Lock down now or watch the numbers: How should Manitoba prepare for the COVID-19 third wave?
Now is the time for restrictions, one expert says, but vaccines and pandemic fatigue factor into decision
As COVID-19 case numbers soar in other parts of Canada, a Manitoba infectious disease expert says the province should be tightening restrictions before a third wave takes hold and case numbers get out of control.
"Better that we do this now than do it in three weeks or four weeks, when we've guaranteed to have another hard lockdown and guaranteed to have another wave of deaths," said Dr. Anand Kumar, who's also an intensive care unit physician in Winnipeg.
Ontario, Alberta, British Columbia and Quebec are among provinces fighting a third wave — one largely driven by more infectious variants.
Ontario has issued a provincewide stay-at-home order, while other provinces have recently increased public health measures.
"There is a third wave coming our way," Dr. Brent Roussin, Manitoba's chief public health officer, said this week. The rise of variant cases in the province is concerning, he said.
Manitoba had identified 339 variant of concern cases in the province as of Thursday, including 298 cases of the B117 variant first identified in the United Kingdom. Variants make up roughly a quarter of Winnipeg's recent cases, Roussin said.
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Souradet Shaw, an epidemiologist and assistant professor at the University of Manitoba, said Manitoba has made the right choice to loosen restrictions slowly, following a provincewide lock down that included restrictions on gatherings, indoor dining at restaurants and the sale of non-essential goods.
We're always two weeks to a month behind, and so when the signals are there, there shouldn't be hesitancy- Souradet Shaw
But Shaw doesn't think they should be eased further until it's known what impacts variants are having in the province.
"We're in a better position than other provinces, but it's best to sort of take the cautious approach."
He said while the idea of increasing restrictions proactively until there's enough vaccination in place to mitigate a third wave does have merits, other factors such as pandemic fatigue play a role in policy decisions like this.
"I think tightening, I'm not entirely sure that would be palatable to the population."
Still, he says there are some things that should be done now, such as increasing testing and ramping up vaccine efforts. He said that includes both getting more people immunized and ensuring people at risk — including essential workers and their families, racialized communities and multi-generational households — get the shot.
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And he said the province needs to shut things down quickly — while also increasing economic and psychological and emotional supports — if hospitalizations, case numbers and test positivity rates start to increase consistently.
"I think the last thing we want to do is wait too long and then do half-measures in terms of restrictions," said Shaw.
"The virus and its variants are always going to win. We're always two weeks to a month behind, and so when the signals are there, there shouldn't be hesitancy."
Call for COVID-zero strategy
Roussin said Thursday the current public health measures will stay in effect until the end of the month. However, he said more restrictions could be added if needed.
Kumar said the time is now.
He said there are basically two different strategies that have been used around the world to deal with COVID-19 since the start of the pandemic.
One approach, he said, is implementing aggressive measures when health-care systems are at risk of being overloaded.
The other he describes as essentially a COVID-zero strategy— implementing tight restrictions early, getting case numbers under a target number and keeping them there.
That's something Manitoba could still do now, he said.
"You push it hard now before the numbers go up," he said. "You get the numbers down under 20 and then again you try to keep it under 20 and rather than 200 being your panic point, you let 40 be your panic point."
Kumar said over time a COVID-zero strategy results in fewer deaths, more economic activity and a more targeted approach to shutdowns if cases start to creep up. He uses Australia and New Zealand as examples of countries who have done it.
He said Atlantic Canada has also been successful at keeping case numbers low.
"It's a much more aggressive approach early on," said Kumar. "The problem is that I suspect politically that it's difficult to do because the need for it isn't obvious…. The need only becomes obvious when things are out of control."
He worries things could escalate quickly with more infectious variants of concern circulating in the province.
"B117 in particular, is probably at least 50 per cent more infectious," said Kumar. "So in fact, even if we think that we're making the change early enough to blunt what's going to happen, chances are we're underestimating what's going to happen."
Dr. Philippe Lagacé-Wiens, a medical microbiologist and physician at St. Boniface Hospital, said the signs show a third wave is coming and rethinking some of the measures in place now could help reduce case numbers down the road.
"We're looking at the barrel of a third wave that's hitting all around us," he said "It's pretty certain that it's going to arrive in my opinion, and folks are tired, folks are unable to cope with the amount of hospitalization that would be expected. So to wait for it too long would be disastrous."
He would like to see capacity in places such as shopping centres and inside restaurants reduced from 50 per cent back down to 25 per cent.
It also doesn't make sense to him that people aren't required to wear masks when at a religious service as long as they're seated with their households, physically distanced and not singing or chanting.
"Everywhere else you have to wear a mask indoors," he said.
Lagacé-Wiens said when restrictions were imposed last year early on in the pandemic, the province saw very little of a first wave. Working hard now to keep case numbers down, he said, gives Manitobans a much better chance of having a better summer.