What must happen before Manitoba starts to ease up on COVID-19 restrictions

By | April 24, 2020

After six weeks of mostly dutiful adherence to public orders aimed at slowing the spread of COVID-19, Manitobans are about to be rewarded with fewer restrictions on their lives.

As early as next week, Chief Provincial Public Health Officer Dr. Brent Roussin will unveil a plan to allow some shuttered businesses and likely daycares to reopen.

This will mark the start of a long, gradual and likely bumpy process of reopening the economy. The process is bound to last a few months, if not more than a year.

Every new freedom — such as allowing dentists to mess around with our mandibles again and letting eye doctors ask us to recite incorrect versions of the alphabet — will be followed by a few weeks of waiting and watching to count up new cases of COVID-19.

Reopening the economy will look a lot like playing a board game: Two steps forward, one step back but hopefully more forward momentum than reverse motion. 

The goal of the game is not to eliminate the virus; there is no means of doing that without a vaccine. What Manitoba is trying to do is manage the spread of SARS-CoV-2 to the point where active cases of the disease never rise to the point where our hospital intensive-care wards are overwhelmed by severe cases of COVID-19.

Here’s what has to happen in order to achieve that goal:

1. A plateau as a starting point

Manitoba wouldn’t even be thinking about easing COVID-19 restrictions without one key measure that’s already in place: A disease growth curve that looks a lot more like a pancake than a ski jump.

Over the past three weeks, new known cases of COVID-19 have arrived at rate of single digits per day. The number of active cases of the disease has been dropping. The proverbial curve has been flattened to the point where it would take months, not days, to double the number of total cases of the disease in Manitoba.

(Jacques Marcoux/CBC)

This is among the best performances of any jurisdiction on the planet. It’s the result of our isolated geography, early action in the form of public health orders, a socially responsible reaction to those orders by the vast majority of the populace, and maybe a little bit of luck.

The COVID-19 plateau is the starting place for what’s about to look a little like the jumpy line on a heart-rate monitor, with little peaks and valleys to mark the rise and fall of active cases as restrictions are loosened up.

2. More diagnostic testing

As of this week, Cadham Laboratory in Winnipeg is capable of completing about 1,100 diagnostic tests for COVID-19 every day. The lab uses a process called polymerase chain reaction testing, which takes a smidge of viral genetic material and copies it to the point where it can be identified.

PCR testing is  accurate when it comes to sampling nasal material from people with obvious respiratory symptoms. It’s not believed to be anywhere near as accurate when it comes to testing asymptomatic people, who may not shed the virus at similarly high levels.

Cadham Provincial Laboratory can test as many as 1,100 samples for COVID-19 every day. The premier wants Manitoba to be able to test 2,000 samples a day. (Walther Bernal/CBC)

Once the economy starts reopening, Manitoba needs to be able to test anyone with respiratory symptoms. That means ramping up the testing capacity beyond 1,100 people a day.

Premier Brian Pallister says he’d like to see the province in position to test 2,000 people a day. New testing devices such as Spartan Cubes won’t do much to help the province reach that goal, but they may provide quick results for hospitals and nursing stations.

Manitoba must demonstrate it can conduct more testing to provide the populace confidence in reopening. Quite simply, the province needs to be able to know as soon as possible how the loosening up of any particular COVID-19 restriction translates into the further spread of the disease.

3. Epidemiological testing

Last week, Dr. Roussin confirmed the province is starting to research how it will go about testing the public for signs they were exposed to COVID-19, as opposed to testing people to see if they are sick at the moment.

Manitoba needs to be able to conduct blood tests for the presence of antibodies that suggest a person was exposed to SARS-CoV-2 and fought it off.

The purpose of this test is not to diagnose the disease, but to paint a picture of the spread of COVID-19 throughout the population.

“That won’t tell us necessarily when those people were infected,” Roussin said Thursday. “What would be much more important for us to know is the actual prevalence of the infection overall.” 

Testing for the prevalence of the virus will complement diagnostic testing. Together, the two measures will inform decisions about what measures ought be kept in place or loosened up.

4. Robust contact tracing

Once the economy opens up, there will be more cases of COVID-19. It’s not possible to stop the highly contagious disease. It’s only possible to slow its spread.

One key tool is contact tracing, which is the process of identifying everyone who came into contact with a known COVID-19 patient as well everyone who came into contact with the initial contacts.

Manitoba employs people to engage in this time-consuming process. Roussin said Thursday the province has enough workers for the job.

Jurisdictions as disparate as China, the Czech Republic and Ghana are using technology to assist contact tracing. They’ve rolled out Bluetooth-enabled mobile phone apps that either allow people to see whether they’ve come close to COVID-19 patients — or provide public health authorities with reams of data about the movements of those patients.

A visual representation of how a contact tracing mobile app could be effective in stopping the spread of COVID-19. (Oxford University Big Data Institute)

Obviously, contact-tracing apps pose considerable privacy issues. Many Canadians may be uncomfortable granting government agencies the power to monitor their movements. The fear is there will be no way to put the privacy genie back in the bottle once Big Data gets its hands on it.

Nonetheless, Alberta is among the jurisdictions that has ordered up a contact-tracing app. 

5. A flexible reopening plan

On Thursday, Saskatchewan unveiled a five-stage plan toward reopening its economy.

It will begin with the return of dentists and other medical providers on May 4. Clothing stores, hair salons and massage therapists are among the businesses slated to reopen on May 19.

After that, there is no firm timetable for the return of restaurants, gyms and large gatherings of people. That will depend on case numbers and hospitalizations after the first few measures are relaxed.

Manitoba will adopt a plan “along the lines” of Saskatchewan’s, Roussin said Thursday, citing some non-essential businesses and daycares as the first to reopen.

“We’re still looking at other jurisdictions to see how they’re moving and so we’re considering all all of these non-essential businesses and how our plans are going to look,” he said.

It’s unlikely Manitoba will set many firm dates of its own. The number of new cases that emerge from any particular easing of restrictions may not be predicted by the epidemiological models Roussin has thus far refused to make public.

That’s why his plan has to be constructed in a manner that allows him to change it on the fly.

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