466 from Manila to Incheon, Korea — rows 48 to 54.
  • Air Canada Flight AC 0064 from Incheon, Korea, to Vancouver International Airport — rows 30 to 36.
  • Air Canada Flight AC 8622 from Vancouver International Airport to Winnipeg — rows 24 to 29.

Individuals who were on these flights, like all international travellers, are asked to self-isolate and monitor themselves for symptoms for 14 days following the exposure. Roussin said Wednesday there’s little evidence of much transmission on airplanes.

Is community transmission happening?

As of Wednesday morning, there was no evidence to show community transmission is happening in Manitoba —  but Roussin said the risk is increasing as more travel-related cases emerge.

“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,” Roussin said Wednesday morning.

The province already is preparing for that to happen, Roussin said. Social distancing measures that already have been implemented in the province, for example, are usually not used until after community transmission is documented.

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?

The first thing you should do is call Health Links — Info Santé at 204-788-8200 or toll-free at 1-888-315-9257. The service is available 24/7 and staffed by nurses.

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

Siragusa said previously that staffing levels for Health Links have been nearly tripled, with more staff being trained, in response to a spike in call volumes that’s causing the delays. The phone line received nearly 2,100 calls on Tuesday alone, Siragusa said Wednesday.

Health Links staff have been given shorter scripts to speed up interactions, and 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. 

You can also use an online screening tool launched Monday night in an effort to reduce wait times.

The tool will ask you a series of questions, the same ones you’d be asked if you called Health Links, to let you know what to do. Since its launch Monday evening, it’s had more than 13,000 hits, Siragusa said Tuesday.

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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, the province says to call 911 before you go to an emergency department or urgent care centre.

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 being offered to a few groups: people who have symptoms and have travelled internationally, people who have symptoms and known exposure to the virus, and ICU patients with respiratory illness, Roussin said Monday.

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

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 and throat — no special equipment or training required. They’ll send that to the province’s lab, Cadham Provincial Laboratory, to be processed.

If the swab comes up as possible coronavirus, it’s called a presumptive 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 Monday.

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.

As of Wednesday, the province had completed about 2,900 tests for the virus, but that number is growing. Health Minister Cameron Friesen said health-care workers took 500 swabs to be tested on March 11 alone — up from an average of roughly 40 in the days beforehand.

Tests are offered at eight dedicated spots in Manitoba. Four 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.).

All four are open Monday to Friday from 9 a.m. to 7 p.m. and weekends from 9 a.m. to 4 p.m.

The 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 dedicated testing site in Thompson, Flin Flon, The Pas and Brandon, with more expected to open shortly:

  • 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.

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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 and walk-in traffic is discouraged, Roussin said.

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

How can I protect myself?

The novel coronavirus is almost exclusively transmitted by those who have symptoms, and through close, prolonged contact, Roussin said.

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

  • 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.

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

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

He advised all Manitobans to cancel or postpone any non-essential international travel. If you recently travelled internationally, 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.

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.

On Friday, Roussin cautioned Manitobans against “panic buying.”

“We’re certainly advising against fear,” Roussin 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 Monday it will bar entry to all travellers who are not Canadian citizens, permanent residents or Americans.

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 meters (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 door knobs 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?

If someone disobeys instruction to self-isolate, the province has tools to enforce it, Roussin said Monday.

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

“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.”

How is the province reacting to COVID-19?

Right now, the province is using a containment strategy — meaning it’s focused on reducing opportunities for COVID-19 to spread within the community — based on the understanding that the coronavirus that causes the illness is primarily spread by people who are showing symptoms.

However, the province’s planning has turned from prevention to planning for a “robust system response,” Lanette Siragusa, Manitoba’s chief nursing officer and the provincial lead on health systems integration quality, said on March 12. That means increasing staffing, adding capacity and expanding access to testing.

To help curb the spread of the virus, Manitoba schools will suspend classes starting March 23, Manitoba Education Minister Kelvin Goertzen announced on Friday.

The province will end classes a week ahead of spring break and keep kids out until April 13.

Services at licensed daycares, except home daycares, will be suspended at the end of Friday, Premier Brian Pallister announced Tuesday. Roussin said provincial regulations limit home daycares to eight children per centre.

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 at the end of Tuesday.

As of Tuesday, the province also recommends individuals and organizations cancel or postpone any gatherings involving more than 50 people.

The province said it will provide 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 Monday.

What about hospitals and health-care centres?

Hospitals are already in the process of looking for space for patients and keeping staff up-to-date. Public health officials have sent a memo to health-care workers discouraging any non-essential travel out of the province.

Visitor restrictions are in place at all acute care centres in Manitoba, limiting visits to one visitor at a time, except for parents of children in hospital and possible exceptions made on a case-by-case basis.

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

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 an email Wednesday. It also has positive pressure rooms, which are protective environments for patients with compromised immune systems.

If you have surgery scheduled, it may be postponed, if your surgeon has determined the procedure can be safely delayed for three months or longer without any significant effects on your health, in an effort to protect vulnerable patients.

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.

If your surgery is postponed, you’ll be contacted directly.

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On Friday, the province posted signs at long-term care centres discouraging visits from ill or potentially exposed people. They’re also asking 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 is also advising 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 Monday, 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.

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

As of March 12, Manitoba had 243 ventilators and had ordered 20 more, Siragusa said. That doesn’t include ventilators currently in operating rooms, she said.

The province has 85 ICU beds, a provincial spokesperson said Tuesday.

Manitoba, like other provinces, is taking inventory of the personal protective equipment and other supplies currently in the province, and planning for what else would be needed if there’s an outbreak here, 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,” he said 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 Wednesday. Fit-testing for the N95 respirators, which need to be fitted to the wearer, is also ongoing.

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