Letting in the sunlight, bit by bit: The thinking behind Manitoba's cautious reopening
Data will drive decisions, the public health officer says. Don't expect to see many hard dates.
After seven weeks of placing an escalating series of restrictions on day-to-day life in Manitoba, the premier and chief provincial public health officer are about to reveal a plan to start pulling back the chains.
Perhaps a plan isn't the right word. Maybe a framework makes more sense, given the unpredictable nature of what lies ahead for this province as the COVID-19 pandemic transitions from its initial shut-down-everything, harm-reduction phase into a more permissive but potentially riskier sort of medium-term management of indeterminate length.
A road map certainly doesn't work as an analogy, mainly because no one knows the nature of the destination.
Dr. Brent Roussin, the ever-careful chief public health officer, is using the term strategy to describe what's bound to be a very fluid set of guidelines governing what conditions will allow more businesses to reopen to Manitoba, people to gather in larger groups and travel restrictions to disappear.
"We'll be announcing [Wednesday] our reopening strategy, which will be a cautious one, one that will be evidence based. Our numbers will be our guides to the strategy," Roussin said of an announcement tentatively slated for late in the morning.
When Roussin talks about reopening, he's not talking about throwing a series of blackout blinds wide open to allow a sudden blaze of sunlight into what used to be a pitch-black bedroom.
What's coming is bound to look more like a tentative pull on the drapes for a few centimetres, followed by a long look out the window, after which Roussin may decide to leave the curtains where they are, open them a crack more or even draw them back to a close.
That's because the goal of his reopening strategy is ultimately the same as his shutdown strategy: To limit the number of serious cases of COVID-19 to the point where they don't overwhelm Manitoba hospitals and health-care workers.
Before this province effectively flattened the proverbial COVID-19 curve, the fear was Manitoba would see more acute cases of the disease than the province's 63 intensive-care-ward beds could handle.
This initial surge failed to materialize, thanks to the combination of our advantageous geography, Roussin's early institution of mitigation measures, a strong adherence to public health orders by many Manitobans and yeah, probably a little luck.
This initial success, coupled with the severe economic impact of the restrictions, means it's time for a frightening public health experiment that involves allowing more freedom of movement and commerce at the cost what most certainly will be more cases of the disease, more hospitalizations due to the disease and likely a few more deaths.
What's off the table, for now
Both Roussin and Premier Brian Pallister have made it clear Manitoba won't rush into a rash reopening that runs the risk of overwhelming the health-care system.
That means domestic and international travel — the initial source of most of Manitoba's COVID-19 cases — are not coming back any time soon. Travel for recreation and leisure purposes won't come back until all provinces agree to a strategy. Travel restrictions are also the best tool at Manitoba's disposal for limiting the spread of COVID-19.
Ultra-cautiousness also means Canadian Football League and NHL games with fans in the stands, large outdoor festivals and major concerts are also not coming back to this province any time soon. Gatherings of that size involve people travelling from all over the province, rubbing shoulders with each other and then returning home.
Those are the economic activities that likely won't have dates attached to them in Manitoba's reopening plan.
What comes first, in all likelihood
In the short term, Manitoba is bound to allow the return of several forms of medical services, such as visits to dentists, eye doctors and physiotherapists, all of whom may be required to be equipped with new layers of protective equipment.
Dental workers in particular must be outfitted with the highest level of protection, as nothing turns human saliva into a fine aerosol mist more easily than the rotating edge of a tooth polisher or dentist's drill.
Dentists are among the first services slated to reopen in Saskatchewan, which has been almost as successful as Manitoba when it comes to combating the spread of COVID-19. Roussin has stated Manitoba's plan will be somewhat similar.
Unlike Saskatchewan, some daycares in Manitoba must resume during the first phase as well. Otherwise, it will be impossible for some workers to leave their homes.
What comes next
Retail stores deemed non-essential during the shutdown phase may not be allowed to resume business immediately. When they do return, expect the same physical-distancing requirements at bookstores as you find in place right now at banks.
Happily, outdoor lineups are easier to endure in Manitoba when there's less of a chill in the air.
Non-essential personal services would also resume with new professional practices. Workers in hair salons may be required to wear masks and therapeutic massage practitioners may be required to wear gloves. Both will most certainly be required to screen customers for COVID-19 symptoms or recent travel.
Manitoba is also set to sanction the slow return of many workers to the offices they abandoned in March. But their workplaces may not look the same as they did before the pandemic.
The province could recommend physical-distancing guidelines, staggered shifts or rotating work-from-home days for all sorts of industries. But that may just be advice, as opposed to new and intrusive public health orders.
Similarly, school and university classes could resume on a rotating or staggered basis. Earlier this week, Roussin mused about primary-school students returning before high school students, as the latter are more capable of remote instruction.
The premier, however, has all but ruled out the resumption of the current school year.
Recommendations for Manitobans to socialize only with the people they live with are also likely to remain for the time being. Roussin has already ruled out expanding bubbles of social contact, which some other provinces are sanctioning.
Pallister has said he'd like to see exemptions made for weddings, funerals and significant religious ceremonies, but even those are bound to be subject to maximum group sizes of some form.
Other medium-sized gatherings are only expected to be allowed later, at some relatively distant point in the future, along with restaurant dining, sitting in a movie theatre and other activities that involve somewhat close contact with random strangers.
Look for data, not dates
If you expect Roussin and Pallister to float specific dates for all these benchmarks, you will likely be disappointed.
Aside from a start date for the first set of relaxed rules, further relaxations may only be announced only when Roussin declares it's safe to do so. He has made repeated comments about relying on data to make decisions.
On Tuesday, he mentioned three specific measures to watch after any new phase of the economy opens up.
One is the number of people with serious respiratory symptoms who show up at hospitals. If many serious cases of COVID-19 elude provincial testing and contact-tracing efforts, that would be a sure sign community transmission of the disease has gotten worse.
A second metric involves serious cases of the disease in intensive care wards. Since the province only has 63 fully staffed ICU beds, plus a total of 406 ventilators, a large influx of seriously ill people would require the province to pull back on reopening.
Roussin also said he will be monitoring the proportion of known COVID-19 cases to tests for the disease. A spike in this ratio would also spell trouble.
The bottom line is no aspect of the reopening is set in stone if Manitobans suddenly begin to get sick in large numbers.
Simply put, far too much has been sacrificed over the past six weeks — socially, psychologically and economically — to allow the virus to spread among the population unabated now.
That's why the reopening strategy will only be a strategy, not a road map, framework or plan.