How Manitoba will decide whether economic reopening moves ahead, halts or reverses

One day before pandemic restrictions ease in Manitoba, thousands of businesses are still trying to determine how they can safely and successfully operate in an environment where their employees and customers still run the risk of contracting COVID-19.

Dental clinics are only opening immediately for urgent procedures. Retail stores are figuring out how to enforce physical-distancing rules as they prepare to reopen Monday.

Some hair salons are reopening and others are playing it safe. Some restaurants will see whether they can make a profit off patio service when only half the seating capacity will be utilized.

This alone will prove to be a fascinating experiment in supply and demand. On the supply side, it's unclear how many employees feel safe to work right now, and how much more economic hardship their employers are capable of withstanding as they adapt to new and likely volatile market conditions.

On the demand side, it is equally unclear how many customers are ready to take advantage of the full range of renewed economic options and what their collective purchasing power will be after a month of heavy job losses.

Nonetheless, it's safe to assume there will be more economic activity underway in this province, even if it takes weeks for many businesses to reopen their doors.

This sets up an even more fascinating, if far more morbid exercise: Manitoba is about to embark on an unprecedented public health experiment to see how much economic activity can take place in the midst of a pandemic, without allowing for too many new cases of a potentially fatal disease.

Manitoba's 34-page "economic road map for recovery" is not just a three-phase plan to restore the province to a semblance of its pre-pandemic vigour.

It's also a plan to see how many more people will become severely sick from COVID-19 before the province has to slam the brakes on its reopening strategy.

While the premier and the chief provincial public health officer have never described their reopening strategy in such macabre terms, they have been clear more cases of the disease will result from reopening.

The big question is how many more cases of COVID-19 constitute too many more cases for Manitoba.

The answer to that question is something Dr. Brent Roussin has struggled to communicate since Premier Brian Pallister made the reopening road map public on Wednesday.

Over the coming weeks, the province will be monitoring no fewer than five metrics to determine whether pandemic restrictions can be lifted further, must remain in place or have to be ratcheted back.

Here is what we know about those measures, based on recent statements made by Roussin, an April 28 Manitoba Shared Health slide presentation about the conditions for reopening, and a May 1 background briefing by Grant Doak, one of the provincial deputy ministers on a panel of senior officials tasked with co-ordinating Manitoba's pandemic response.

1. Lab positivity rate

Over the coming weeks, public health officials will be watching the proportion of COVID-19 laboratory tests that turn out to be positive cases of the disease.

As of Saturday, that proportion was 1.07 per cent — 280 cases out of 26,169 completed lab tests.

In the short term, this proportion is expected to decline, especially now that all Manitobans with flu-like symptoms are eligible to be tested.

A spike in the positivity rate in the coming weeks would be a very strong signal the virus that causes COVID-19 is circulating more widely among the population. 

2. Active COVID-19 cases

Contrary to conventional wisdom, the total number of COVID-19 cases is not an important number when it comes to managing public health restrictions.

The active caseload — the number of people who are sick from the disease at the current moment — is a far more important measure. It is a very strong indicator of the number of COVID-19 patients that could require health care at any given moment.

Around the world, somewhere between three and six per cent of active COVID-19 cases are sick enough to require hospitalization.

The number of active cases in Manitoba was 38 as of Saturday. It is expected to rise as more people become infected in the weeks following reopening.

The active caseload can easily double a couple times before it becomes too much of a concern. Precisely where that line lies depends on the next measure: the use of hospital beds.

3. Hospital beds in use

As of Saturday, there were only six COVID-19 patients in a Manitoba hospital. None of them required intensive care.

The low demand on hospitals is the main reason reopening is going ahead.

As of April 26, Manitoba hospitals had 1,455 patients occupying 2,432 acute care beds. That left 977 acute care beds vacant and available for new patients.

On the same date, hospitals in this province had 57 patients occupying 86 intensive care beds. That left 29 ICU spaces available for new patients.

The province also has a plan to add 100 more intensive care beds if it must. It also has a total of 430 ventilators at its disposal, including some in surgical rooms.

Reopening the economy will increase the demands on these resources, and not just from COVID-19 patients. More people going to work and shop means more people getting into vehicle collisions, hurting themselves in other mishaps or suffering strokes and heart attacks.

A rise in active COVID-19 cases coupled with a drop in available hospital spaces would put a stop to further efforts to open up the economy.

4. Community transmission

Pop-up cases of COVID-19 — that is, cases with no connection to travel or other known patients — are a big concern because they suggest other unknown pockets of infection exist.

There appears a broad sense of worry among many Manitobans that many cases of COVID-19 have eluded testing.  Roussin has said repeatedly this is unlikely. 

If community transmission was prevalent, many more severely sick people would be presenting themselves at hospitals, Roussin said. So far, that hasn't happened in Manitoba.

Nonetheless, community transmission is an important measure to watch. Roussin said Friday Manitoba has nine cases of community transmission, based on a seven-day rolling average.

A significant spike in that number would also put reopening on pause.

5. Personal protective equipment

Manitoba's struggle to acquire protective equipment for health-care workers has been so severe, Lanette Siragusa, the chief nursing officer and systems-integration lead for Shared Health, has advocated rationing under the guise of what she describes as "appropriate use."

The province has uneven supplies and is trying to source more. Relatively low demand on hospitals right now means there is no imminent crisis — but that could change if the number of COVID-19 cases spikes or more people start winding up in hospitals for any reason.

Even if no new cases of COVID-19 emerge, a continuing shortage of protective gear could force the province to put a hold on reopening the economy. Getting caught flat-flooted without enough equipment would allow health-care workers to get sick and potentially create a runaway chain of infections.