Off the charts in early October: How Manitoba failed to heed its own pandemic warning signs
When COVID-19 counts exceeded the worst-case scenario, Manitoba tinkered instead of sounding the alarm
Nearly nine months after COVID-19 was declared a global pandemic, Manitoba public health officials finally offered the public a glimpse at projections previously kept under lock and key.
On Friday, Manitoba's chief public health officer and chief nursing officer walked reporters through a 30-slide presentation about the current state of the pandemic and how it may unfold over the next four weeks.
Ostensibly, this amounted to the first time Manitoba unveiled projections of future COVID cases and hospitalizations. The true intention of the exercise — based on the narrative the officials attempted to convey — was to reassure Manitoba's cranky and impatient masses the tough restrictions they imposed on the province in November are having some effect other than making us all impatient and cranky.
Dr. Brent Roussin and Lanette Siragusa took pains to demonstrate Manitoba's expansive code-red restrictions have actually limited the number of new COVID-19 cases this fall, and by extension the number of COVID patients in hospital beds, intensive-care units and coffins.
To prove their point, they unveiled a chart illustrating how Manitoba's daily case count flattened out around the 400-diagnosis mark in late November, instead of ballooning to about 800 new cases — the range predicted by provincial modelling before red restrictions were imposed.
"We dodged a crisis that is reflected on this graph," Siragusa said at a Friday press briefing, noting Manitoba's intensive-care capacity could have been overwhelmed in November.
The same slide that held this crucial piece of information, however, also revealed something officials had never before disclosed: Back in early October, Manitoba's daily case counts exceeded the worst-case scenario in their pandemic model.
In retrospect, those early-October counts may not seem like a big deal:. For example, there were 66 new cases on Oct. 8, 84 new cases on Oct. 9 and 97 new cases on Oct. 10.
But when you're talking about a contagious disease that spreads exponentially, actual case counts are less important than the rate at which cases grow.
In early October, the growth rate for COVID-19 in Manitoba was quite literally off the charts. The diagnoses reported every morning to public health were not even envisioned by nightmare scenarios.
Dr. Roussin, for his part, took pains to note Manitoba was "moving in the wrong direction" with its case counts when Manitoba's test-positivity rate passed the three per cent threshold that signifies a worrisome disease transmission rate.
Manitoba did not, however, sound a general alarm — at least not the way the Australian state of Victoria did when a relatively small COVID-19 growth spike led to a lengthy but eventually effective lockdown.
What Manitoba chose to do instead was tinker with restrictions. On Oct. 7, hours were scaled back at licensed bars and restaurants. On Oct. 19, nightclubs classified as live-entertainment venues and casinos were forced to close.
Fearing the economic and social consequences of a large-scale lockdown, Manitoba pursued a series of targeted restrictions that eventually proved to be entirely ineffective.
Roussin acknowledged this on Friday, when the modelling was unveiled.
"This is the benefit of hindsight on these type of things," he said.
"We absolutely did see numbers increasing. And we tried the targeted approach. We tried those various orange restrictions to try to bring down those numbers. But you could see that we didn't get the the buy-in from it and then were eventually required to go to red.
"So we couldn't predict at that time, that we wouldn't get buy-in with the orange restrictions."
To be fair, a series of orange restrictions in western Manitoba in August had in fact proven successful at battling back outbreaks in Brandon and rural Hutterite colonies.
The difference was in western Manitoba, public health officials knew where the COVID-19 clusters were and understood how the disease was spreading.
In Winnipeg, where contact-tracing had fallen more than a week behind in October, case investigators had no such luck.
"Unfortunately, with October and then with people getting together over Thanksgiving, numbers just kept going up and up," epidemiologist Cynthia Carr said in an interview.
"So the more cases you had, the more opportunity there was for those cases to reach other people."
By the end of October, the battle was lost. The night before Halloween, Manitoba announced 480 new COVID-19 cases, a shocking number for a province of this size.
Case counts of that size continued to be disclosed throughout the month of November, as the disease continued to rip through the province and place record numbers of Manitobans in hospital beds, funeral plots and urns.
Store the gun and there is no need to dodge the bullet
To be clear, it is not Dr. Roussin's sole responsibility to react to pandemic indicators. Health Minister Cameron Friesen signs off on the doctor's public health orders. Every MLA in the provincial cabinet, including Premier Brian Pallister, is involved in provincial pandemic decision-making.
With the benefit of hindsight, it is fair to say our leaders did not react as aggressively as they could have when real-life case numbers blew past the worst-case-scenario pandemic projection.
"A basic epidemiological tenet is that once a propagated epidemic starts to take off (especially with exponential spread in the community), even small delays in implementing effective interventions to curb spread in contexts where a lot of the spread is happening can allow the epidemic to gain momentum," said James Blanchard, a medical microbiologist at the University of Manitoba as well as a Canada Research chair in epidemiology and global public health.
"It becomes much more difficult to contain and reverse later."
Manitoba is learning this painful lesson right now.
Being told we dodged a bullet in November is not very comforting when we also found out the pistol could have been safely stored in the basement in October.